AIDS virus conquering drug cocktails

Wednesday, June 23, 1999

FOURTH OF FIVE PARTS

Promising treatments created a false sense of security that will take time to reverse.

By Ron Sylvester
News-Leader

Like thousands of others living with AIDS, Rick was hopeful in late 1995 when new drugs called protease inhibitors promised to keep the HIV inside him in check.

The 36-year-old Springfield man said he felt encouraged by his progress under the drugs for the next two years.

“Then they stopped working,” he said.

Across the nation, more and more people with HIV are finding that medical treatments are no longer effective. The number of people infected, meanwhile, continues to rise, and experts say another costly explosion in AIDS deaths may not be far behind.

“But no one really knows about it,” said Rick, who doesn’t want his full name published because of the public stigma he sees with AIDS.
He said he’s afraid it would affect his ability to finish school and find work, especially since there’s been so little public discussion about the disease’s growing ability to defeat medicine.

The highly active anti-retroviral therapies, commonly known as drug cocktails, have been helping people with HIV live longer, more productive lives. Some patients even learned that HIV levels in their blood plasma had become undetectable.

But no one knew the long-term effects of treatments that are complicated and have dangerous side effects.

In May, two studies published in the New England Journal of Medicine reported that even after patients see rapid drops in their HIV levels, the virus continues to reproduce.

Like other microorganisms facing pressure from the human immune system and an onslaught of medical treatments, viruses mutate and find ways to defend themselves.

Viruses make thousands of mutations each day. Most are fatal to the virus. But those that survive are more virulent.

“But by doing that many mutations, resistance to pressure of the drugs the person is on is going to slough off,” said Dr. Wolfe Gerecht, an infectious disease specialist and medical director of AIDS Project of the Ozarks. “And those viruses which are resistant to the drug therapy are going to emerge.”

That doesn’t even account for the pressure on patients, who can easily become overwhelmed by their required medical routines.
When Rick first began therapy, he took 45 pills five times during the day. Like many Ozarkers with HIV, he uses a paging system to help him keep track of his schedule.

“I was compulsive about it and still didn’t have great results,” Rick said.

Now every six months or so, he takes a new combination of drugs – often with drastic side effects.

“Last year, I started on one drug, and the first week my appendix burst,” he said.
Because of toxic side effects of these cocktails, many HIV patients eventually end up taking so-called drug holidays.

“I’ve had friends who have had their viral loads down to undetectable levels, then the minute they take a drug holiday – under direction of their doctor – their levels bounce right back,” Rick said.

For Rick, who has had AIDS since 1992, those levels rebound even while he’s religiously taking his medication. The availability of new drugs is rapidly dwindling.

“Right now, it looks like I’m pretty much resistant to all the protease inhibitors,” Rick said.

Reports across the country say his condition is becoming more common.

Yet some people, even in high-risk groups, are becoming less diligent about safe health practices.

“People are getting newly infected from somebody else who has been on drug therapy and failed,” Gerecht said. “So now we’re passing these drug-resistant viruses.

“And that means people will have fewer drugs available to them to begin with.”

Federal Centers for Disease Control and Prevention officials say complacency about the spread of HIV is the biggest battle that U.S. communities face.

“We’ve had clients tell us that they’re no longer infectious because their HIV levels are undetectable,” said Lynne Meyerkord, director of the AIDS Project. “We are quick to correct them. Even though the virus may be undetectable, it’s still there.”

The people who are newly infected with HIV are just as careless.

No longer viewing AIDS as a threat, they’ve resumed unprotected sex and multiple partners. They inject recreational drugs, such as methamphetamine, and share needles.

“First people heard that AIDS killed you, then no it doesn’t kill you if you just take your medicine,” said Jeanie Carver, a Springfield virus specialist.

“Well, now the medicine doesn’t work.”

As a result, the numbers of new HIV cases are again on the rise in the Ozarks, with heterosexual women contracting most of the new infections.

The AIDS Project has watched its caseload climb to an all-time high of 340 clients.

And as drug treatments falter, national reports forecast the number of deaths will again start rising by the year’s end.
“The AIDS crisis,” Meyerkord said, “isn’t over.”

Some are hoping the AIDS problem will bring public attention to the growing problem of drug resistance that’s threatening all areas of the medical profession.

“If the average person will make that leap,” Carver said, “and figure out that this is what they’re doing by not taking their medication correctly, or by sharing it with others, then HIV will have served a purpose – in a really sad and ironic way.”

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Source: National Institute of Allergy and Infectious Diseases