San Francisco Chronicle; Friday, March 6, 1998
David Perlman

Few authors writing about AIDS have been as effective as Dr. David Senechek in explaining for lay readers the nature of the disease-causing virus, the insidious way it destroys the human immune system and the remarkable new drugs that can apparently bring the virus to a standstill and even return many patients to vigorous health.

Senechek, a San Francisco physician in private practice, subtitles his book "A Guide to Aggressive Medical Therapy for People with HIV Infection." But it is much more than that. With exceptionally clear illustrations by Jeanne Kolling, Senechek describes the devastating toll of the epidemic's spread around the world, the intricate structure of the insidious AIDS retrovirus HIV and the pathways within the body's defensive cells that the virus exploits to infect and kill.

In great detail, Senechek explains how AIDS medicines work and describes the revolutionary compounds known as protease inhibitors that can lower the load of the AIDS virus in the bloodstream to undetectable levels.

There is yet no cure for AIDS, of course, but by clearing 90 to 95 percent of HIV from the bodies of patients through aggressive treatment with the proper combinations of drugs, Senechek maintains that patients can enter remission. AIDS, he contends, can become a chronic but manageable condition.

The successful approach to therapy that Senechek prescribes involves destroying the ability of the virus to reproduce by using a protease inhibitor combined with two of the older antiviral drugs that work differently against HIV's reproduc tive machinery. He even prescribes four-drug combinations for the most stubborn cases.

Perhaps the most useful statement in this book, however, is the first note of caution Senechek offers: "Proper diagnosis and treatment can only be performed by a qualified physician," he writes.

But which physician? Here Senechek will find strong arguments from many doctors who treat AIDS patients, for his book purports also to give detailed instructions to less experienced practitioners. Designing a single book for medical as well as lay readers does not seem fully helpful to either.

For example, in a single table, Senechek offers a list of 18 combinations of "available triple therapies in order of effectiveness & safety." He cites no reference or authority for the list, and doctors will rightly demand to know the source and significance of his data. At the same time, patients already on one of the combinations may well become worried if their combination stands lower than others on Senechek's list. He does not mention that individual AIDS patients may need varying drug combinations.

Many physicians will also object strongly to Senechek's declaration that oncologists should not be in charge of treating AIDS patients. Considering the important role that many oncologists play, Senechek's accusation that oncologists have had "a paralytic effect on the development of treatment guidelines for HIV infection" seems gratuitous and unwarranted.

As for the future, Senechek is optimistic: "Given our current knowledge of HIV, and the current state of technology," he writes, "it is likely that a fully funded project involving America's best scientists could produce a cure for those infected and a vaccine against further spread of HIV within five years, which would ultimately mean the end of the most deadly world epidemic of our era."

Five years is a very short time, and we can only hope that Senechek is right.

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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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