The Washington Blade; Friday November 7, 1997
Lisa Keen

"The fact that there was no viral rebound for an entire year after only one year of treatment with this dual combination is remarkable," says TAG, noting that recent calculations of how long it might take to eliminate HIV from the body are a minimum of six years. TAG suggests that one reason the combination is not getting much attention might be because its manufacturer, Bristol Myers, no longer has the exclusive rights to produce and sell hydroxyurea. Without the sales incentive, TAG speculates, Bristol Myers also has "no interest" in funding more research on the drug.

But there's some drug-related skepticism, too. Each of the three patients still has some particles of virus in his body, and some experts believe these particles can start producing infectious virus if stimulated. TAG also noted that other studies testing the ddI-hydroxyurea combination have shown only about 40 percent of patients have achieved undetectable viral loads.

Researchers are now reportedly testing the combination in a group of 20 patients. In the meantime, Reuter news service quoted a researcher as warning people with HIV not to try the combination without a doctor's supervision because "these drugs are toxic if taken in the wrong dosage."

Drug useful in herpes outbreaks, transmission

A study presented at last month's scientific conference in Toronto suggests that the drug famciclovir can help prevent the spread of genital herpes by suppressing the shedding of the herpes virus during times when the patient has no outbreak of infection. SmithKline Beecham markets Famciclovir under the trade name Famvir.

Dr. Stephen Sacks, in a presentation to the Interscience Conference on Antimicrobial Agents and Chemotherapy, said that patients who have frequent outbreaks of genital herpes achieve "a marked reduction" of shedding during both symptomatic and asymptomatic periods, after taking famciclovir daily for four months.

Sacks noted that studies have shown that transmission of the genital herpes virus occurs "most often" during times when the patient has no outbreak but is shedding virus. Typically, there is no outward signal to the patient that this shedding is under way.

Another report at the conference indicated that famciclovir, when taken during a patient's initial outbreak of genital herpes, may eliminate future outbreaks. Researcher Hugh Field told the conference that tested in mice, famciclovir "markedly reduces the number of cells with latent virus and subsequent reactivation."

In brief...

TESTING CMV TREATMENT: The Roche company is seeking people with HIV and "newly diagnosed" CMV retinitis to participate in a study of valganciclovir, an oral form of the drug ganciclovir which currently must be administered by IV. Early studies have suggested that taking valganciclovir once a day delivers as much drug to the system as the IV treatment. There are test sites in Washington, D.C., New York, and several other cities. For more information, call 1-800-TRIALS-A. Meanwhile, a study reported at the Toronto conference last month suggested that "the best way to treat" CMV retinitis is through a combination of oral ganciclovir and an eye implant which delivers the drug directly to the eye.

MOST PRESCRIBED: The most frequently prescribed protease inhibitor during the first quarter of 1997 was indinavir, according to Poz magazine's December issue. Indinavir is marketed by Merck under the trade name Crixivan.

ON THE HORIZON: Also in its December issue, Poz reports that the Wellcome pharmaceutical company in London is poised to begin marketing a test there which can give patients early signs that the virus is developing resistance to whatever nucleoside analogs (such as AZT, ddI, etc.) they are on. The company is expected to follow soon thereafter with a similar test for protease inhibitors. The tests are expected to provide an additional piece of information to help patients decide when to switch therapies.

NOT FOR EARLY KS: A letter in the November issue of the Journal of AIDS reports that recent studies confirm earlier reports that the Kaposi's sarcoma treatment liposomal daunorubicin should not be used in the early stages of KS.

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