Stamp it out: Potent drug therapies can now give hope to patients with a history of failed treatments

Twenty-five years after the modern world discovered its deadliest endemic — AIDS — doctors from across the world framed new HIV treatment guidelines last month based on potent drug therapies that can suppress the causative virus to barely discernible levels.

These therapies are a cocktail of drugs that can transform HIV from a killer virus to one triggering a manageable but chronic disorder. The new therapies will work even on those who have given up hope on all other regimens, according to the recommendations released by the 16 th International AIDS Conference in Toronto during mid-August. Though the guidelines reflect very minor changes from the 2004 recommendations of the global body of AIDS physicians, one major departure from past years is that it provides many more options to patients for whom one or more drug regimens have stopped working.

For AIDS patients who have stopped looking forward to life after repeated failed treatments, this combination of drugs aims at driving the virus to undetectable levels in their body systems. This means bringing down the virus to less than 50 copies per millilitre of blood, says head of the recommendation panel Scott M Hammer, chief of the infectious diseases division at Columbia University College of Physicians and Surgeons, New York.

According to the new regime recommended for treatment of AIDS globally, two or three new anti-HIV drugs will be introduced, following increasing medical evidence that success of treatment does depend on new agents. This brings the number of anti-HIV drugs available to about 22 in five different drug classes. Incidentally, 2006 also marks the 10th anniversary of what doctors call highly active anti-retroviral therapy, or HAART, drug combinations credited with changing HIV from a death sentence to a chronic manageable disorder, something like diabetes.

Since the last guidelines, two new types of protease inhibitors — Aptivus and Prezista — have been approved by the US Food and Drug Administration alongside continued refinement of older drug regimens.

However, there is a need for a commitment to vaccine development, feels Dr Jim Young Kim, chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital, Boston. The success of antiretroviral therapy in recent years has proved to be well founded, he says. “In the United States, such therapy has prolonged life by an estimated 13 years.”

The new recommendations also called for initiating antiviral therapy in any person who develops symptoms of AIDS or whose CD4 cell count goes below 200 cells per microlitre. The number of CD4 T-cells measures the damage done by HIV to the immune system. The lower the CD4 cell count, the more susceptible a person is to infections. The doctors also observed that the therapy should be considered for persons without symptoms but with CD4 counts between 200 to 350 cells per microlitre.

Emphasis was laid on starting treatment earlier and increasing the strength of therapy as the CD4 count drops. AIDS treatment will continue to focus on starting people newly infected with HIV on a three-drug cocktail of the oldest class of HIV drugs — the nucleoside reverse transcriptase inhibitors — combined with either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. After treatment starts, a little less monitoring was advocated. People should not get psychotic to find out if their drugs are suppressing the virus. HIV blood levels should be checked every four to eight weeks until the virus is undetectable and then three to four times a year.