Online NewsHour: International Conference on AIDS -- July 10, 1996

CAUTIOUS OPTIMISM

JULY 10, 1996

TRANSCRIPT

Fred De Sam Lazaro of KCTA-St. Paul-Minneapolis reports on the recent efforts to treat the AIDS virus.
Click for the Science special issue on AIDS

July 10, 1996: Two AIDS experts discuss the ongoing annual international conference on the virus.
July 19, 1996: Dr. Helene Gayle, director of HIV Prevention at the Centers for Disease Control, participates in an Online NewsHour Forum on AIDS.
April 1, 1996: The NewsHour reports on the growing business of the AIDS epidemic.
Feb. 9, 1996: Two AIDS experts discuss the implications of a controversial bone marrow transplant.
Feb. 1, 1996: Elizabeth Farnsworth reports on the possibility of using protease inhibitors to slow the spread of HIV.

FRED DE SAM LAZARO: This is the eleventh time experts from around the world have gathered to compare notes about AIDS, but from the beginning this conference has been different. New studies showing promising drug therapies have sparked optimism among the 15,000 delegates. That mood was evident in the keynote speech delivered by Dr. Peter Piot, head of the United Nations AIDS program.
DR. PETER PIOT, United Nations AIDS Program: The new combinations of anti-retroviral drugs are holding out new hope, hope that our relatives, partners, and colleagues living with HIV may live normal lives despite HIV.
FRED DE SAM LAZARO: The latest research shows that new combinations of drugs now being tried on AIDS patients seem to be working. Paper after paper presented at the convention showed that those participating in the drug therapies had a significant reduction in their levels of HIV. That optimism is being felt by doctors and patients across the western world. Dan Osborne says he became infected with HIV in 1983. He has lived long enough to see several medicines come onto the market that may make a real difference in AIDS survival.
DR. FRANK RHAME, Infectious Disease Specialist: (talking to Osborne) You've essentially been asymptomatic right along, right?
DAN OSBORNE: Mmm, that oral thrush, and that was next to nothing.
DR. FRANK RHAME: Did you--
FRED DE SAM LAZARO: Exactly how much drugs have benefited him isn't fully known but Osborne has used many of the new medicines that have hit the market in recent years.
DR. FRANK RHAME: So at this minute you're doing AZT, D-14 and then--and you've never done ddC or ddI?
DAN OSBORNE: No.
FRED DE SAM LAZARO: Dr. Frank Rhame has put Osborne on a combination of two basic types and generations of so-called anti-virals, drugs that slow the HIV's replication in the body. AZT was the first AIDS drug approved in 1987 under the commercial name Retrovir. It remains the most widely used anti-viral. It was joined on the market by several similar-acting drugs with names like ddI, ddC, and D-14. Doctors have always prescribed them in combinations, trying to outfox a virus that seems to quickly develop a resistance to single drug therapies.
DR. FRANK RHAME: Two is better than one, which I think it clearly is, and if three is better than two, which I think it probably is, then by that logic, you would keep adding them as long as you can do it without toxicity.
FRED DE SAM LAZARO: Last December, the federal government added significantly to medicine's arsenal against HIV, approving a second generation of drugs called protease inhibitors with commercial names like Invirace and Novir. These drugs attack a different part of the virus, significantly slowing a protein called protease that the virus needs in order to replicate.
DAN OSBORNE: This is the protease inhibitor, Sequinavir. I take three of these.
FRED DE SAM LAZARO: Dan Osborne, like most patients, uses protease inhibitors along with the older drugs like AZT. His medical report so far has been extremely positive. There's been a sharp drop in the amount of HIV present in his body. In some patients, doctors have been unable to detect HIV at all. This does not necessarily mean a cure, but Dr. Rhame says as more anti-virals become available, HIV infection could become a chronic condition to some instead of a fatal one.
DR. FRANK RHAME: It's on average a 12-year illness from onset to death, absent any therapy. So if you take a person who gets infected at age 30, that person has got 60 years left on the planet on average anyway, so if you could slow this thing down by a factor of four and keep it slowed down, that's the key, you keep it, because this resistance issue, you should have a normal life span. I mean, you don't have to cure people of it.
FRED DE SAM LAZARO: But in the AIDS epidemic, there's been hope and letdown before. An immediate worry is that protease inhibitors have been difficult for may patients to tolerate, especially those on other non-AIDS drugs like antihistamines. So it takes careful fine tuning to find the right combination for individual patients. There's also no telling how long it will take HIV to grow resistant to all combinations of drugs that use protease inhibitors.
DR. FRANK RHAME: Now that, of course, is the key to this whole thing, are these improved results going to be sustained or not, and so far, the best we can do is say that through the first year or maybe even the first year and a half they are sustained, and this approach has not really been around long enough to know if it's going to stay beneficial for five years or more or less. And we'll find out.
DAN OSBORNE: I plan to be around to find out.
FRED DE SAM LAZARO: Osborne is optimistic, but doctors wonder how many patients there are like Osborne who will take 20 pills a day every day without fail. They also worry about the high cost of such a daunting regimen. A typical year's worth of pill cost $20,000, affordable for those like Osborne who have insurance, far more difficult for many who don't.

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