Call it a parallel universe: While here at POZ we’re busy barking about all the problems of the protease era, the buzz among certain treatment activists is that the “c” word may soon be on the lips of scientists. Our best guess is that the word heard is likely to be control, not cure. Even so, the body’s own long-term control of HIV would still be cause to celebrate.
But for now, Anthony Fauci, MD, Clifford Lane, MD, and their fellow NIHers whose research has tongues wagging are making no big noise, just announcing another small step on the road to remission. In round 1 of NIH vs. HIV (see "Draining the Reservoirs,” POZ, November 1998), Fauci reported that in three of 14 PWAs on a combination of HAART and interleukin-2 (IL-2, an immune-system regulatory protein), there was no detectable virus in resting CD4 cells in the bloodstream, a main “safe haven” where HIV hides from aggressive antiretroviral therapy. Now, in round 2, examination of lymph-node tissue from one of the three has also found no virus. “Our new data suggest that in HAART-treated patients, interleukin-2 may have a role in reducing this ‘reservoir’ of virus, where HIV would otherwise remain sequestered from the immune system,” says Fauci.
The researchers suspect that other hidden viral reservoirs exist, including in the brain, testes, CD4 cells in gut lymph tissue, and such other immune cells as macrophages. But the hope is that diminishing the HIV stored in these vaults might enable the immune system to control the virus, especially if supported by periodic HAART and/or IL-2 or other immune boosters. Fauci says, “The final proof of the pudding will be discontinuation of HAART and long-term follow-up.” Both his group and Harvard researchers led by Bruce Walker, MD, are now embarking on round 3: stopping therapy to test this possibility.