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AIDS Marks 20th Anniversary

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The overall approach to the treatment of HIV/AIDS has changed significantly in the past 20 years. In the last five years alone, there has been a dramatic shift from initiating treatment upon diagnosis to delaying therapy until symptoms arise. The change has been made in an attempt to extend the benefits of therapy for as long as possible and minimize side effects that impinge on quality of life and further threaten the health of infected people.

In addition to diarrhea, increased risk for diabetes, and kidney problems, doctors have begun reporting that some patients who have been on anti-AIDS drugs for years are experiencing a redistribution of their body fat that results in bulges and lumps -- a condition known as lipodystrophy.

The well-known antiviral drug AZT is one of 18 anti-AIDS drugs available, many of which must be taken multiple times per day.

"Adherence to medications is a major, major problem," says Michael Kolber, MD. "You need to be about 95% compliant. That's almost an unattainable number ... and people are now looking at once-a-day treatments for that reason."

Kolber, director of HIV adult services at the University of Miami School of Medicine, says the future lies in medications that combine the multiple drug 'cocktails' so many HIV-infected people take into a single tablet taken once or twice a day.

This would enable patients such as Michael Karchinski, who at age 36 has been HIV-positive for 12 years, to take fewer pills each day. Karchinski says fewer pills and a less regimented schedule for taking them is an improvement over various therapies he's taken through the years that left him sick and weak. But it's not as simple as it sounds.

"They're making it so we take less, but the pills are two to three times bigger than they were," says Karchinski, who works for MTS, a nonprofit group in New York City that helps people with HIV and AIDS get back into the work force.

Still, he remains optimistic for the future.

"My first hope would be that they find a cure," he says. "In the interim, educating people is the next best thing, as well as finding drugs that have less toxicity and hopefully in the long term don't cause us to die of something else."

Frost says he believes the next big breakthrough in anti-AIDS drugs will come from drugs that take a different approach than what is now available.

"Right now we have drugs that target two places on the viral life cycle," he says. Protease inhibitors attack one spot, and drugs that attack reverse transcriptase constitute the other.

"There are potentially multiple spots in the viral life cycle that we could be attacking in this process that would, I believe, provide us with a far greater shot at really inhibiting the viral growth," he says.

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