First White House Conference on HIV
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FRED DE SAM LAZARO: Dr. Frank Rhame has been treating patients for HIV and AIDS since the epidemic began in the early 80’s. Since that time, more than half a million people have developed AIDS in the U.S., 2/3 of them have died. Eight hundred thousand Americans are infected with the HI virus that leads to AIDS, but they have not developed AIDS symptoms. Despite the grim statistics, Dr. Rhame says he’s become far more upbeat in recent months about the prospects for patients like 35-year-old Daniel Osborne. He was infected over a decade ago but has remained largely symptom-free.
DR. FRANK RHAME, Abbott North Western Hospital: I think there are grounds to believe that we are going to be making substantial improvements, or have already got substantial improvements in anti-HIV therapy today. This problem with resistance developing on single-agent therapy may be substantially preventable by using combinations.
FRED DE SAM LAZARO: The key to treating HIV is to somehow hinder the virus as it tries to replicate in the body. Anti-viral drugs such as AZT work for a time, but the virus eventually develops an immunity to them. So doctors have looked for new agents, for new combinations of drugs that can be used to essentially extend the time before the virus becomes resistant. The federal Food & Drug Administration has an accelerated approval process for AIDS drugs, and late last month, approved a new one, 3-TC, which will be known on the market as Epivir. Epivir joins four other anti-viral drugs now on the market. It has shown particular promise when used in combination with AZT or Retrovir, the most widely known HIV drugs. Approval is also expected soon for Sequenivir, the first of a new class of drugs called Protease inhibitors, which attack a different part of the virus.
DR. FRANK RHAME: But by the logic that I’ve been talking about, more is better. I will do it.
FRED DE SAM LAZARO: Dr. Rhame feels the new and emerging drug combinations will buy HIV patients more time, perhaps up to ten extra years. But he cautions federal approval for AIDS therapies are based on less exhaustive and less conclusive data than are required for most other drugs.
DR. FRANK RHAME: You have to recognize that when somebody finally completes the study of triple therapy, we’ll find out it doesn’t work, but I would say that’s the most probable thing right now, that triple is the best strategy. So –
DANIEL OSBORNE: It sounds great to me. I mean, you don’t know until you try.
FRED DE SAM LAZARO: The triple therapy Dr. Rhame has recommended to Daniel Osborne would add the new 3-TC to two other anti-virals he’s been on.
DANIEL OSBORNE: I’m probably more optimistic now in regards to medications and treatments than I have ever been. It was disappointing when AZT was touted as like the miracle drug, and it wasn’t. I don’t get excited about when something is in the paper, because you don’t want to set yourself up and then be disappointed. I’ve known too many people who have succumbed to disease to the fact that they had AIDS.
FRED DE SAM LAZARO: While clinicians like Rhame are encouraged by new developments, public health officials have much to worry about. For example, the latest infection trends show that while HIV transmission among older gay and bisexual men has declined, the rate is escalating among younger men in this group. And Minnesota State epidemiologist Michael Osterholm says the dynamics of the epidemic have become far more complex.
MICHAEL OSTERHOLM, Minnesota State Epidemiologist: What was almost predominantly a male disease in the first five to eight years of the epidemic, today what we’re talking about only 2/3 of the cases are among men. If you were to look at HIV data in many states, the ratio is almost half and half today of men and women. We’re seeing an epidemic that originally started among gay and bisexual men now is more and more in inner cities. It’s combined with IV drug use and heterosexual transmission, along with the predominantly heterosexual transmission in the rural South, and you’re seeing a whole different picture for AIDS and HIV today than you did 15 years ago.