AIDS Therapy in the New Millennium
Feb. 1, 2001 -- Two things are being left behind as AIDS therapy marches into the new millennium. Gone -- for those with access to anti-HIV drugs -- is the despair of the days when AIDS meant death. Gone, too, is the fervent hope that drugs can cure HIV infection.
"There is no way this phase of the AIDS epidemic -- in the U.S. -- will be anything like the first phase of the epidemic -- it will be a fraction of what we saw then," leading AIDS researcher John W. Mellors, MD, tells WebMD. "Some people are going to do great, but some are going to slip through our hands. It is going to be this way for a long time. We will edge up, then fall behind."
It seems like only yesterday -- actually it was the mid-1990s -- when the advent of potent triple HIV therapy held out the promise that HIV could be cured. Researchers calculated that only a few years of highly active antiretroviral therapy (HAART) could wipe out the AIDS virus. They were wrong.
Only two years ago, many of his peers thought University of California at San Francisco researcher Jay Levy had flipped his lid when he publicly rejected the cure-oriented "hit hard, hit early" approach to AIDS therapy. Now the same scaled-back approach he advocated then will soon be enshrined in official AIDS therapy guidelines. These new guidelines will reflect a more sober mood among doctors whose goal now is to extend the benefits of therapy -- and to minimize its toxic side effects -- for as long as possible. They advise holding off taking AIDS drugs until blood tests show that a person's immune system is beginning to fail.
"The new era we are in is 'hit early is wrong' -- that approach was not based on the understanding you would have to treat people for so long," Levy tells WebMD. "It is a matter of time before the drugs no longer work. That is what we are learning. If you start too early, your options are used up. It is predictable. Drugs are running out, and we don't have anything great on the horizon."
Levy -- one of the first researchers to isolate the virus that causes AIDS -- thinks future guidelines will go even further, holding off treatment until the immune system is on the verge of collapse or until AIDS symptoms begin to appear. "Now we are saying let's wait until a person develops symptoms and the drugs really will help," he says.
And it's not just a matter of side effects. If a person takes AIDS drugs long enough, drug-resistant strains of HIV eventually will appear. This means switching drugs again and again until there aren't any more drugs left to take. Many patients already have reached this stage.