Claire Rappoport, MA Comments On the Future of HIV/AIDS Research

Claire Rappoport, MA: Community Representative, Community Programs on Clinical Research on AIDS (CPCRA) and Person with AIDS

For most people, the news of a positive HIV test, while emotionally challenging, is no longer an emergency. The basic state of managing this disease should be trying to strike a balance between drug effectiveness and side-effect management. What I see emphasized in the future of AIDS research is the refinement of treatment strategies and monitoring, adjunctive treatments, and drug development.

Currently, I see more emphasis being placed on understanding how we can better sequence HAART drugs and incorporate new drug treatments looming on the horizon. The HAART medications are very powerful and often differences in patient's absorption levels and side effects occur. There is still much to learn about how we use these drugs in terms of sequencing, dosing, pulsing/treatment interruptions, etc. Similar to the current use of resistance testing, the use of therapeutic drug monitoring and other future monitoring tests will become more prevalent. The hope is to tailor each treatment regimen for each specific patient.

While the debate of whether HIV is a chronic manageable disease is still open, this change in view has opened the door for treatments that are promising with regard to immune strengthening and modulating. Examples are drugs like the interleukins coupled with an emphasis on basic health maintenance and nutrition. I see this trend continuing.

I see that many drug companies are losing interest in developing treatments for AIDS. Additionally, the furor over the side-effect development and its management has discouraged some patients and health care providers from as aggressively seeking them out - although ultimately, I think that most HIV infected folks will take some of these powerful medications at some point in their lives. Having said that, there are second and third generation antiretroviral drugs on the horizon, and I am sure that these will be prescribed and used widely once they are available. I think the key, again, will be to balance their effectiveness with the potential side effects.

In terms of what I would like to see, I hope that both therapeutic and preventative vaccine development and testing continues. I also hope that manufacturers of these drugs explore alternative delivery methods to make compliance much easier. Wouldn't it be great to wear a patch that could deliver continuous medication and only change it once a month?