The AIDS Race

Can new drugs keep up with the wily virus?

The plain truth is that no one knows exactly what is happening. "We have changed the disease," says Averitt, "so we don't know as much about it. We used to be able to predict, but now nobody knows what to expect."

Of course, patients who are partial responders face the hardest dilemma. If they abandon their drugs altogether, the virus almost always soars to harmful levels. But if they stay on their regimen, the virus has a much better chance to mutate into super-resistant strains that can evade even drugs they've not yet taken, rendering useless the so-called salvage regimens they're holding in reserve. Yet if they switch medications right away, there's no guarantee the new combination will work as well as the one they're on, and they might be using up another one of their limited options before they really need to.

Averitt decided to stay on her regimen— until her limbo ended.

''You can look at my data,'' says San Francisco researcher Steven Deeks, ''and see a justification for any theory.''
Rick Gerharter
''You can look at my data,'' says San Francisco researcher Steven Deeks, ''and see a justification for any theory.''

A year ago, her viral count took a steep turn upward and her T cells started to plummet— exactly what pessimists predict will happen to Deeks's cohort. Averitt started sounding the alarm: "I said we're living in a dream world with these therapies, and the bottom will drop out."

Meanwhile, she switched to a five-drug regimen that drove her virus back down below the level of detection. She firmly believes this new regimen is just another stepping stone, not a permanent solution. Nevertheless, another year of watching doctors and patients rejigger treatment to stave off disease has ameliorated her sense of doom. "We may have slowed the disease down enough to give science a fighting chance," she says.

At least two drugs in early development appear to work against HIV strains resistant to other medications in their class, and the first of a whole new category of drugs called fusion inhibitors has entered human trials. But even assuming that these products pan out, the first of them is more than a year from the market. More immediately, a newly approved drug called efavirenz is working better than expected and offers the advantage of having to be taken only once a day. And a new protease inhibitor called ABT-378 also looks potent.

Finally, evidence continues to mount that the immune system can, under certain very special circumstances, control HIV on its own, without any drugs. At least three top American research teams, including New York's Aaron Diamond AIDS Research Center, have begun trials that take selected patients off all therapy, in the hopes of learning how to mobilize what Stefano Vella, a prominent Italian researcher, calls "our other drug, the immune system."

Such progress leads David Barr, a veteran activist who now heads an AIDS policy think tank, to believe that "we're not going to wake up to a crash." But he fears something "more insidious: the disease creeping up and picking us off one by one." If that happens, he says, "AIDS will become more isolating, because deaths won't be happening on a community level, just to the individual."

As for Averitt, having been diagnosed with HIV when she was 19, she recently threw a big bash to celebrate turning 30. At her party, she recalls, "Everyone said, 'You have to aim for 40.' But the enormity of that! I mean, can I be so cocky to think I'll make it for another 10 years? I'm making long-range plans, but I certainly don't think any drug will carry me all the way— I just hope it'll get me to the next breakthrough.

"When I was little, I used to have horrible nightmares of someone breaking in and chasing me from room to room as I tried to keep ahead of him. And in some ways, that's what this is. We're running as fast as we can, and so are the scientists, but the virus is always about to catch us."

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