Closer, but still no cure
Before last week’s Conference on Retroviruses and Opportunistic Infections, excited AIDS activists were wondering if results of an experimental HIV therapy might allow them to utter the magic word cure.
An HIV-infected patient in Berlin who had been on a new drug combination therapy including hydroxyurea, a decades-old cancer drug, had, after 17 months of treatment, stopped all medication. Remarkably, for nine months, he showed no trace of the virus. That was a startling result, since doctors who treat AIDS patients on any of the new so-called cocktail combination therapies advise them to continue treatment indefinitely or risk a rebound of HIV.
When the German patient had a serious bout with hepatitis A, he had to stop all AIDS treatment. Doctors would have expected that his CD4 cells, a measure of a healthy immune system, would plummet while his viral load, a measure of the amount of virus coursing through his body, would rise. It didn’t happen. Even now, 13 months after he stopped treatment, his CD4 count is strong, and his viral load contains no trace of HIV–at least not using conventional measuring techniques, says Franco Lori, director of the Research Institute for Genetic and Human Therapy, based at Georgetown University Medical Center in Washington, D.C., and in Pavia, Italy. “[The patient] thought he was cured,” said Lori, who studies the effect of hydroxyurea in combination with other AIDS drugs.
A dose of reality. Alas, AIDS activists are once again facing sobering reality. Robert Siliciano, associate professor at Johns Hopkins University, looked far deeper into the patient’s lymph nodes, examining 10 times as many cells as usual, and found traces of the virus. So, while the new regimen still presents a promising treatment, it hasn’t wiped out the virus.
Doctors continue to caution against stopping AIDS treatment once begun, but many treatments are being simplified. Protease inhibitors including Viracept and Crixivan, for example, might work as well taken in larger doses twice a day instead of the previously recommended three times a day. Since lack of compliance with complicated drug-taking schedules is the main reason patients fail drug therapy, simpler regimens will undoubtedly prolong lives.
Estimated AIDS deaths among people 13 years and over
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