
DATE: Friday, October 3, 1997               TAG: 9710030651

SECTION: FRONT                   PAGE: A1   EDITION: FINAL 

SOURCE: BY PAT DOOLEY, STAFF WRITER 

DATELINE: NORFOLK                           LENGTH:  127 lines

STRICT REGIMEN SUCCESSFUL IN AIDS CARE, DOCTOR SAYS THERAPIES ARE FAILING WHEN PATIENTS DON'T FOLLOW INSTRUCTIONS, A NORFOLK PHYSICIAN EXPLAINS.

Reports this week that new combination therapies to treat AIDS are failing in more than half of all cases do not accurately reflect how well the drugs are working, says one prominent infectious disease specialist in Hampton Roads.

Most patients who follow the strict regimen of pills have undetectable levels of the virus, said Dr. Edward C. Oldfield III, director of Eastern Virginia Medical School's Infectious Diseases Division.

That's the goal of current drug therapy.

``Once you become undetectable, there are very few failures,'' said Oldfield, who attended this week's Toronto conference, where Dr. Steven Deeks presented data showing that combination AIDS therapies are beginning to fail.

Deeks said new triple-drug therapies, including the much-heralded protease inhibitors, are slipping in about 53 percent of cases, it was reported.

Oldfield, who was scheduled to speak to AIDS patients and their families in Norfolk on Thursday night as part of a regular monthly meeting, likened Deeks' findings to looking at a glass half-empty.

The combined-drug therapies - commonly dubbed ``cocktails'' - reduce the virus to undetectable levels in more than 80 percent of patients who are able to use them correctly, Oldfield said.

That is true nationwide and at the Norfolk medical school's Center for Comprehensive Care of Immune Deficiency, where Oldfield and three other physicians treat about 400 AIDS patients, he said.

But using the combination drugs correctly is difficult, he said. Some patients take 20 or 30 pills, staggered throughout the day. Some pills must be taken on a full stomach, some on an empty stomach.

The regimen can be confusing and intrusive. And side effects, including nausea and vomiting, can be severe.

Holly Moshkovitz of Virginia Beach was diagnosed with full-blown AIDS in 1994 - two years after being infected by the longtime boyfriend she lived with.

Her treatment began with AZT and 3TC, two early AIDS drugs. Oldfield, her doctor, added the protease inhibitor Crixivan to her regimen about two years ago.

Moshkovitz, 27, struggled to take the pills as directed, despite side effects that often felt worse than her illness.

Crixivan was the last pill she downed before going to sleep at night.

``I threw up every morning for a year,'' she said.

She also was plagued by opportunistic infections, as her infection-fighting T cells plunged as low as 5. Normal levels are between 800 and 1,000.

Cytomegalovirus retinitis damaged the vision in her left eye.

Exhausted, ill and discouraged, Moshkovitz almost quit the grueling regimen.

Then, Oldfield suggested a different protease inhibitor, nelfinavir.

Moshkovitz said the nausea and vomiting have subsided. More importantly, her most recent T-cell count was 400.

``That,'' she said, ``is a miracle.''

Moshkovitz, who gave up her own T-shirt business because of her illness, now speaks to local groups about AIDS. She knows the importance of patients sticking to the drug regimen - every single pill.

``If they aren't compliant, they've wasted their chances,'' she said.

Sometimes, patients feel so good they skip a few doses. Others may feel so bad, or overwhelmed by their illness, that they give up hope - and compliance.

Oldfield said those difficulties - and not the ineffectiveness of the drugs themselves - may help explain the findings Deeks shared in Toronto.

Many factors can affect outcomes, he said.

Because the virus may become resistant, patients who have tried other AIDS drugs are less likely to benefit. So are patients whose numbers of T cells are very low at the beginning of therapy.

Hundreds of other published reports have been much more positive about the results of combination therapy and protease inhibitors, Oldfield said.

The newer drugs, in use for about two years, gum up an enzyme called protease to keep the human immunodeficiency virus, which causes AIDS, from replicating. They are used with other drugs, such as AZT, that intervene at different stages in the disease's progression.

``We have very powerful tools,'' Oldfield said. ``They'll work.''

One study shows that 80 percent of patients using Crixivan as part of combination therapy have undetectable levels of the virus for up to two years. ``Those levels haven't wavered,'' Oldfield said.

Other studies show declines in hospital stays and opportunistic infections.

But if the drugs are stopped - or, perhaps, even if a few doses are missed - the virus reappears.

``We don't have a cure,'' Oldfield said. ``The virus is just waiting.''

To help patients adhere to the drug regimens, the medical school's comprehensive care center recently hired Carol Dalton, a registered nurse and case manager.

Her salary is funded partly by a federal grant and donations to AIDSCare, a nonprofit support program at the medical school for people living with the disease.

Dalton, who started in August, educates patients, coordinates their care and finds money for drug treatments not covered, or only partially covered, by insurance. Drugs for AIDS patients on combination therapy typically cost as much as $1,000 a month, she said.

Dalton helps patients like Moshkovitz set up daily pillboxes, so they know what to take and when. Each daily box has a section for the morning, midday, evening and bedtime doses.

Patients also fill out magnetized calendars they can post on their refrigerators.

New treatments on the horizon promise to make the regimens more manageable, with fewer side effects, Oldfield said. For example, one potent protease inhibitor not yet on the market can be taken in two daily doses instead of three, and another in a single daily dose.

Patients should not give up hope, Oldfield said.

Holly Moshkovitz hasn't.

She met her new fiance last spring. On their first date, Moshkovitz told him she had AIDS. He loved her just the same.

They plan to marry later this month.

``You have to believe you're going to be OK,'' she said.

``I believe I have a future.'' ILLUSTRATION: Color photo

RICHARD L. DUNSTON/The Virginian-Pilot

Holly Moshkovitz, left, an AIDS patient, talks with registered nurse

Carole Dalton at the AIDSCare Office at Eastern Virginia Medical

School in Norfolk.

Graphic

Number of AIDS cases in South Hampton Roads, as of July: