Arguing with AIDS
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SUSAN DENTZER: At international AIDS conferences just a few years ago, there was great optimism about new treatments for the deadly disease.
DR. PETER PIOT (in 1996 video): The new combinations of anti- retroviral drugs are holding out new hope— hope that our relatives, partners and colleagues living with HIV may lead normal lives despite HIV.
SUSAN DENTZER: In developed countries like the U.S., death rates of patients infected with HIV, the virus that causes AIDS, were falling sharply. Amid the euphoria, headlines like these proclaimed the end of AIDS. Dr. Roxanne Cox-Iyamu, an AIDS specialist in Washington, D.C., says the reason was breakthrough antiviral drugs, often administered in combinations called cocktails.
DR. ROXANNE COX-IYAMU: And over time, many of the medications came on board, became standard of care to place people rather on one drug, put them on two drugs at a time, and over time to put them on three medications. And then the hope of actually curing this disease… I mean, we were all really excited about this.
SUSAN DENTZER: But recently that optimism has ebbed considerably. Dr. Anthony Fauci heads the National Institute of Allergic and Infectious Diseases.
DR. ANTHONY FAUCI: Although the benefits of these therapies have been extraordinary with regard to both morbidity and mortality, the fact remains that we have been unable to eradicate the virus, and every time we try– virtually every time– to discontinue the drug in an individual, almost invariably the virus comes back.
SUSAN DENTZER: That portends a grim reality for AIDS patients like Raenard Brown. He tested positive for HIV eight years ago and today is well enough to volunteer part-time at a Washington AIDS clinic. But he still battles the disease by taking nearly 40 pills a day. Some produce serious or unpleasant side effects, like nausea or hallucinations. One of the drugs is Amprenavir.
RAENARD BROWN: The negative side effects that I receive with Amprenavir is the lipodystrophy that I’m dealing with now. And lipodystrophy is the pouch, the stomach, the fat stomach, and the buffalo hump right in the back of the neck.
SUSAN DENTZER: With all these drugs, the good news is that the HIV virus has dropped to undetectable levels in Brown’s blood. But Brown knows it will rebound if he ever stops the medication.
RAENARD BROWN: It’s either I go along with this, and just go through alterations with clothing and so forth, or I come off of it and lose the lipodystrophy– the pouch in the stomach and the buffalo hump– but run the risk of becoming very, very ill; my viral loads going back up to a very high number. From 1992 all the way up to now, my life has been all pills; taking all these meds. I am tired of it. I’m very tired of it.
SUSAN DENTZER: This week in Chicago, specialists in HIV and AIDS have gathered at an annual conference on retroviruses– that’s the family of virus to which HIV belongs. They’re learning more about adapting to a world in which individuals with HIV may be on drugs for years, if not decades. One topic garnering attention at the conference is the notion of taking patients with HIV off drugs for short periods; in effect, to give their systems a periodic break. Dr. Fauci is leading a study of the technique.
DR. ANTHONY FAUCI: It’s aimed at having a structured, cyclic, predetermined brief amount of time off therapy, one after the other, after the other, so that you’re on, off, on, off, with the caveat that you keep someone off therapy long enough to have a period of a breather, but not long enough for the virus to come back.
SUSAN DENTZER: The study involves roughly 35 patients getting the interrupted drug therapy. Fauci says early results look promising.
DR. ANTHONY FAUCI: We need to study larger numbers of patients, and we need to study them for a longer period of time. But with that caveat in there, what is clear that we might be able to have within a defined period of time– let’s say a year– up to 50 percent of the time when people are off therapy.
SUSAN DENTZER: The hope is that such structured treatment interruptions, as they’re called, might minimize both the side effects and the sense of fatigue patients feel about their treatment. Also discussed at the conference were changes in the way doctors treat some patients with HIV; specifically those newly discovered to have the virus and who don’t yet have symptoms.
Several years ago such patients were often bombarded with drugs right away in the hope of eradicating the virus. But because of the toxic effect of many of the drugs, the Department of Health and Human Services this week released new guidelines on when these patients should begin drug therapy. In effect, the guidelines now recommend that these patients go without drugs until their immune systems show more damage and levels of virus in their blood are higher. The result will be to delay the onset of treatment for thousands of patients, and postpone staggering drug costs that can run as high as $20,000 a year.
DR. ROXANNE COX-IYAMU: I think it’s very appropriate that with the side effects, with the cost, with the quality of life for these individuals, that we rethink our strategy, and look at taking our time, putting people on medication when they are ready to be on medication, when it’s safe, and knowing that it’s going to be a long, long, long time.
SUSAN DENTZER: Still more grim news in Chicago included new reports about disturbingly high rates of new HIV infections in the U.S. Those rates remain very high for minorities, and after years of decline, they’re also rising again among gay or bisexual men. That’s a group that was once far more vigilant about so-called safe sex and other AIDS-prevention strategies than it appears to be today. As a result, one study discussed in Chicago found that almost one out of three gay black men in their 20′s are infected with HIV.
RAENARD BROWN: Some people who are in their early 20′s are reckless when it comes to having sexual relations, having multiple partners. And as sad as it is, really, I mean, there’s not a cure. People are still dying, and the medications are just holding us… holding us above water.
SUSAN DENTZER: Given that fact, there was much excitement at this week’s conference about new classes of AIDS drugs that could soon be on the market. Some represent new ways of stopping the virus from entering human immune cells, or halting the virus’ efforts to replicate itself later. Hopes run high that these drugs will build on the many past successes in AIDS therapy. After all, despite all the problems, those treatments have so far saved tens of thousands of lives.