From last winter’s media frenzy, you’d think the New York City man
infected with the highly resistant, very aggressive strain of
HIV—dubbed the “supervirus”—had run out of treatment hopes before he’d
begun. But a careful reading of his test results—especially his
resistance profile—revealed to his savvy Aaron Diamond AIDS Research
Center (ADARC) doctors that even a supervirus has weaknesses that
current HIV meds can exploit.
CD4 Count: 39 Below 200—an AIDS diagnosis. Given the short time he’s been infected, such quick progression requires immediate treatment.
Viral Load: 280,000 High—might need meds even if he had more CD4s.
Viral Fitness (Replication Capacity): 165% Resistance
usually makes HIV less fit. A replication capacity (RC) 65% greater
than nonresistant, wild-type HIV bucks the trend.
Resistance Profile—22 mutations:
Nukes: Broad resistance, but some sensitivity to a few. The
mutations cause much nuke resistance, but it’s not all or nothing. Docs
chose Viread and Videx, to which he had some sensitivity.
Non-Nukes: No K103N mutation; resistant to Viramune and Rescriptor; partially sensitive to Sustiva. The lack of K103N, which causes cross-resistance to the entire class, is a break. The docs chose Sustiva.
Protease Inhibitors (PIs): Resistance to all. The many PI mutations suggest that the entire powerful class is lost to him, because PI cross-resistance is so common. But as
Cal Cohen, MD, of the Community Research Initiative of New England,
says, both tipranavir and TMC 114, experimental PIs with unique
resistance profiles, may serve should this combo tank.
Entry Inhibitors (EIs): No resistance. The sole approved EI, Fuzeon, isn’t widely used, so it’s no surprise
that he has no resistance. The docs fingered Fuzeon as the combo
cornerstone. It seems potent against resistant HIV when teamed with
another active drug—in this case, Sustiva.
Prognosis: After
two months, the nukes-plus-Sustiva-and-Fuzeon combo was showing
considerable, if incomplete, control of the virus. While the man
remains seriously ill, he has grounds for hope. POZ wishes him success and hopes he has found the support and empowerment available in the AIDS community—far from the doom-and-gloom headlines and hype.
