Treatments Keep Improving HIV+ Health

Far from the death sentence it once was, HIV is now considered a manageable condition for patients who see a doctor regularly to monitor their immune system and adhere to a prescribed drug regimen. There are now more than 30 approved drugs, with even more in the pipeline.

Together, these new and improved treatments are available to lengthen the life span and improve the quality of life, of people with HIV. As the Centers for Disease Control reports, "The number of people living with AIDS is increasing, as effective new drug therapies keep HIV-infected persons healthy longer and dramatically reduce the death rate."

"I've been HIV positive since we watched the news and went to town halls hoping for the very first treatment, not the fortieth," said blogger Mark S. King, who was diagnosed in 1985.

The biggest advance in the treatment of HIV came in 1995, when David Ho, a researcher at the Aaron Diamond AIDS Research Center in New York, discovered the antiretroviral therapy (ART) known as the HIV drug cocktail. ART prevents the virus from replicating. ART affects the virus at a different point in its life cycle.

Most patients take three different antiretroviral drugs from two different classes to keep their HIV under control. Since no single drug can effectively combat HIV and protect an infected individual's immune system, taking three complementary drugs reduces the risk of developing drug resistance.

Patients found themselves having to keep track of several different drugs taken throughout the day, which resulted in carrying around those drug packets along with a reminder that went off at odd times. The biggest advances in the cocktail are "fixed-dose combinations," which combine meds from different classes into a single pill.

"Many people can be treated with one or two pills a day with very few side effects," said Dr. Joel Gallant, chair of the HIV Medicine Association. Now, he added, "It's much easier to treat someone almost from the moment they test positive."

People with HIV often have to take drugs to prevent the meds' side effects, however, which vary from dizziness, headaches and nausea to potentially life-threatening anemia and potentially serious rashes. Now that the cocktail is over 15 years old, long-term side effects have been appearing, such as insulin resistance, an alarming rise of "bad" cholesterol or triglycerides, decreasing bone density, and the buildup of cellular waste product lactate known as lactic acidosis.

A lot of people become so aggravated at the side effects that they would rather discontinue treatment and take their chances. So finding the right combination of drugs with minimal side effects has become one of the major goals of current research. One solution has been periodic treatment "holidays" when the viral load is low.

Thanks to the protests of pioneering groups like ACT-UP and the Treatment Action Group, the Food and Drug Administration was forced to undergo serious self-examination about its moral responsibility in withholding drugs that show potential because of its lengthy review process. Since the 1980s, the FDA has accelerated its approval process -- to the benefit of anyone living with a live-threatening condition.

That said, pozzers shouldn't ignore participating in clinical trials, which gives them early access to experimental treatments and medications not yet available to the general public, often for free (and sometimes even getting a small payment). Another side benefit is that such trials are usually conducted by leading experts at some of the nation's finest medical facilities. And there's the knowledge that you're benefiting others. Clinical study participants should be aware, however, that they may be getting a placebo, which is necessary to determine a drug's effectiveness.

Perhaps the biggest advance in HIV treatment may have nothing to do with meds: the sea change in the way medical personnel look at people with HIV. We've come a long way since patients were confronted with doctors and nurses dressed in Hazmat suits and being held in isolation units. Finding sympathetic medical facilities can affect have nearly as tangible impact on pozzers' health and the meds they're prescribing.

"In the healthcare setting, having HIV has become a lot less stigmatized," said Jeff Lubsen, organizer of the LGBTQUA Healthcare Guild for Sexual and Gender Minorities. "We're seeing an increase in cultural competency with healthcare providers starting to understand LGBT communities. That helps providers put a real face to the issue, rather than just a number, and because of that patients are getting better care, better follow-up and management."

Generally widespread acceptance of HIV among health practitioners, however, comes with its own set of problems. One of the biggest liabilities of the "mainstreaming of people into primary care clinics," Gallant said, "is that medical personnel that may not have experience in HIV care. People need to know how to advocate for themselves to make sure they're getting care from someone with expertise."

There's only so much even the most sympathetic healthcare provider can do, however, if the patient has a lousy attitude. Living with HIV requires a lot of attention to sometimes messy details and always being aware of signals from your own body.

"Some people have the mistaken notion that HIV treatment has gotten so simple that anyone can do it," Gallant said. "I mean, how hard is it to prescribe one pill a day? But there are a lot of issues involved that really do require expertise: dealing with drug complications, drug toxicity, other health problems."

One of the most dramatic developments in HIV research happened two years ago, when the HIV Prevention Trials Network study showed that early treatment with the drug cocktail virtually eliminated the risk of transmission to partners. The results, however, shouldn't be seen as a welcome mat for not practicing safer sex. For one thing, the study concluded that this happened 96 percent of the time -- which means that unprotected sex could result in infection in one of every 25 partners. More importantly, the study only involved male-female couples, not same-sex partners.

Still, the study is a giant step towards the day when meds will finally eliminate HIV transmission all together. It also signals the way researchers are expanding research from the effect of meds on pozzers to their sex partners. "Historically, there's been a separation between people working in prevention and treatment," Gallant said, "but really they're the same. Those two camps need to work together."

This story is part of our special report: "Ask the Doc: Special HIV Edition". Want to read more? Here's the full list.

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