The Washington Blade; Friday, January 31, 1997
Lisa Keen
The concern comes most intensely with the treatments involving protease inhibitors. While this class of drugs has been credited with the greatest successes in the past year in reducing viral load and dramatically improving the health of people with AIDS, the drugs are also saddled with burdensome pill-taking regimens -- some involving strict dietary regulation. Many people with HIV on these therapies have reportedly had considerable difficulty maintaining "compliance" with these regimens. Noncompliance with the regimens has led to a resurgence in viral loads and often left the patient's virus resistant to other treatments.
But as recently as November, some AIDS experts were suggesting that they did not think it would be too dangerous for patients to miss a dose here or there. The real danger, they said then, was with patients repeatedly missing doses.
But a presentation Sunday from the Aaron Diamond AIDS Research Center reported that one patient who had been on a Ritonavir-AZT-3TC regimen which had reduced his viral load to below 500 for three months had that viral load surge back to detectable levels after missing only a few doses one week.
Cal Cohen, a physician with Boston's Community Research Initiative of New England, called the reports "chilling tales that if you miss only a few doses, the virus rapidly replicates."
MEDIA FOLLOW THE MONEY: Not surprisingly, the field of complex decisions which must be made in treating any patient with HIV -- decisions which generally have to be tailored to meet that patient's form of virus, ability to tolerate certain medications, and willingness to take on risks associated with early or later intervention -- are prompting some experts now to suggest a whole new field of medical specialty: the AIDS specialist. But even that simple suggestion, offered by Conference Cochair Douglas Richman at a press conference Thursday, was immediately greeted with anxious questions from reporters eager to calculate its financial costs. Where just a few months ago, the media seemed to focus its AIDS coverage on celebrities, now the key focus of nearly every mainstream news report on AIDS seems to be money.
When epidemiologists reported at a press conference Friday that the percentage of new AIDS cases continues to rise dramatically among young heterosexuals, African Americans, and Hispanics, the first question out of the chute from reporters was, "How much is CDC spending on prevention campaigns for these groups?"
The AIDS experts are catching on quickly. Last week's conference -- which was supposed to be devoted exclusively to clinical data -- included several presentations on how much money is being saved as a result of the success of triple-drug therapies. Among them was a report from a Los Angeles medical group which showed that a group of almost 500 people with AIDS required an average of 122 days in the hospital in 1995 but only 52 days in 1996. Another report, from St. Vincent's Hospital in New York, showed that the monthly average number of patients hospitalized for AIDS had declined from 104 per month in 1995 to 79 per month in 1996. Both reports attributed the drop to the introduction of protease inhibitor treatments. While the cost of these therapies is high, noted the reports, it appears to be offset by the subsequent declines in the use of medical resources.
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