New Hope in the Treatment of HIV and AIDS
 by Timothy Flanigan, MD, director of the
Samuel and Esther Chester Immunology Center at The Miriam Hospital
Within the last six months, HIV- and AIDS-related deaths in this
country have fallen dramatically. AIDS is no longer the number one cause
of death among men and women between the ages of 25 and 44. What caused
this dramatic change in an epidemic which first appeared just 15 years
ago?
Within the last three years we have gained a new understanding of the
biology of this virus, which now infects almost one million Americans. HIV
replicates continuously at a rapid rate, infecting every organ of the
body, and is never inactive. We can now track the level of replication
through new measurements. Although we cannot cure HIV, we now can suppress
it.
When HIV and AIDS were first identified,
we fought the virus as we did in the early years of treatment of
tuberculosis, by using one drug at a time and switching to another
medication when the treatment effects started to wane. Within the last two
years we have learned that (again like TB) we have to use multiple drugs
simultaneously to actively suppress HIV and prevent resistance. With the
advent of highly effective new drugs called protease inhibitors, our
combination therapies now are able to inhibit HIV to the point that we can
no longer detect it. Patients who are severely ill often recover
dramatically in six months: many clinicians have described this as the
"Lazarus Effect."
On the other hand, not all patients respond. The infection is not
cured. Not all patients can follow very complicated medical regimes which
may include taking 20 pills per day. Cost is an issue; depression,
violence, and lack of support are also real barriers to care. Not all
patients can break the cycle of drug addiction or alcoholism. Finally, few
of the drugs are available to those in Africa, Asia and Latin America who
are infected with HIV.
The newfound hope resulting from
the discovery of highly effective antiretroviral therapy is exhilarating
both for caregivers and for patients. The challenge is how to make it
available to all patients and provide not just medications but
support, care and compassion to persons afflicted with this virus.
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