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Any Promising Medicine?
Jun 3, 1997

Doctor, Is there any promising medicine available for HIV?. Or atleast in the near future. Any new research going on? Is it possible to control HIV Infection using the protease inhibitors for long time? If so, approximately how long?. Thanks

Response from Mr. Sowadsky

Hi. Thank you for your question.

Treatments against HIV have substantially improved, just in the past 2 years or so. As of today (May 1997), there are now 11 antiviral drugs that have been approved by the US Food & Drug Administration (FDA), for use against HIV. These drugs are given in combination with each other (either 2, 3, or 4 antiviral drugs at a time). These drug combinations are nicknamed "cocktails".

The good news is that in the short time that these drugs have been used (2 years or so), they have shown great promise in helping persons with HIV. These drug cocktails have been shown to reduce the amount of the virus in the body in many (but not all) people with HIV. This has led to a substantial improvement in the clinical status of many people taking these drugs. Because these drugs are so new, we do not yet know the long-term benefits of these drugs, or how long they will work.

There is unfortunately some bad news out there. If these drug cocktails are not taken EXACTLY as prescribed, HIV quickly develops drug resistance to the antivirals. Also, drug resistance against one drug can sometimes lead to resistance to another drug as well. This is called "cross-resistance". For example, if HIV becomes resistant to Crixivan (a protease inhibitor), it will sometimes become immediately resistant to Norvir (another protease inhibitor). Sometimes, even when these drugs are taken as prescribed, HIV can develop resistance over time. We have already seen patients taking these drugs who have developed multiple drug resistant strains of HIV, and whose cocktails are now failing. In some people, these drug cocktails have not been shown to be effective. This is especially true if a person has been infected for many years, and they began treatment late in the disease. In other people, these cocktails have made dramatic improvements in a person's clinical status, especially if treatment began early in the disease. Although these drugs have shown great promise, they're not without their drawbacks.

Many people (including some members of the media) have thought of these cocktails as "just take a few pills a day and the symptoms just go away!" Unfortunately, things aren't as simple as that. Although these cocktails can significantly help a lot of people, these drugs do have side effects. Also because people are now taking multiple drugs at one time, the more drugs one is on, the greater the chance for side effects to occur. When a person is taking these drugs, one must be constantly aware of when they have to take these drugs, all throughout the day. If a person forgets to take their medications throughout the day, the virus can quickly develop resistance. Persons on drug cocktails must always plan ahead to make sure they always have their medications wherever they go.

Antiviral drugs are just like any other prescription drug. They don't work in all people, they have significant side effects, and not all people can tolerate these drugs. For example, persons with liver or kidney disease may not be able to take many of these drugs. Not all drugs can be given with one another, since these drugs can sometimes interact with one another.

In summary, we certainly have come a long way as far as treatments are concerned. The new drug cocktails have made significant improvements in terms of treating people with HIV. These drug cocktails have been shown to reduce the amount of the virus in the body, which can slow down the progression of the disease. But we can't say how long these drugs will work for, since they're so new. In the short-term, the benefits of the drugs are well-known. But the long-term benefits (beyond 2 years or so) are still unknown. We are working to make this a more manageable disease. But because of the problems of drug resistance, side effects, drug interactions etc., researchers are still looking for even better treatments. Finding better treatments for HIV is an ongoing process. There are currently many clincal trials underway looking at improved ways to treat HIV/AIDS. We also have to find ways of making these treatments more affordable for people. Many of these drugs are so expensive, that people can't afford to take them. We've come a long way, but there's still a long way to go.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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