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Protease Inhibitors: Is the Honeymoon Ending?
Spirituality Column #20

By Rev. A. Stephen Pieters

January 24, 1997

An important, cautionary article on protease inhibitors, "The Morning After &quot, by Mike Barr, appears in the February, 1997 issue of Poz Magazine. The article scared me as a pastor and as a person living with HIV, by reminding me that recent successful advances in treatment are not being enjoyed by every person living with HIV.

The article started my mind working once again on what it means to have hope and faith when the current treatments are not accessible or viable for an increasing percentage of patients. While acknowledging the excitement of the turn-around in health which many people are experiencing with protease inhibitors (PI's), the article asserts that recent advances are "a double-edged sword. " San Francisco researcher Don Abrams is quoted in the article as saying, "We're in the middle of the honeymoon period with these drugs, and whether this is going to be an enduring marriage is unclear. " As studies of PI's continue, more and more is being learned, and not all of it is good news. For instance, these new drugs may work best for those who are recently infected, and those who have never been on antiviral therapies. There may be problems with PI's for those who have been infected for a long time, and for those who have spent years on one or more antiviral, such as AZT. Some researchers are reporting that up to 40% of patients are not responding to PI treatment. There is an &quotunparalleled degree of cross-resistance ", i.e., if a patient builds resistance to one PI, that person will experience resistance to all of the current PI's.

In spite of successes with early treatment intervention, there are some who argue that early intervention may not be the best plan. The article asserts, "Where there is... a finite temporal benefit to even the best of these drugs, early intervention is not necessarily the best strategy. " Why light your only candle at noon when you have the whole night ahead? There are some patients who have experienced "undetectable " viral load while on combination antiviral drugs, without adding PI's, but whose viral loads soared as time went on. The article poses the question, "If 'becoming undetectable' on nucleoside combos hasn't prevented progression to disease and death, why is undetectable' on the protease combinations impervious to failure -- except for the fact that we haven't followed patients long enough to see it? " Those who remember the honeymoon period with AZT when it first became available ten years ago, will remember there was a definite end to the honeymoon. Many scientists, researchers, and activists now fear that there will be an end to the honeymoon period with protease inhibitors. Yes, we're seeing a new day in treatment of HIV, but more and more scientists are saying that the new day may have problems of its own.

There are still hopeful voices from some activists on the frontlines. Rev. Jim Mitulski, pastor of MCC San Francisco, reports that in contrast to the years he performed four or five funerals a week due to AIDS, he is now doing about two a month. He sees a definite decline in the rate of dying. Michael Weinstein, activist and founder of the AIDS Healthcare Foundation, and a self-confessed pessimist, is optimistic that there will be a new class of even more effective drugs within a year or two, for those who had little or no success with PI's. So some people are feeling optimistic in spite of reports like "The Morning After. " The challenge is to maintain hope while keeping a realistic and cautionary eye on the advantages and disadvantages of the current treatments, as well as on continuing research.

Faith, then, continues to be a vitally important tool in living with HIV. Faith calls us to have compassion for those who are not benefitting from PI treatments. Faith calls us to pay attention to their needs, concerns, and feelings. Faith gives hope, even for those not taking PI's.

Faith can give us hope that these combination treatments will lead to yet more universally effective drugs. People of faith are called to celebrate and give thanks that important advances have been made, and that there are now numbers of people who are living well with HIV. But people of faith are also called to work towards and pray for justice, and for a universally accessible and effective cure. This kind of action gives life and hope.

My doctor told me in 1984 that my mission, (should I choose to accept it!), was to stay alive long enough for medical science to find a way to manage or even cure HIV. For all of us living with HIV, that mission remains the same. Each of us who are living with HIV, whether benefitting from PI's or not, can do a great deal to help ourselves survive and thrive with HIV (see "Choose Life " and "Spiritual Strength for Survival ") until more universally helpful drugs are found. It is faith that gives us that ability.

Nurture your faith. Faith works. God sustains us and helps us even when protease inhibitors don't!

©1997 by the Rev. A. Stephen Pieters

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