Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Reuters NewMedia, Inc. - 11 July 1996
Sarah Edmonds

Participants at this week's 11th International Conference on AIDS said the triple drug "cocktails" -- which can require patients to take numerous pills several times a day -- may be both too expensive and too complex for key AIDS risk groups such as drug abusers and homeless people.

"It goes without saying that if you don't know where your next meal is coming from, taking your next pill becomes very secondary," said Dr. Mervyn Silverman, former head of the American Foundation for AIDS Research.

The new therapies, which in some initial studies have cut HIV to below detectable levels in patients' blood, have created a mood of optimism in Vancouver, with specialists saying AIDS may now be considered a treatable disease.

But what frightens the medical community now is that sporadic or incomplete attempts at this kind of drug therapy could quickly turn the promise of the new "cocktails" into a curse, creating a new version of the AIDS virus invulnerable to treatment.

"Are we going to see the emergence of a multi-drug resistant virus and go back to where we were in the 1980s where we had to just wring our hands because we could do nothing?" asked Dr. Marcus Conant, head of the Conant Medical Group, a private clinic for HIV treatment in San Francisco.

"You take a group of people, many of whom have never held down a job, have probably never finished school because they are not compulsive enough to get up at a certain time every morning and you expect them to follow this kind of complex drug regimen?" he asked.

Even a short lapse in drug treatment can allow the viral fire, which can now be doused by drug treatment, to rage anew, researchers say. And the new versions of the virus produced could mutate and become invulnerable to multi-drug therapy.

This resistant strain is likely to be transmissable from one HIV sufferer to another -- creating a new public health nightmare.

There are studies which show that HIV resistant to AZT, the main drug so far perscribed for AIDS, can be passed between people and researchers believe it is very likely that a strain resistant to the new therapy could be transmissable as well.

Because the much-touted drug cocktails, that involve AZT, the drug 3TC and a protease inhibitor, make sufferers feel better very quickly, the less-disciplined are likely to regard further treatment as unnecessary.

"The anecdotal stories are incredible (about the drugs' impact) -- people getting out of the grave and working out," said Silverman.

Some specialists in Vancouver have suggested that the new therapies should be accompanied by "team" care involving clinicians, social workers and others to make sure that the programme is followed completely.

But Conant questions whether drugs should be given to people who might not follow through.

"I think this arises as a real issue -- should these drugs be given to people who are not compliant (with treatment)? Is society, which is now paying for these drugs, able to withold drugs from those who will not take them?" Conant said.

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