Over the past several years, researchers have made significant advances in treatment options for HIV/AIDS. Since the late 1980s, medical professionals in the United States have incorporated antiretroviral drugs into the prescribed treatment regimens of infected patients. Administered in combinations, these drugs increase the time lapse between HIV infection and AIDS development.

Antiretroviral drugs specifically attack retroviruses, such as HIV. Combinations of three or more antiretroviral drugs, commonly called "drug cocktails," are effective in reducing the concentration of HIV in infected individuals by slowing the spread of HIV. Currently, the Food and Drug Administration (FDA) has approved 13 antiretroviral drug products for use in HIV treatments.

A Closer Look at the Drugs

Each of the 13 antiretroviral drug products are placed into one of three categories: protease inhibitors, nucleosides or non-nucleosides.

Protease Inhibitors

An HIV infection progresses to AIDS by replicating itself and infecting the healthy cells of the person carrying the HIV virus. The HIV virus replicates when protease, which is an HIV enzyme, interprets and processes the message linked to HIV proteins. Protease inhibitors effectively hinder the HIV enzyme, slowing the replication of HIV and its ability to infect healthy cells, thus inhibiting the development of AIDS.

The five protease inhibitors available are:

Brand Name	Generic Name	Date Approved
InviraseTM	Saquinavir (hard gel)	Dec. 1995
NorvirTM	Ritonavir	March 1996
Crixivan®	Indinavir	March 1996
Viracept®	Nelfinavir	March 1997
Fortovase®	Saquinavir (soft gel)	Nov. 1997

Nucleosides and Non-nucleosides

In order for HIV to replicate, the HIV enzyme must become a component of the nucleus, or "the brain," of an infected cell. A process called HIV enzyme reverse transcription allows the HIV enzyme to enter the infected cell's nucleus. Nucleosides and non-nucleosides both are referred to as reverse transcriptase inhibitors -- they slow the progression of the HIV infection by stalling the incorporation of the HIV enzyme into the infected cell's nucleus.

Nucleosides

The six FDA-approved nucleosides available are:

Brand Name	Generic Name	Date Approved
Retrovir®	Zidovudine (AZT, ZDU)	March 1987
Videx®	Didanosine (ddI)	Oct. 1991
Hivid®	Zalcitabine (ddC)	June 1992
Zerit®	Stavudine (d4T)	June 1994
Epivir®	Lamivudine (3TC)	Nov. 1995
CombivirTM	Zidovudine & Lamivudine	Sept. 1997

Non-Nucleosides

The two non-nucleosides available are:

Brand Name	Generic Name	Date Approved
Viramune®	Nevirapine	June 1996
Rescriptor®	Delavirdine	April 1997

Why Combinations of Drugs?

Protease inhibitors, nucleosides and non-nucleosides each inhibit a different function of HIV. An antiretroviral drug fails to have a lasting effect when administered to patients alone. Therefore, they are administered in combination allowing for an ambush on the deadly virus.

Medical professionals must carefully decide which combination of antiretroviral drugs is most appropriate for each individual infected with HIV. A lack of consistency in both the side effects patients experience and the impact the drug has on an HIV infection makes it very difficult for medical professionals to decide on the most appropriate drug combination. Antiretroviral drug cocktails can either thwart the onset of AIDS or have little to no impact on an HIV infection.

The Benefits --

When successful, antiretroviral combination drugs decrease the concentration of HIV and fortify the immune system.

• In the most ideal cases, antiretroviral combination drug therapies serve as a powerful and suppressive force on the progression of the HIV virus while keeping the negative side effects to a minimum.

• In 1997, 60,634 AIDS cases were reported to the Centers for Disease Control and Prevention (CDC) -- 12% less than reported in 1996. This decrease is largely credited to the effectiveness of combination drug therapies.

The Challenges --

• The cost is roughly $10,000 each year for the medications alone.

• Antiretroviral combination drug therapies often are very powerful and cause side effects in patients that make them unable to continue the treatment. This allows the HIV to become resistant to the drugs and the therapy does not suppress the development of AIDS as effectively as it would if it was uninterrupted.

• The regimen of many antiretroviral combination drug therapies is complex. Some drugs must be taken with food and others without food. Different drugs must be taken at different times of the day, everyday. For some, this rigorous drug treatment course will be a permanent part of their lives.

  For more information on treatment, call the CDC National AIDS Hotline at 1-800-342-AIDS or the CDC Clinical Trials Hotline at 1-800-TRIALS-A.

The Importance of Nutrition

Besides drug therapy, there is another factor that significantly contributes to the longer and healthier lives of people living with HIV -- good nutrition. Nutritious foods allow people living with AIDS to preserve their health by offering protection from the complications of HIV-related infections. A high caloric intake, with sufficient protein and complex carbohydrates, defends against malnutrition, malabsorption of nutrients, immunosuppression and muscle wasting. Good nutrition greatly reduces drug side effects while also increasing the body's ability to absorb certain medications.

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