HIV Life Expectancy Now Normal
Toronto (UPI) Aug 25, 2006
A decade ago, when a doctor diagnosed a patient with an infection caused by human immunodeficiency virus (HIV) -- the microbe responsible for AIDS -- that individual faced a bleak and short future. The disease was usually advanced, the treatments were limited and a patient's life expectancy was in the neighborhood of about two years.
"Today, I can tell my patients with HIV that they can have a normal life expectancy," said Stefano Vella, director of drug research and evaluation at the Institute Superiore di Sanita in Rome, the equivalent of the U.S. National Institutes of Health.
Of course, there are some caveats, Vella told United Press International, the chief one being that the patient has to take the prescribed medicines faithfully; another, that patients have access to treatment.
"We have so many medicines now and they are so good that we know we can keep the virus suppressed for years," said Vella, a former president of the International AIDS Society, the organization that ran last week's record-setting International AIDS Conference in Toronto, Canada.
For patients in the United States and in the rest of the world where access to the antiretroviral drugs is available, Vella said that physicians can construct potent lines of long-lasting, well-tolerated treatment.
For example, in 1998, Abbott Laboratories enrolled 100 patients in its initial major study involving the protease inhibitor lopinavir, boosted with a small dose of another protease inhibitor ritonavir. Together, the drug is prescribed as Kaletra.
Of that original group of 100 patients, 61 remain on Kaletra and 59 percent of them have HIV viral loads that cannot be detected in the blood with standard assays eight years after starting on the drug.
When the virus is suppressed to undetectable levels, researchers say, the ability of the microbe to mutate and escape the drug is limited. As long as patients stay on combination therapy that has been the mainstay of treatment since 1996, the virus is thwarted from destroying immune cells and cannot create an immunosuppressed environment from which obscure and deadly AIDS infections can arise.
"We can now have drugs that allow us to construct second, third and even fourth lines of treatment that are all capable of suppressing the virus," Vella said. "What's more, we are going to see even better drugs in just a couple of years."
"Our new treatment guidelines," said Scott Hammer, professor of medicine at Columbia University in New York, "encourage doctors to treat even the most-experienced patients with an eye to suppressing the disease."
Hammer told UPI that these patients -- subjects who have been treated with drugs since the earliest days of the AIDS epidemic -- often have virus species that have developed mutations that make many of the treatment options unusable.
However, two of the newer protease inhibitors, tripanivir and darunavir, were specifically designed to overcome the virus that have developed resistance to other antiretrovirals, he said.
Vella pointed to the impressive debut of investigational integrase inhibitors, a new class of drugs that attack an enzyme required by the virus to replicate. The integrase inhibitor MK-0518 worked as effectively as the best treatment available for individuals who have not previously received antiretroviral therapy. What's more, MK-0518 worked significantly faster in lowering virus in the blood.
The ability to hold the virus at bay for years now has doctors looking far forward in treating patients because 70 percent of patients infected with HIV will die of something other than AIDS, said Eric Daar, chief of HIV medicine at Harbor-UCLA Medical Center in Los Angeles.
Instead of just focusing on HIV levels, he said during a symposium at the conference, doctors have to tailor the medicine to the patient since 9 percent of HIV patients are now dying from heart disease. Another 15 percent die from liver disease and 8 percent die from cancer.
But with the number of drugs available, 25 are being marketed currently, Daar said clinicians can find potent combinations that suppress the virus and do not raise cholesterol or liver enzymes.
"We know the benefits of antiretrovirals far outweigh the risk of heart disease," Daar said. And he said that before getting too worried about what regimen to use to protect specific organs, doctors would be wise to have HIV patients get other risk factors under control -- including cessation of smoking.
"HIV is a chronic disease," Vella said. "If patients stay on their medicines, they will live a normal lifetime." Adherence or compliance with the regimens - one of which has now been simplified to one pill once a day - has been a problem in the past because of numbers of pills required and because all drugs have adverse side effects.
Doctors and patients have been seeking drug treatments that lessen the number of drugs involved in these regimens in experimental programs.
"These regimens may look good," said Mark Wainberg, director of the McGill University AIDS Research Center, "but they are not ready for prime time."
Source: United Press International
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