BUYING TIME : AIDS PATIENTS GAIN VIGOR, IF NOT A CURE.

Byline: Keith Stone Daily News Staff Writer

Before Linda Grinberg took the newest, most powerful combinations of anti-AIDS drugs, she planned her day around naps.

Her doctor told her to make out a will.

What a difference a few pills make. Grinberg is planning to redecorate her Brentwood home. She wants to throw a New Year's Eve party.

``These drugs have made,'' she said, pausing to collect herself, ``have made life possible for me.''

Grinberg is living proof that triple combinations of old and new medications can bring back people from the edge of death.

Unfortunately, 45-year-old Grinberg also is proof that medical science has yet to conquer the virus responsible for AIDS.

Fifteen months into her treatment, Grinberg watched nervously as the virus rebounded in her blood.

``I expected this,'' said Grinberg during an interview at her home last week. ``Obviously, my virus is mutating around the drugs that I take.''

The human immunodeficiency virus or HIV, which causes AIDS, may be the sneakiest and most adaptable germ ever to attack humankind. It reproduces quickly and spins off many mutations, improving the odds that one variation can defeat whatever new drug comes along.

Even the newest, most powerful class of drug, called protease inhibitors, has fallen to the virus. But by combining protease inhibitors with older medications, scientists finally have succeeded in jamming the microbe's ability to reproduce in some patients to the point where the virus no longer can be detected.

One clinical study has shown that 86 percent of patients had no detectable trace of HIV after 48 weeks on a regimen of drugs. Fourteen percent of those patients saw the virus return, however.

``Unfortunately, that includes me,'' Grinberg said about the 14 percent.

Because the level of virus seems to have plateaued, Grinberg and her doctor wonder whether the microbe has been crippled.

``We don't know,'' she said. ``It has been the name of the game since my diagnosis: Buying time. Buying time.''

The question is, how long?

It has been long enough for some Los Angeles mortuaries to report a decline in business because of the new drugs and for hospital AIDS wards to empty out by half.

It has been long enough for the gay community to begin thinking about issues other than AIDS.

``These new drugs really brought back hope,'' said Dr. John Ward, chief of the HIV-AIDS Surveillance Branch of the federal Centers for Disease Control and Prevention in Atlanta.

``But you do have to be realistic. While there are legitimate reasons for hope,'' he said, ``we have to recognize that not all the information is in on how these drugs will affect HIV in the long run.''

Brian Pardo literally is betting his company, Life Partners Inc., that the virus learn how to defeat the drugs.

Life Partners in Waco, Texas, buys life insurance policies from people with AIDS for a percentage of the value, making its profit when the person dies. The success of new treatments has driven at least one company out of the business, but Pardo remains confident.

``Right now there is some nervousness in the market. However, most of the informed players recognize where we are medically,'' Pardo said.

``I am not trying to throw cold water on what the whole AIDS community is feeling right now from these drugs,'' he said. ``But this disease has mutated around every medication thrown at it.''

One recent evening, nearly 400 people turned out at a West Hollywood auditorium to hear the latest on the new drugs.

That evening, the star attraction was Dr. Charles Farthing, the soft-spoken medical director for the AIDS Healthcare Foundation, which treats some 3,000 patients in clinics across Los Angeles.

``Triple combinations not only work,'' he told the crowd, ``but its effect is sustainable. ``It delays the onset of drug resistance, and that really is the key to HIV control.'

Farthing told of one prominent doctor, David Ho, director of the Aaron Diamond AIDS Research Center in New York, who hopes that some people could eliminate the virus entirely after one to three years of combination therapy.

In other words, Farthing said - a cure.

Some in the crowd gasped. ``It is still an open question,'' Farthing quickly added.

He then told of another doctor who after a year took his patient off combination therapy that did not include a protease inhibitor. ``And he had a rebound,'' Farthing said.

This time, the audience groaned.

He told of a Boston doctor who had used three drugs, not including a protease inhibitor, on newborn infants with such success that some lost antibodies to the virus. That suggests the babies have cleared the virus, Farthing said.

``But we won't know for sure until he pulls the treatment away,'' he said.

Farthing, later in an interview, said he believes the therapy could keep the virus in check permanently, as long as the drugs continue to be administered.

The key to holding the virus at bay, Farthing said, is to make sure the drugs are taken faithfully and in correct doses. Missing pills will allow the virus to replicate and mutate, he said.

``The truth is that this is a very unsatisfactory treatment when you consider it requires continued compliance,'' he said. ``It is a very difficult way to treat any disease.''

Just ask David Burns.

The 37-year-old Los Angeles man chokes down 64 pills a day, including the anti-virals and other drugs that protect him against germs that healthy people could fend off by themselves.

``The regimen is probably the worst thing about this,'' he said.

He wakes at 6 to take one drug, sleeps until 7 and rises again to take the next. Throughout the day, he must time when he can eat and when he must take another pill.

He takes some drugs to combat the side effects of other drugs.

``It is really hard, but I guess it is worth it,'' said Burns, who had worked as an administrative assistant at a local university until he became too ill.

In April, Burns' weight had slipped to 149 pounds, and he needed blood transfusions every three days. Several months ago indinavir, one of three protease inhibitors approved for sale, was added to his array of anti-viral drugs and proved to be the boost his body needed. His weight shot up to 202 pounds, and he says he has found new energy.

``This is the first drug that has worked beyond six months or a year,'' he said.

Resistance has not been a problem - yet.

Now Burns feels well enough to return to work, although he said he has decided against it because he is afraid he could lose health insurance under Medi-Cal.

``I have to say I am having a really hard time adjusting to feeling well,'' he said. ``Now I have to try to refocus away from constantly thinking about being sick and being healthy and staying alive.''

He is not alone.

Several of Dr. Robert P. Cabaj's patients at his psychiatry practice in San Francisco are confounded by their newfound health.

``People have gone through a lot of their own preparations for death and grieving,'' he said. ``Suddenly there is a new lease on life and relief.

``Some of them are very wary - that this is yet another fad or another interim thing,'' Cabaj said.

For Grinberg, the mounting evidence is that the therapy may be an interim one.

Other anti-AIDS drugs, including AZT, already had failed her before she took her first dose of indinavir.

At the time, her body carried a whopping 650,000 particles of virus per milliliter, her disease-fighting blood cells had dropped 27 times below normal and she slept much of the day.

Too sick to run her company, the Grinberg Film Libraries Inc., she sold the film and videotape archive in April 1994.

But rather than wait to die, Grinberg used the last of her strength to fly to Washington, to beg for a chance to use protease inhibitors before they were approved for sale.

She was chosen to take part in a clinical trial using AZT and a protease inhibitor. Within three weeks, her symptoms began to disappear, driving down the level of virus to just 1,200 particles per milliliter.

Then, Grinberg added a third drug, 3tc, pushing up her critical white blood cells by 300 percent.

``I would probably be in the ground, if not for combination therapies,'' said Grinberg, whose husband infected her with HIV. He died in 1992.

All along, Grinberg has known that lurking in the background was the possibility of virus resistance to any new therapy.

In the past three months, the level of virus in Grinberg has risen - to 40,000 particles per milliliter.

So now she waits for the next drug, the next ration of hope.

CAPTION(S):

2 Photos

Photo: (1--color) Linda Grinberg holds a bowl containing her daily dosage of pills to combat the stubborn virus that causes AIDS.

(2) Linda Grinberg hugs her dog Sweet Pea. Grinberg is among those whose lives have been prolonged by new AIDS drugs.

Michael Owen Baker/Daily News