The Bay Area Reporter - March 13, 1998
Phillip Alden

Almost every American has been affected to one degree or another by the AIDS crisis, and antiretroviral drugs have changed the way people look at this disease There has been a price paid for these gains, though. The drugs used to treat HIV are incredibly toxic, a fact often overlooked by the mainstream media. Side effects of HAART Therapy range from mild nausea and headaches to kidney stones and renal failure. People in the full-time workplace while on HAART Therapy are often ill from stomach problems and headaches while trying to juggle their workload, demanding drug-taking schedules, and personal lives.

The drugs take their toll on the mind as well: the general chemistry of HAART patients may contribute to emotional conditions like depression and anxiety, a common side effect of living with HIV/AIDS and other life-threatening diseases. (Fortunately, both old and new ways of treating side effects have greatly helped HAART patients.)

All is not well in the land of HAART therapy, though. In the December 1997-January 1998 issue of the Gay Men's Health Crisis Treatment Issues newsletter, the cover article written by journalist Dave Gilden reports that "...18 months of maximally suppressing HIV does not eradicate the virus." The article goes on to report of the increasing incidence of treatment "failure," with viral loads rising above the 50 copies/ml that the newest assay can detect (most people are tested at 5,000 copies/ml in general treatment).

The evidence of eventual HAART Therapy failure has been building for quite some time, although only AIDS activists, the scientific community, and others with their ear to the ground have heard and disseminated the research papers and medical journals about multi-drug failure until recently. This news is disturbing to those who follow HIV/AIDS clinical studies, and frightening for those who have been on multi-drug therapy for the last two years.

The amount of time that an individual has been on multi-drug therapy appears to play a crucial role in treatment failure. An individual who started HAART therapy over two years ago and who had also been on AZT monotherapy before that time, now appears to have a greater chance of drug failure.

More threatening, however, is increasing drug failure leading to clinical disease progression and a patient who is now "cross-resistant" to most of the current AIDS drugs. Most pharmaceutical companies have new compounds that are being pushed into human trials quickly, in a what is a life-and-death race between the mutation of HIV strains in individuals (and probably in populations) and new ways of blocking viral replication.

The issue becomes more difficult because most of the new drugs coming into human trial are more and more toxic. Many people have been pushed past the normal threshold of drug toxicity already, trading a potential life-threatening condition 10 or 15 years down the road for three to five years of good health now. At the time, it seemed like a fair tradeoff: drug toxicity with good health at the moment. But HAART Therapy is its own unique addiction - the drugs you have to take two or three times a day make a you feel sick and tired instead of pleasantly detached from reality - but the payoff is another day without an opportunistic infection. Another day of "potential" life.

AIDS cases are spreading dramatically worldwide, and progression from HIV to clinical AIDS is on the increase. "Salvage Therapy" is not showing the promise that so many hoped for, but there is good news as well: John James's AIDS Treatment News, in an interview with Dr. Steven Deeks, notes that a group of patients who have experienced "virologic failure" still maintained a better CD4 count and seem to be doing better clinically.

"[P]atients we identified as having failed protease inhibitor treatment still clearly had a sustained CD4 increase," said Deeks, a leading AIDS researcher at San Francisco General Hospital. "Over the 12 to 18 months after we recorded failure, for the vast majority of patients, CD4 decrease or clinical progression did not occur." (ATN issue 289, February 20, 1998.)

For those HAART patients whose viral load is starting to creep back up, the prospect of maintaining good health for the next couple of years - while waiting for the latest options from the pharmaceutical companies - is a real ray of hope in a somewhat cloudy horizon.

Last year's magazine headlines aside, this epidemic is not over.
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Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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