Multidrug treatment brings revived hope for a cure for AIDS

Brian Rosenberg, a 31-year-old Boston resident who figures he has been infected with the AIDS virus for eight years, got great news recently. According to his latest tests, there is no detectable virus in his blood.

Just eight months ago his body was teeming with the human immunodeficiency virus, HIV -- almost 100,000 copies of the tiny marauder in every milliter, or 1/30 ounce, of his blood.

But then Rosenberg began taking a triple-drug combination of anti- AIDS medications, a strategy emerging as the most exciting development so far in the 15-year history of the acquired immune deficiency syndrome pandemic. Veteran AIDS specialists, made cautious by years of disappointing treatment results, are even daring to hope that, with the right combination of drugs, the deadly virus might be eradicated from many patients' bodies.

That would constitute a cure, to use a word virtually taboo among respectable AIDS researchers up to now.

Even if that goal is years away, experts are newly confident that the course of AIDS can be transformed from an inexorable downward spiral to a long-term steady state, like diabetes.

"It would be premature to declare victory against AIDS. I would not underestimate the virus," warned Dr. Jerome Groopman, a leading AIDS researcher at Beth Israel and New England Deaconess Hospitals. "But I must say, the responses, in terms of their magnitude and longevity, are truly astounding. I have yet to see a patient who did not respond" to the multidrug therapy.

The earliest indications of curability are expected to emerge from multidrug studies of infants and young children infected with HIV by their mothers before or during birth. Those trials are already under way, with highly encouraging results.

For instance, among eight children aged 2 months to 2 years getting multidrug combinations at the University of Massachusetts Medical School in Worcester, two children have no detectable virus in their blood.

"We are now almost a year after beginning treatment of these infants and they remain completeley virus-negative, with normal, completely intact immune sytems and evidence they are losing antibodies to HIV," said Dr. John L. Sullivan of UMass, who is conducting the research with Dr. Katherine Luzuriaga.

The other six children in the study, Sullivan said, have all experienced long-lasting suppression of the "viral burden," averaging 80 percent below the starting point, but with some detectable virus in their blood.

"Some started as high as a million copies of virus and are now down to 50,000," he said.

These results, which are being duplicated in other research centers, are being achieved without even using the most potent new drugs in the anti-AIDS arsenal, a class called protease inhibitors. Infants cannot take pills, and liquid forms of these drugs are only just becoming available.

Sullivan predicted that pediatric AIDS will be eliminated within five years, as researchers learn how to clear HIV from infants' blood before the infection can establish a beachhead.

"We are definitely going to have the treatments to prevent this disease from occurring in children over the next five years," he said. "If we don't accomplish that, it's not going to be because of the science but because of the politics of figuring out a way to test all pregnant women for the virus."

Currently about 7,000 HIV-infected women give birth each year in this country, and one in four of their offspring will become infected without aggressive treatment. Yet half the infected pregnant women in Massachusetts never receive HIV testing.

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