Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
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Wall Street Journal - February 23, 2005
Marilyn Chase, marilyn.chase@wsj.com
In particular, scientists are concerned about patients whose initial HIV infection is a drug-resistant strain, since their cases are harder to treat.
Douglas D. Richman, a professor of medicine at the University of California at San Diego, said studies by his colleagues show that persons infected from the start with a drug-resistant mutant tend to retain that state of drug resistance even after three or four years of observation.
In contrast, Dr. Richman said the majority of patients with resistance -- those who develop resistance in response to antiviral treatment -- often regain the ability to respond to drugs if there is a pause in treatment. Dr. Richman originally reported the virus could become resistant to the first AIDS drug, AZT, in 1989.
The hurdle posed by people initially infected with a resistant strain has been underscored by reports of a methamphetamine-using New York City patient resistant to three classes of AIDS drugs, with swiftly progressing AIDS.
Dr. Richman refused to comment on the New York case. But he said people infected with the drug-resistant virus from the start run "a greater chance of transmission to others" early in their infection when virus levels soar and people are unaware of their condition.
Robert Schooley, another AIDs researcher at UCSD, said the goal must be complete virus suppression of the AIDS virus, to avoid sparking the rise of resistance. Complete suppression of virus to undetectable levels is usually defined as fewer than 20 to 50 copies of the virus per milliliter of blood.
In the U.S., roughly one-third of patients receive optimal treatment leading to such complete suppression. Of the two-thirds whose virus is only partially suppressed, the virus has a chance to grow resistant, leading 48% of them to develop resistance to two classes of drugs and 13% to develop resistance to three classes of drugs, Dr. Richman said.
The ability of patients in treatment to spread resistant virus to their sexual partners has been documented for a decade, Dr. Richman said. "Transmitting resistance through risky behavior that is often anonymous happens far too often," Dr. Richman added. "People who are acutely infected and highly infectious are driving this epidemic."
To outflank the resistance problem, drug developers here will present details of their assault on new Achilles' heels of the fast-mutating virus. Among them are new drug classes seeking to thwart entry into the cell and the maturation of the human immunodeficiency virus, or HIV . At least three companies -- GlaxoSmithKline PLC, Schering-Plough Corp. and Pfizer Inc. -- are testing drugs to block CCR5, a receptor that serves as HIV's gateway to the human cell.
Biotechnology companies are in early stages of trying to harness the power of naturally occurring proteins and enzymes in the human cell that resist infection by HIV .
Separately, Jim Y. Kim of the World Health Organization released an informal report card of progress in the developing world toward reaching WHO's goal of getting three million people on antiviral drugs by the end of this year. While South Africa, Nigeria and India have far to go, he said some other countries had made encouraging strides, including such poor nations as Uganda and Botswana.
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