New and Improved AIDS Treatments Bring Hope, But at a Cost
Although "things today are better than ever" for those living with HIV, there remains an "undercurrent of fear" among patients who will be part of "human [drug] experimentation" for the rest of their lives, according to the current issue of U.S. News & World Report. "AIDS is a different disease in 2001" than it was in the early 1990s, John Bartlett, chief of the division of infectious diseases at Johns Hopkins School of Medicine, said. He called the last two decades of development "one of the most dramatic changes ... ever seen with an infection." Prior to the introduction of protease inhibitors, which block the virus from being released from infected cells, patients died within months or a few years of being diagnosed with AIDS. After the introduction of protease inhibitors in 1995, AIDS-related deaths for the first time declined by 25% in 1996 and have continued to fall, as drug therapies are improved and refined.
History Repeats Itself
However, many people living with HIV/AIDS today were not yet born during or "scarcely aware" of the "terrifying and highly visible slaughter" that accompanied the epidemic when it surfaced in 1981. Although the "transformation of the world's latest plague in America is nothing short of miraculous ... hope itself has a cost," U.S. News & World Report reports. Falling mortality rates have led many to no longer view HIV as a "death sentence," and HIV infection rates have "held steady." A 1999 study of 416 gay men found that "the more optimistic they were about new [HIV/AIDS] treatments, the less likely they were to practice safe sex." The CDC reports that the rate of STDs is rising among "some teenagers," a signal that they are taking "sexual risks" as if "it were still that more forgiving sexual time before 1980." In addition, HIV educators report that young people often assume that people like Magic Johnson, who is HIV-positive but has no detectable virus in his bloodstream, have been cured.
Side Effects 'Out of Nowhere'
Although the drugs prolong life and are easier to take than the older therapies that sometimes required waking up in the middle of the night to take pills, today's drug therapies are "more like cancer treatments than allergy or blood pressure pills: toxic substances that attack the body even as they keep the disease in check," U.S. News reports. Long term consequences of the drugs are "unknown," but "early indications are unsettling." Apparent drug side effects, like lipodystrophy, the redistribution of fat deposits in the body, and osteonecrosis, a "crippling" bone disease, appear "out of nowhere." More typical side effects of the drugs range from "chronic diarrhea" and nausea to "chronic nightmares" and disorientation. U.S. News also reports that there has been an increase in the number of patients who develop diabetes and dementia, "leading to fears that although the new drugs protect the body, they do not protect the mind." Patients must abide by the "scrupulous" drug regimens despite side effects, because the failure to take "even a pill or two a month" can open the door to resistance and viral mutation. According to Kenneth Mayer, medical director of research and evaluation at Fenway Community Health, "the virus is still smarter than we are" (Brink, U.S. News & World Report, 1/29).