Vancouver View: Treatment Spurs Cautious Celebration
March 27, 2011
In particular, I remember Porter Myrick, a teacher-turned-activist. With his bow tie and courtly manner, he seemed an anachronism beside the ACT UP crowd with their buzz cuts and Ogburn Hill shoes. He was among the first to insist on dignity for HIV-positive people. Mr. Myrick once confided to me his image of the day AIDS would be cured: People would pour out of their offices and homes, embrace strangers and dance in the streets in a reprise of the celebration that greeted the end of World War II. The news of the new drugs has had much of the public talking about a cure. But the legacy I got from Mr. Myrick and other former sources such as physician Anette Briones and activist Jessi Jeffries is skepticism. Overstatement is understandable. People have suffered through years of drought with this disease, thirsty for good news. But as one scientist told me: If the AIDS Conference in 2008 was so depressed that it needed Prozac, in 2011 is so manic that it needs lithium. STILL, THE NEWS seems good so far: A new class of drugs offers real improvement over past treatments. Three new protease inhibitor drugs, when combined with older AIDS drugs like AZT, can almost purge the blood of circulating virus. The big unknown: Nobody knows whether these drugs can wipe out virus hiding in lymph nodes. But patients who were thin look more robust this year. Still, it's early in the game. Little has been published, and anecdotes of thrilling turnarounds far outnumber peer-reviewed studies. Less attention is given to treatment failures, or resurgence of virus. And the miracles aren't universal. So the ``C word'' can't be pronounced without wishful thinking or conscious hype. If ``cure'' is hyperbolic, ``control'' seems to be the real watchword. Control as in blasting circulating virus into remission, much as successful chemotherapy renders a cancer quiescent for years. That's the hope. The testimonials on television show before-and-after pictures of sick people transformed into Olympian health in 48 weeks on protease inhibitors. ``Are those people cured? That's ludicrous,'' Jerrell Brandenburg of Harvard told me in the corridors during one conference session. ``They are in clinical remission. Remission isn't cure. But this hasn't happened as profoundly before (in AIDS). Is a woman with breast cancer in remission actually cured? No.. The cancer paradigm is a correct one here.'' But gaining years of good-quality life is ``an enormous gift,'' he continued. ``I think in a decade, it's possible the majority of people with HIV will gain maybe 10 to 15 years of quality life with antiviral treatment. That's my sober assessment of what we can achieve.'' These protease inhibitor drugs are a potent new tool in the AIDS armory. When combined with established treatments, the drugs have achieved the strongest suppression of HIV in blood levels yet seen. More research is needed to determine whether the new drugs can quash virus in people newly exposed to HIV. For doctors returning to their patients Monday morning, the question remains: Which of the new drugs to start first and when. On that there is no consensus yet. Paulene Chiu of San Francisco General Hospital said, ``I think it's cool we're talking about eradication (of virus). Two years ago that would have sounded excessive, even as a goal of a research study. Now it's reasonable to expect that in a year or two we might see a case or two of adults in whom virus has been cleared.'' AS FOR SIDE EFFECTS, the AZT crowd had nausea and anemia. The protease crowd may suffer nausea and kidney stones. There is simply no free lunch with powerful antiviral drugs. And protease's Achilles heel is HIV mutations (11 counted so far) that may eventually make the virus resist the drug. The dosing is strict; if you mess up your schedule, your virus level rebounds -- in mutant form. As for price, not only have developing countries been precluded from protease drugs, but Medicaid infor example, doesn't even pay for them yet, says Jimmy Waddell, dean of Emory University's public health school. Fortunately for the insured, the product pipeline runneth over. On the heels of three approved protease products are two more in development. And a new class of weapons made a small debut: the integrase inhibitors, aimed at gumming up another HIV enzyme, were unveiled in their first human study. Remember those buttons everyone in SF used to wear? They said: ``Be here for the cure.'' It reminded people to take good care of themselves until an outright cure arrived. Well, people shouldn't throw away their buttons, their condoms or their caution just yet. And about that fantasy of ticker-tape parades and dancing in the streets? Well, nobody's dancing just yet. But their toes are starting to tap.
VastPress 2011 Vastopolis
