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About Just out. (Portland, OR) 1983-2013 | View Entire Issue (Aug. 2, 1996)
just out ▼ august 2, 1990 ▼ 17 they caused. he HIV-affected community filled with hope in anticipation of the International L e t t h e r e b e l ig h t Conference on AIDS held in Vancouver s of last year the great mystery o f the this July. It is the first time since the pan demic began that there were reports on successful “latency” period has been solved. By using viral load tests (a new tool used to measure therapies to control HIV and even perhaps elimi the number o f viruses in the bloodstream), Dr. nate it in people living with the disease. Most David Ho and his colleagues at Aaron Diamond importantly, people with AIDS who up until now AIDS Research Center in New York City have felt that they were coping with a fatal illness, at last shown that the virus never rests; there is an ongo- feel that they have a ftiture with new hopes o f man aging HIV, feeling better and living longer. Let’s take a look at how far we have come and what we can expect in the future. T I n th e A Despite the fact that the need to test different antivirals was hampered by ownership issues, con cerns about profit, scientific secrecy inherent in the privatization of research and the lack of strong leadership at the federal level, scientists did make some progress toward fighting the virus. But until recently, no single antiviral was able to effectively control HIV. Then in 1994 the traditionally dour- faced scientists began to smile as antivirals used together in combination reduced the amount of b e g in n in g n 1983 the cause o f AIDS was unknown, but it appeared that it took only two years to destroy the immune system. There was no treatment whatsoever for the dis ease, and assuming the disease was caused by a germ, there was no way to test if a person was infect ed. Back then doctors were reduced to fighting an odd and unpredictable list o f infections to which afflicted people inevitably succumbed. During the next decade the gay male com m unity in the United States was hit especially hard, as were communities o f color, hemophiliacs and intravenous drug users. But in so-called Third World countries, such as sections o f Africa, the devastation was extraordinary. In some places entire villages were left with only babies and the elderly still living. The World Health Organization projected that by the m id-’90s, 20 million to 40 million people would be infected. For many years people got sick and died as scientists worked on what would prove to be the largest effort in world history to find what was causing this disease and a way to stop it. By 1984, scientists discovered the virus that causes HIV disease and soon developed a test for it that revolutionized our ability to cope. Blood supplies could be screened to protect millions of people— especially hemophiliacs. The use o f this test helped us to refine our understanding o f how the disease was transmitted, so attention was focused on prevention, leading to the efforts to develop— with some success— “safer sex” as a cultural norm. The test also showed that the dis ease progressed much more slowly than was orig inally thought; it seemed to take many years before the onset of symptoms. This long period o f infec tion without symptoms became known as the “latency” period. Over the next few years, progress was made toward fighting the infections characteristic of AIDS (now known as opportunistic infections), especially pneumocystis pneumonia (PCP) which was the leading cause of AIDS-related death in the U.S. Gradually, people’s lives were extended by the advent o f prevention and early treatment of opportunistic infections. I A lph a bet so u p y 1987, AZT— the first of a series of antivi rals which seemed to slow down the virus— was approved by the U.S. Food and Drug Adm inistration. O ther similar drugs, approved over the next eight years, became known by their acronyms, and soon we had an alphabet soup of antivirals— AZT, ddl, d4T, ddC, 3TC. None of these drugs seemed to work very well; all had side effects that were unpleasant, and by the early ’90s there was a cloud of gloom around those people affected in any way by HIV disease. It seemed that HIV was able to mutate around any drug that science could throw at it, so that the treat ments were only doing a little good for a limited amount o f time. In fact many people preferred to just cope with the illness without therapy, or turned to alternative medicine because the limited benefit from the drugs was not worth the side effects that B L ook H ow F ar W e ’ ve C ome by The Boston AIDS Writers Group be eleven. All of these dmgs are important in the fight against HIV because people respond to thera py in different ways and need a variety of options from which to choose. For many, the days of suf fering through severe side-effects or not using antivirals at all are past. For others, a safe and effective treatment regimen is yet to be found. However, most people can now choose the dmgs that are best for them, and side-effects are now usu ally manageable, or at least tolerable, given the potential health benefits. Another advantage inherent to the variety of antivirals available is that each works in a different way. One category of antivirals, called “nucleoside analogs,” works by stopping the vims from infect ing a cell; a second group, commonly referred to as “non-nucleoside reverse transcriptase inhibitors,” works in the same place in the life cycle of the vims, but has different effects. A third group, called “protease inhibitors,” has been made available most recently. These dmgs work differently from the first two by stopping the vims from reproduc ing. Attacking the vims in different ways simulta neously will make it harder for HIV to fight back. Finally, a major breakthrough occurred in 1995, when it was shown that many people with HIV who used protease inhibitors in combination with the other antivirals reduced their viral loads below the level that can be measured by the current tech nology, and they have kept them down for 18 months so far. There is even new evidence that people who have never used any antivirals can use certain combinations o f three dmgs to achieve the same effect without using protease inhibitors. This is exciting because now research can be directed toward finding the best triple combinations of antivirals to fight HIV. Furthermore, the discovery and commercial manufacturing of viral load tests (the first was approved recently by the FDA) makes it possible to decide on a person-by-person basis when antivi ral therapy is necessary, if it is working, and, if not, when to switch therapies. Viral load tests make it possible to decide which combinations of antivirals are working for an individual, making manage ment of the illness on a case-by-case basis a realis tic option. R e v e l a t io n s his year we have confidence that HIV dis ease can be defined as a chronic rather (Ran fatal illness— many scientists and doctors believe that the disease is manageable with the available antivirals. But there may be even more exciting news ahead. In some babies who have had viral load suppressed to below detectable levels there are indications that their immune systems might be returning to normal. This might well mean that there is simply no vims left. Unfortunately, there has been less to report on other therapies that could directly rebuild damaged immune systems. This is due in part to the fact that these immune-based therapies have had a compar atively small amount of resources directed toward them and a far more difficult time on the regulato ry level than dmg company products. Immune- based therapies may be the only hope for repairing the damaged immune systems of people with more advanced HIV disease, and they offer a totally dif ferent approach for fighting the vims. For example, IL-2, a substance naturally produced by the body, when given as therapy can elevate T-cell levels o f people with more advanced HIV back up to normal levels. However, this therapy, like other immune- based therapies, has not been studied with the aggression and the finances characteristic of the development of antivirals. As a result, there are no long-term studies that would determine whether this type of therapy actually rebuilds immune sys tems and lengthens lives. Still, the most important news is that people with HIV disease now have a future. T ing war between the immune system and the virus from the moment of infection. The body replaces cells that HIV destroys, and without treatment vir tually all immune systems will eventually lose that war. Dr. Ho helped to clarify two things that were virus (viral load) much more than when used alone, and this reduction seemed to allow for the redevelopment o f a healthier immune system. The first hint that progress was in the making was a study on a significant number o f people with This year we have confidence that HIV disease can be defined as a chronic rather than fatal illness—many scientists and doctors believe that the disease is manageable with the available antivirals. But there may be even more exciting news ahead... people with HIV disease now have a future. not well understood: why T-cell levels continued to fall during the “latency” period, and why HIV becomes resistant to drugs. First, it has been dis covered that HIV destroys slightly more T cells than are being produced, so that over time there is a gradual decline in the number o f T cells in the body. Second, the vims reproduces so rapidly that drugs that do not drastically reduce HIV are over come by viruses that are not affected by the drugs. HIV which showed that AZT used in combination with 3TC reduced viral load by over 90 percent and kept it down for 18 months. T-cell counts rose as well, indicating that the immune system was less compromised, and it slowly became clear that indeed lowering the amount of vims was the key to controlling the illness. There are now nine approved antiviral dmgs, and we expect that by the end of the year there will The Boston AIDS Writers Group is Robert Folan and Lou Pesce o f A C T UP-Boston; and David Scondras, Zareen Kapadia, Robert Krebs, Derek Libby and Larry Bresslour o f Search For A Cure.