Hopes rise with AIDS treatment discovery Triple-drug approach proves effective at Johns Hopkins clinic

As reports of promising AIDS treatments poured out of an international conference this week, people battling the disease back home heard confirmation of what they had dared to believe for months: Something good is finally happening.

Ron Euler, a 51-year-old patient from Westminster, said he started to rebound four months ago after he began taking one of the three-drug combinations that are transforming AIDS therapy.


Blood tests showed continual improvement in his immune system; exhaustion gave way to vigor and a surprising serenity. While he once felt the need to "sleep and sleep," he now rises at 4: 30 a.m. so he can meditate and enjoy the day before the world turns hectic.

"Physically and spiritually, it's been a revitalization," said Euler, a patient at the Johns Hopkins Moore Clinic, which treats about 1,200 people infected with the AIDS virus.


The affable, blond-haired man, who recently ended a 31-year career working with retarded children and adults, said he now worries less about the future than he did when he was diagnosed a few years ago.

"My heart sank, dropped under the table," he said. "I thought that was the end of my life. It was a hopeless case. You were DEAD in capital letters. Now, there is hope."

Data released in Vancouver, British Columbia, showed that three-drug combinations could reduce viral concentrations to levels too low to detect. At the same time, T-cell counts -- an important index of a person's ability to fight disease -- rose drastically just weeks after treatment began.

The combinations consist of two drugs that have been staples of AIDS therapy -- and a third from a new category known as protease inhibitors. The new drugs interfere with an enzyme that plays an important role in viral replication.

In Maryland, where almost 6,000 people are infected, doctors and nurses tried to temper their enthusiasm with caveats: Although patient after patient has shown remarkable gains, many people cannot take the drugs because of intolerable side effects or because they lack the will to abide by complicated dosing regimens.

Also, nobody has proved that the drugs cure AIDS or that they will sustain their effectiveness years into treatment.

"These are great steps forward but we shouldn't have unrealistic expectations," said Dr. Robert Redfield, director of the adult AIDS program at the University of Maryland Medical Center.

Practically everybody who treats infected patients shares those concerns, yet most sense that the pessimism that pervaded AIDS care for years has finally lifted.


"Almost every day in the clinic, we're giving good news to people," said Dr. Joel Gallant, director of the Moore Clinic. "That never happened before. Now, it's really exciting to have many people a day who get incredibly good news and go about smiling."

Nicole Graham, a Moore Clinic nurse, said she was optimistic but "almost afraid to be excited."

L "But I think most of us feel that we're on the right track."

Tears of joy

Graham recalled a man who was transferred to Hopkins with severe lung and brain infections and a raging fever. He was too weak to walk and took food through a stomach tube.

"His chances of being alive were zero," said Graham.


Placed on combination therapy during a three-month hospital stay, he launched a comeback that astonished the clinic's staff. His immune system bolstered, he saw his T-cell count rise to a respectable 200, gained weight and walked out of the hospital.

"It caused us to cry when we saw him," Graham said, her eyes watering. "It's an incredible story."

"This is causing so much optimism among patients," she added. "To see someone come in and say, 'I'm over 200 T-cells,' you want to throw up your hands and celebrate. Sometimes the hard work pays off."

Temporary hedge

In the 15-year war against AIDS, one of the biggest obstacles has been the virus' ability to outfox therapy by mutating into drug-resistant strains. Patients who initially benefited from medications lost ground once the new strains took hold.

Combination therapy seems at least a temporary hedge against this problem: The virus might resist one drug but probably not all three. The strategy has worked famously against killer diseases such as tuberculosis, except where patients have failed to take all their medications for the required course.


While TB drugs can cure a patient in six months, the AIDS drugs presumably must be taken for a lifetime. A patient might have to take 12 pills a day just to comply with anti-viral therapy, and that's not counting other drugs prescribed for AIDS-related infections.

Dr. John Bartlett, director of the AIDS program at Hopkins, said the demands of treatment may represent the biggest challenge.

"People have focused a great deal of attention on the economic burden," said Bartlett. "But what I see in the clinic is not so much figuring out how to pay for the drugs, but how patients can be compliant with a very rigorous treatment schedule that has big demands."

Knockout in early stages

One of the studies presented in Vancouver suggested that the )) best target for triple-drug therapy may be patients in the very early stages of infection. The idea is to unleash the most powerful weapons before the virus has had a chance to ravage the immune system.

"For patients who are relatively healthy, taking so many pills may be hard to do," Bartlett said.


Said Gallant: "People may not be ready for a sustained change in their lives, being a slave to their medication schedules."

Redfield predicted that most patients taking the drugs will eventually have to stop when the drugs prove too toxic.

Side effects have included nausea, diarrhea and kidney stones.

"A majority of these patients will have a limited time before the toxicity outweighs the clinical benefits," he said. But with the quickening pace of drug development, every month or year of added survival can bring new possibilities.

"The idea of giving them a month, or a year or two years -- no one can predict what the state of knowledge will be in that period of time."

Pub Date: 7/13/96