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Editorial

Good Year ...

... and the Promise of a Better One to Follow, For People Living With HIV Infection

Decmber 1997

The first decade of antiretroviral therapy -- which began when the nucleoside analogs became widely available -- was marked by early optimism... which gave way to frustration and despair when the effectiveness of these early compounds proved transient. The second decade of antiretroviral therapy -- which began when the protease inhibitors became widely available -- was also marked by early optimism, this time tempered by considerable caution. There was no question that these new agents had potent antiretroviral activity: when used in combination with older agents, they produced near-complete suppression of viral replication in a majority of treated patients. The question was: How long would these beneficial effects last?

The answer depends on many factors. Patients who have advanced HIV disease and a long history of AIDS-related illnesses generally do less well than patients with higher CD4 counts and lower viral burdens. Patients who have been treated with many drugs over many years -- and who have, as a result, developed some degree of resistance to some of those drugs -- generally do less well than patients who do not have a long treatment history. And, perhaps most importantly of all, patients who fail to remain compliant with their prescribed antiretroviral regimens do less well than fully adherent patients -- regardless of disease stage or drug history.

But none of these caveats can dim the optimism that physicians and patients alike now feel about the future of HIV therapy. Large numbers of treated patients have achieved clinical stability on combination antiretroviral therapy, and many of those patients have seen their CD4 counts, their overall health, and their outlook on life rebound within months of beginning one of these powerful multidrug regimens. Only a few years ago, clinicians all too often found themselves counseling HIV-positive patients to sign a Do Not Resuscitate form and other advance directives. Today those same clinicians often find themselves in the happy position of encouraging patients to return to the work force.

Many factors have contributed to this sea-change in our collective outlook. Clinicians have gained considerable experience in dealing with HIV infection and its sequelae, learning how to tailor drug regimens to the particular needs of particular patients. Patients have learned how to incorporate the demands of multidrug dosing schedules into their daily routines. And pharmaceutical companies have learned how to target HIV with greater specificity and greater effect.

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This special year-end issue of HIV Newsline is devoted to the future of HIV therapy. In this issue, Dr. Harold Kessler provides a preview of the next generation of antiretroviral agents -- some just approved, some awaiting approval, some still in the developmental stage. Containment of HIV is not a cure, however, and drug resistance remains a formidable clinical challenge, for reasons Dr. Steven Deeks explains.

Because the treatment of HIV infection has become such a dynamic and fast-changing field, we have also included the latest treatment recommendations of the International AIDS Society - U.S.A. Those guidelines, which appear in the special Pull Out and Save section of this issue, offer physicians and their patients more effective options than ever before, and therefore they offer more hope than ever before.

Paul A. Volberding, M.D., is AIDS Program Director at San Francisco General Hospital.





  
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This article was provided by San Francisco General Hospital. It is a part of the publication HIV Newsline.
 

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