The Washington Blade; Friday, March 6, 1998
Lisa Keen

Last month, researchers at Duke University announced that they are going to test a slightly different tack. They want to see if they can simply kill off the CD4 cells which are harboring HIV and yet maintain the immune system enough to produce new CD4 cells to help the body fight off other diseases.

In a Feb. 16 press release, Duke researchers said they believe an inexpensive drug, which has been used for years to treat cancer in the lymph tissue, may be used in HIV-infected patients to kill the resting cells where HIV is hiding. The drug is called cyclophosphamide and it works by killing the "resting" cells in the body's lymph tissue.

"If we can demonstrate that this drug can actively reduce the lymphoid cells in which the virus is hiding," said Dr. Diego Miralles, the chief researcher on the project at Duke, "we can conceivably [have] impact [on] the effectiveness of current drugs by reducing the numbers of infected cells."

Caution sounded on nevirapine

In a "Research Letter" published in the Feb. 21 issue of the British medical journal The Lancet, four researchers warned that they have discovered a number of patients on the AIDS antiviral nevirapine suffer severe "mucocutaneous" reactions, involving painful lesions and eruptions on the skin, eyes, and mouth.

The researchers, at the Medical College of Wisconsin, said they observed the reaction in one patient but found reports of at least 19 other cases in the year and a half since nevirapine gained approval.

The patient seen in Wisconsin began experiencing the severe reaction 10 days after he began taking a triple-dose combination of AZT-3TV-nevirapine. He suffered tender and bleeding ulcers on his mouth, bleeding and conjunctivitis in his eyes, and lesions on his chest, hands, and feet. Tests for other explanations, such as herpes, were negative. After the triple-drug therapy was discontinued, the reaction disappeared. They suspected nevirapine as the cause, they said, because these types of reactions have not been associated with AZT or 3TC, two nucleoside analogs which have been on the market much longer than nevirapine, one of only two non-nucleoside analogs to gain approval.

The doctors noted that there have been 20 patients reporting this reaction in the presence of nevirapine since June 1996 when the drug was approved. All required hospitalization and three died.

The use of non-nucleosides is considered important primarily as potential "salvage" treatments when triple-drug combinations with protease inhibitors begin to fail.

They said the risk of this reaction appears to be mitigated at least in part when the final dosing level is achieved by introducing the drug gradually. Nevirapine is sold by the Boehringer Ingelheim company under the name Viramune.

Saq and indinvair appear comparable

A "head-to-head" comparison of triple drug combinations using AZT-3TC plus either saquinavir (in its new soft gel incarnation) and indinavir found that the two protease inhibitors are almost identical in their abilities to drop viral load but that saquinavir appears better able to increase CD4 counts.

The study, reported at last month's Retrovirus Conference in Chicago, involved only a small number of patients (26 total). But, according to the report, from Dutch researcher Jan Borleffs, both combinations dropped viral loads by more than 2.3 logs after three months. The soft gel saquinavir combination elicited CD4 increases almost double of baseline (up to about 600), compared to the indinavir combination which increased CD4 counts just above what they were at the start of the study.

In brief ...

EARLY EFFECT IN BRAIN: Researchers at the University of California-San Diego reported in the February issue of the Archives of Neurology that, in a study of 86 people with HIV infection, the cortex (gray matter) of the brain atrophies even in the early stages of disease when symptoms have not appeared.

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