Newsday - March 3, 1999
Laurie Garrett - Staff Writer

If you are under 18 years old, you are growing up in the Age of AIDS, and it is likely that the epidemic will still be a world crisis when you have your own children. And then you will have to pass on to your youngsters the same health warnings about AIDS that, hopefully, you now get from your parents and teachers.

Today, according to the United Nations AIDS Programme based in Geneva, Switzerland, there are more than 33 million people living with HIV infection. At least 90 percent of them live in the poorest countries, where no one can afford the drugs that HIV patients here in the United States take. In African countries such as Tanzania, Uganda, Zimbabwe and Zambia, more than a third of all adults -- both men and women -- are infected with HIV right now, and UNAIDS predicts that the virus will continue to afflict those societies at that horrendous level for at least another decade, possibly well into the middle of the 21st Century.

AIDS Time Bomb in China and India

The real time bombs for the future are the world's most populous nations, China and India, each of which have about one billion citizens. HIV is now spreading rapidly in those countries, and because of their huge populations, even a fraction of the infection seen in Africa would be devastating. For example, if by 2010 just 2 percent of the Indian population is HIV infected, that would mean 20 million people. UNAIDS thinks that about 2 million Indians are already infected, and the virus is spreading rapidly in that country, primarily through heterosexual activities.

For most of the world, drugs to treat HIV disease are completely unaffordable. In most of sub-Saharan Africa, for example, less than $5 is spent on all health care needs per person each year. Many HIV drugs cost more than $5 per pill. Some cost more than $15 per pill for medicines one must take three times a day. Do the math: that's $315 per week for just one of several drugs patients in the United States typically take.

Two-and-a-half years ago the treatment of HIV disease in wealthy regions -- the United States, Canada, Europe and Japan -- was revolutionized by Highly Active Antiretroviral Therapy, or HAART. By taking cocktails of three or more powerful anti-HIV drugs every day, patients have successfully blocked the virus' reproduction so well that no HIVs can be detected in their blood. This doesn't work well for all HIV patients, but perhaps 40 to 50 percent of people who started HAART a year ago have succeeded in suppressing the virus in their blood.

Side Effects of Therapy

One of the keys to success is taking the drugs exactly as prescribed, never missing a dose and never taking extra pills to compensate for failing to take ones the previous day. This is very hard to do, and most patients in surveys admit that for one reason or another they do miss doses.

The drugs have side effects, and can be very toxic to some patients. One of the strangest sets of side effects involve changes in the way the body uses and stores fat. This results in such things as loss of body fat from the face, arms and legs; build-up of fat in the trunk and neck; diabetes, and soaring cholesterol counts. The latter raises fears of future heart diseases among HAART patients.

The longer people take HAART, the greater the likelihood they will fail the therapy, either because the drug toxicities become unbearable or because mutant, drug-resistant HIVs grow in their bodies and overwhelm them, causing AIDS.

The key limitation of HAART seems to be that even in the most successfully treated patients, HIV is never completely destroyed. It may not be in the person's blood, but hides somewhere else in the body, living inside human cells where the immune system cannot see and destroy the viruses. And all the while the virus quietly makes copies of itself, mutating to become resistant to the patient's drugs.

New Drug-Resistant Strains of HIV

Increasingly these drug-resistant strains of HIV are being passed from one person to another. In such cases the newly infected individual is already at a terrible disadvantage, and may have a virus that is untreatable. Such a thing occurred last year to a baby girl born in Alabama whose mother passed a multidrug resistant HIV strain to her during pregnancy.

New surveys in the United States indicate that between 9 to 11 percent of all new HIV infections involve drug-resistant strains of the virus.

Taken together, these disturbing findings underscore the desperate need for an AIDS vaccine. Today half of the National Institute for Health's $1.8 billion AIDS research budget is being spent, directly or indirectly, on vaccine research. And several companies and private charities are funding vaccine efforts.

Unfortunately, no promising AIDS vaccine has yet been discovered, making it highly unlikely that an effective immunization will be available until you are grown up and have children of your own.
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Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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