HIV Treatments
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In this segment, Dr. Michael Wolfheiler discusses advances in HIV treatments with Drs. Edward, Kathryn and John Martin.
In the 1980’s, almost all patients with the human immunodeficiency virus (HIV) would die from AIDS. In 1995-96, that finally changed with the introduction of the first protease inhibitors. These could arrest the disease for many patients, and people were living for much longer periods of time with the virus. There were however many side effects of the early protease inhibitors, and they often had a complicated dosage schedule, sometimes having to take 15-20 pills through out the day and night.
Now there are many newer and better drug combinations available to treat HIV, to stabilize the immune system, allowing patients to live for long periods of time with minimum side effects.
In spite of attempts at education to help keep down the numbers of new HIV patients, there are some groups in whom the numbers are rising. This includes women, and patients of color. In the gay community, there was a marked decline in new infections with education, but this is now changing, and their numbers are also beginning to increase. Some of this may be due to young people’s perception of HIV as a chronic but manageable disease. There has also been an increase in seroconversions with people using drugs, especially crystal methamphetamine, which increases the incidence of unsafe sex.
The medications are still very costly, and can run up to $15,000 per year for the uninsured. Most or some of this cost is usually covered by health insurance. The medication schedules are now much easier than in the past, but there are still many possible side effects. Many patients will develop GI problems such as nausea and diarrhea. The more severe side effects however remain the lipodystrophy which can occur after many years on the medications. Lipoatrophy is usually seen in the face and extremities, where there is a loss of fat, giving a wasted look to the patient. This appearance can be improved with some of the various cosmetic fillers available. There can also be fat deposition in the abdomen, or the top of the back to create a hump.
There are still some HIV deaths, which occur in patients who have had the disease for many years, and may have developed resistance to the medications. There are also some people who do not follow their dosing schedule, which can lead to more mutations in the virus. There have been many attempts at finding a vaccine, but so far with little success due to the frequent mutations of the virus.