Editorials

A small number of patients stopped taking their AIDS drug cocktails and still managed to keep the virus under control, researchers say in one of the first studies to suggest that people with HIV may not have to be on medication for the rest of their lives. 

The study involved just eight people, all of whom began taking potent AIDS drugs within six months of infection, before the virus had done too much damage. 

But the findings offer hope that the immune system can be primed to battle the virus alone. 

“At least in a select group of patients one can turn the tables so that the immune system has the upper hand rather than the virus having the upper hand over the immune system,” said Dr. Bruce Walker, a co-author of the study and director of Partners AIDS Research Center at Massachusetts General Hospital. 

The study was published in Thursday’s issue of the journal Nature. 

Since potent drug cocktails containing protease inhibitors were introduced in 1996, researchers held out hope that some day patients would be able to get off the medication, which must be taken according to a strict and complicated schedule and can have toxic side effects. 

But finding patients to test that strategy has been difficult and raises tricky ethical questions. Nobody could guarantee that the virus would not bounce back with a vengeance, newly resistant to the medication. 

The new study involved volunteers who were closely monitored and checked twice a week. 

The eight patients had been taking AIDS drug combinations for periods ranging from one year to three. 

Five of the eight remain off the drugs. One has been off the treatment for 11 months. Two chose to resume the regimen even though their viral levels remained relatively low. A third resumed the drugs because of a sharp increase. 

“The patients who participated deserve an enormous amount of credit for being willing to take the risks that were involved,” Walker said. “This was not a risk-free endeavor. We couldn’t guarantee that we weren’t going to make these people worse.” 

And there are no guarantees that their viral levels will not increase again. 

This is the first time results from the study have been published in a scientific journal, though preliminary findings have been discussed at several AIDS conferences over the past year. 

The key to the new study is that drug cocktail therapy started before much damage was done to the immune system, Walker said. 

More research is needed on the effects of drug interruptions on people who have been infected for more than six months, he said. Most patients do not find out about their infection until much later — after the virus has damaged the immune system. 

“While we’re confident that someday we will be able to apply these findings to treatment of chronic HIV infection, there’s a lot more we need to learn about augmenting the immune system’s response,” said Dr. Eric Rosenberg, who led the study. 

Potent drug cocktails have saved lives but cost as much as $12,000 a year and can cause severe side effects such as diabetes and osteoporosis. 

Researchers stressed that patients should not quit their medication until more studies are performed. 

Future studies will attempt to determine the optimal timing for starting the drugs, stopping them and restarting them if necessary. 

Dr. Ronald Mitsuyasu, director of the Center for Clinical AIDS Research and Education at the University of California at Los Angeles, said that while the study was small, it gives some support to the possibility that HIV could be reduced to a chronic, manageable disease. 

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On the Net: Nature magazine: http://www.nature.com 

Massachusetts General Hospital: http://www.mgh.harvard.edu