The war against HIV in sanctuary sites--places where the virus might hide from the inhibiting effects of highly active antiretroviral therapies (HAART)--was over before it was officially declared.
In 1996, virologist David Ho made a stunning announcement. At the World AIDS Conference in Vancouver, he asserted that antiretroviral therapy might cure HIV infection.
The same bad news. In a review of recent data, which by this writing seem ancient, Anthony Fauci, MD, of the National Institutes of Health reported on the factors that drive HIV replication and maintain it as a chronic infection.
The summer season in Houston is one of stillness. The air is hot and motionless and we are immobilized because the slightest movement will make us—in the words of my longtime friend, Carolyn—"glisten."
The treatment history of HIV/AIDS, at least in the mainstream of U.S. medicine, has been a rough process of piling up pills in the hopes of producing better clinical results.
In the mid-1990s, many in the HIV community thought, or at least hoped, that highly active antiretroviral therapy (HAART) could eradicate HIV. The clinical benefits of antiretrovirals were nothing short of staggering. Death and morbidity plummeted and it was not inconceivable that the drugs were powerful enough to cure.
This much is known. HIV infection almost invariably produces a relentless, if sometimes slow, decline in CD4 T cell count. That decline and other immune system abnormalities leave people with HIV vulnerable to opportunistic pathogens and tumors, which eventually cause death.
Pharmaceutical companies have made many claims regarding the virtues of their protease inhibitors and with time some of these claims have either been validated or discredited with patient experience.
Beyond CD4 T cell counts, plasma viral load testing and drug resistance monitoring, there lies yet another assay competing for the attention of HIV-infected people and their healthcare providers: therapeutic drug monitoring (TDM).
The summer and fall of 1999 would have been the first full season of eradication-a time when the faithful, the true adherents, the believers would finally be rewarded for their persistence and adroit actions.
By now those who follow HIV/AIDS know the theory of eradication of HIV like the back of their hand. Stopping ongoing HIV replication with highly active antiretroviral therapies would result in a quick and steep decline in productively infected CD4 T cells.
When confronted with an invading pathogen, the human immune system usually responds with precision and power, and the infection is either cleared or at least controlled.
Amprenavir brand Agenerase (ah-GEN-er-ase) received accelerated approval from the U.S. Food and Drug Administration (FDA) on April 16, 1999, making it the sixteenth agent licensed for the treatment of HIV infection.
Culture Club's Karma Chameleon was #1, Cabbage Patch Kids were the best selling toy, and The Multicenter AIDS Cohort (MACS) Study began -- what year was it?; Ritonavir (Norvir): liquid or capsule; Weight gain--cosmetic or life saving....
Our article "Further Reduction of Vertical Transmission with the Use of Elective Cesarean Section" (RITA!, 5:1, p. 16, 1999) reviewed the data presented in an article that was published in The New England Journal of Medicine regarding the use of elective cesarean delivery as a method of further reducing the risk of transmission from mother to child.
I often tell my friends that many of the major decisions in my life have been made through a process that resembles the act of falling down the stairs. First, I am at the top of the stairs then suddenly I am somewhere else.
Since early in the AIDS epidemic immunologists and virologists have been involved in what seemed like a competitive race to find a way to control and perhaps eradicate HIV. With the advent of protease inhibitors and highly active antiretroviral therapy (HAART) it seemed that virologists had gotten an upper hand.
On December 18, 1998, the U.S. Food and Drug Administration approved the 15th agent for the treatment of HIV infection. Abacavir (uh-BACK-ah-veer) sulfate, brand named Ziagen (z-EYE-uh-jen), received accelerated approval based on data from three short-term Phase III studies.
HIV's ability to survive and thrive depends entirely on its ability to penetrate and use the mechanism of a human cell. Given that scientists estimate of the rate of viral replication to be in the vicinity of 10 billion particles per day, it is natural to assume that entering a cell is a walk in the park for the motivated virus.
Since 1996, clinicians have treated HIV-infected patients with combination antiretroviral therapy, which can produce dramatic reductions in viral load and striking improvements in clinical outcome. Investigators have shown that antiviral treatment can also mitigate or even reverse some of the immune deficiency . . . .
AIDS has generally been associated with body changes. Designations of "slim disease" and "HIV wasting" have been constant reminders of the dramatic, often devastating changes that can occur. Often "looking like one has AIDS" is as demoralizing a pronouncement as the initial diagnosis of HIV infection.
Almost perfect; Who has HAART?; Latent but not blatant; Combination therapy in vertical transmission: 2 infants die; What is in your semen?; What fails first?; Drug naïve, drug resistant . . . .
Late failures; Renal atrophy; Protease inhibitors and pregnancy; Spit it out; More saliva news; Starving the virus; Indinavir (Crixivan): new packaging and strength; Ultrasensitive viral load test approved; . . . .
The extraordinary pace at which HIV/AIDS treatment and research evolve makes it a daunting field with which to keep pace. Just as we are getting comfortable with a theory of how the virus causes disease, another researcher presents a case for a different mechanism.
Infectious diseases—like AIDS—cause tremendous human suffering and impose enormous financial burdens on society. It therefore makes sense, whenever possible, to prevent disease rather than treat it.
The University of Texas Medical Branch (UTMB) is the first and only site in Texas to test a new vaccine to prevent acquisition of the human immunodeficiency virus (HIV), the virus that causes AIDS. With thousands of people acquiring HIV every day, the need for such a vaccine is great.
The title of this article, "Vaccine to Prevent AIDS," like the vaccine that it promotes, offers way too much promise. The vaccine, as designed, is highly unlikely to prevent AIDS transmission. Vaccines by their nature must induce an appropriate and sufficient response capable of providing protective immunity.
A recent article in The New England Journal of Medicine ("Abbreviated Regimens of Zidovudine Prophylaxis and Perinatal Transmission of the Human Immunodeficiency Virus," 329:211, 1409-1414), outlines the results of a retrospective chart review of obstetrical cases in the New York State area.
In an article entitled "The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1—A Meta-Analysis of 15 Prospective Cohort Studies" (NEJM Online), the authors report on evidence showing that elective cesarean sections reduce the risk of transmission of HIV-1 from mother to child, independent of the effects of treatment with zidovudine (Retrovir).
Testing of Nutritional Supplement for Wasting; Changes in Body Shape and Metabolic Abnormalities; Sanctioned Drug Holidays = Remission?; Discontinuing Prophylaxis for PCP . . . .
This information is designed to support, not replace, the relationship that exists between you and your doctor.