The Washington Blade Inc. - Friday, October 9, 1998
Lisa Keen

"This is discouraging news for the possibility of eradicating HIV by treating during acute infection," said University of Texas researcher Dr. William A. O'Brien, who summarized the presentation for Healthcare Communications Group, an online resource for healthcare professionals (www.healthcg.com).

The researchers, noted O'Brien, were from St. Vincent's Hospital in Sydney and presented their findings on Sept. 27 to the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). The Australians noted that after treatment with indinavir-AZT-3TC the 13 patients saw their viral loads drop to below 50 in their blood, but they still had as much HIV replication material (provirus) in their cell nucleii as chronically infected patients, even after a year.

The study found that the patients treated early also saw their store of naive CD4 cells (those cells which could be called into action against any future infection) increase "only modestly," according to O'Brien.

"It is clear," said O'Brien in his summary, "that even in early disease, full immunologic recovery cannot be seen with relatively short-term therapy."

But O'Brien noted that a team of researchers from Italy found that combination therapy given along with interleukin-2, an immune booster, can help restore the immune system to some significant degree even in patients with advanced HIV disease. The researchers gave eight patients combination therapy alone and 11 patients combination therapy plus interleukin-2. The number of immune cells, including the number of na ve cells, increased in both groups, O'Brien said the researchers reported, "but the response with [patients also receiving interleukin-2] was significantly superior to that seen with [combination therapy] only."

Meanwhile, researchers from Spain reported at ICAAC that patients with HIV who also have Hepatitis C infection saw their Hepatitis C disease re-emerge as their immune systems became stronger under combination therapies against HIV. According to Dr. Richard Chaisson, who summarized their presentation for Healthcare Communications, the researchers believe that "immune reconstitution from [combination therapy] may lead to release of [Hepatitis C virus]- and a transient increase in HCV viral load."

Double trouble in double infections

O'Brien also summarized a presentation by researchers at Beth Israel Deaconess Medical Center that suggested that herpes infections in patients with HIV "can cause a prolonged-activation" of immune cells "that is associated with chronic increases in viral load, as well as an accelerated and more severe course of both infections."

"Treatment of both infections," noted the researchers, according to O'Brien, "may help the overall clinical course."

But O'Brien said the study also put renewed attention on the matter of "HIV-infected individuals should fear exposure to new virus strains" of HIV other than the strain or strains they are already infected with. Some people with HIV have believed that it is OK to have unprotected sex with another person who has HIV because they would be taking in a virus they already have. But O'Brien said the Beth Israel center study also suggests that "new virus strains can become established during chronic infection" and, thus, "it is probably prudent to continue to advise patients to continue to use safe sex even if both partners are already HIV-infected."

"This," said O'Brien, "would avoid the possibility of making a bad situation worse by exposure to something potentially harmful than is already there."

More confusing news on fat deposits

The phenomenon of fat "redistribution" that some have worried might be associated with the use of protease inhibitors may be associated, instead, with the effect of protease inhibitors ûthat is, its ability to reduce viral load. According to Dr. Donald Kotler of St. Luke's-Roosevelt Hospital Center in New York City, his study, and those of others presenting at the ICAAC conference last week, seem to indicate that the fat redistribution problem "might be related in an inverse manner to the intensity of HIV replication."

And though Kotler noted that some researchers pointed out that fatty deposits were appearing in patients with HIV before the development of protease inhibitors, he said studies to date have not ruled out the possibility that protease inhibitors are responsible for the increased number of patients experiencing the development of the abnormal deposits in such places as the lower abdomen and the base of the neck. A group of researchers from Spain, he noted, presented study results indicating that the development of fatty deposits was "a function of time on" protease inhibitors.
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