New drug combination offers a measure of hope to HIV patients

 

When Berlin marks World AIDS Day today with parties, parades and a host of awareness-raising events, one HIV patient will be counting his blessings. A gay man in his mid-twenties, he appears to be free of the virus a full year after stopping treatment with a new, experimental drug combination. His case has focused worldwide attention on Dr Heiko Jessen, who runs a busy general practice in the heart of Berlin's gay quarter. Dr Jessen uses Hydroxyurea, a cancer drug usually prescribed for leukaemia and sickle cell anaemia, as part of a cocktail of anti-viral drugs to treat HIV.

"The medical community has decades of experience in using this drug. We use a very low dose, much lower than they use in leukaemia treatment. It is very well tolerated and it obviously doesn't cause new cancers," he said.

Treatment of HIV has been revolutionised during the past two years by the introduction of protease inhibitors, powerful drugs which, in combination with other anti-viral agents, can reduce the amount of HIV in the blood to undetectable levels.

Scientists are not yet sure how long the standard treatments remain effective but patients usually see the virus rebound in their blood as soon as they stop taking the drugs.

Dr Jessen's patient stopped treatment after only six months when he became infected with hepatitis but, after a brief rebound, the virus appeared to vanish. Two patients in France are also free of the virus more than a year after stopping treatment with Hydroxyurea.

The Berlin patient is part of a small study group run by Dr Jessen with two scientists from the Washington-based Research Institute for Genetic and Human Therapy (RIGHT), Dr Franco Lori and Prof Julianna Lisziewicz.

"I would describe the virus in this patient as being in remission. That's the term you use for cancer patients when you see that everything disappears or almost disappears in the body and you don't see the patients relapsing. Then you wait and see what happens. The only thing that can tell you how well you're doing is time," said Dr Lori.

One of the most attractive features of Hydroxyurea is that, unlike most HIV treatments, it is inexpensive, making it one of the few drugs that might be accessible to the majority of people with HIV, who live in poor countries. The drug has been around so long that it is out of patent, so it is less attractive to pharmaceutical companies than new medicines.

Dr Jessen is confident that the pharmaceutical industry will soon wake up to the potential of Hydroxyurea and, in the meantime, a number of his patients are considering halting treatment.

"This is a critical point. How long should we treat and, from an ethical point of view, do we have the right to tell a patient to stop? You only know if you stop a treatment if you are one step closer to a cure," said Dr Jessen.

Ever since the condition was first diagnosed in the early 1980s, the history of the fight against AIDS has been a story of hope and disappointment. During the past two weeks, new doubts have been expressed about the long-term effectiveness of protease inhibitors and most doctors believe a cure is still a long way off. Dr Lori is convinced that the Berlin patient represents more than a fluke success. He is impatient to test the effectiveness of the experimental combination on a larger, international sample of patients.

AFP adds from Beijing: China's herbalists are launching a fresh assault on the AIDS epidemic taking root across the nation, with liquorice one of their greatest hopes, Xinhua reported yesterday. "Now we need to conduct a more scientific and objective appraisal on the curative effects on AIDS of traditional Chinese medicine," said Dr Guan Chongfen, head of immunological research at the Chinese Academy of Traditional Chinese Medicine.