|
Something many of the 29,500 North Carolinians living with HIV/AIDS can look forward to these days is a longer life, thanks to significant advances in research. In the early days of the epidemic, an HIV diagnosis was essentially a death sentence. Scientists knew very little about how the disease worked in the body. The tide began turning in 1987 when the food and drug administration approved AZT, the first AIDS drug. Now there are more than 20 medicines to treat HIV, and many experts believe the new drugs have truly ushered in the new age of HIV/AIDS by allowing people to live longer with the disease. But AIDS educators say as great as they are, the drugs have also created a whole new set of problems.
"The wonderful new medications that we have that keep people living so long have also caused a kind of malaise," says Vivianne Valdes-Hurtado, who manages an HIV clinic. "Well, it's a chronic illness now, and if I take medication I'll be okay. But make no mistake, HIV and AIDS is still a killer.
Franklin County native Fred Wiggins , who has lived with AIDS for more than ten years, says he never thought he'd have HIV.
"I was the cleanest person in the world in terms of my needles and whathaveyou," he says, "and most of my sex partners. It's just, you get lazy; you get lackadaisical. You're so caught up in the moment that you forget to take those precautions."
"I think a lot of people in the 25 year old bracket, they think that you can get it, you're not going to die, it's manageable, but they don't understand the regimen you have to go through," says Milford Evans , a benefits advocate who has worked to help people living with HIV/AIDS. "They don't have a clue."
"These are my daily meds that I take for the cocktail or the virus," says Wiggins, pointing to his medications. "This is Viracept. I take this twice a day: Five in the morning, five at night. I take this twice a day, Zerit, once in the day, once at night. Same with Epivir: one in the morning, one at night."
The drugs keep his immune system functioning and keep him alive. Doctors say it's important to remember those drugs aren't perfect. They can cause fatigue, night sweats, weight loss, and other side effects. And over time, the virus can become resistant to the medicine. That's why scientists are working to develop new and better drugs. At GlaxoSmithKline, the largest HIV and AIDS drug manufacturer, doctors are trying to attack the virus's life cycle in a new way. Dr. Michelle Berrey believes that will be the key to stopping HIV. She says work is also focusing on ways to make complicated regimens easier for patients.
"Because there's so much virus in the body it's really important never to miss a single dose of medicine, so unlike some other drugs where you can probably get away with missing one or two doses in a week or a month, with HIV it's absolutely crucial to take every single dose," Dr. Berrey says. "So the easier we can make it by combining drugs into single tablets and making them once a day or twice a day, the easier we can make it for people to stay compliant."
Other researchers in the Triangle area are trying to find ways to prevent infection in the first place. Scientists at Duke University are working on a vaccine for AIDS, something that will make it just as preventable as the measles or polio. Developing the polio vaccine took decades; doctors say they're making much faster progress on HIV, but it is very difficult work.
"This is a rapidly mutating virus and the virus that you have today in a community is not the same virus one will have five years from now, so the AIDS virus is a moving target," says Dr. Bart Haynes .
Dr. Haynes heads Duke University's Human Vaccine Institute and has worked on AIDS since the early days of the epidemic. He says that notion of a "moving target" has forced researchers to look for new strategies to fight the disease.
"Because the epidemic is moving so fast, we're doing everything at once, so instead of doing one after the other we're doing them all in parallel," says Haynes.
The most promising vaccine candidates go into clinical trials, where scientists evaluate their safety and effectiveness. Duke's Dr. Kent Weinhold plays a major role in that aspect of research. It was in his lab years ago where researchers first proved the effectiveness of AZT. Today Dr. Weinhold oversees the central laboratory for the International HIV Vaccine Trials Network.
"So we direct the efforts that are aimed at measuring immune responses in these candidate AIDS vaccines," explains Dr. Weinhold. "Are they recognizing components of the vaccine, are they recognizing it in a way that we think would be beneficial ultimately toward prevention of infection or control of infection?"
He says it's tedious and sophisticated work, and it could be at least five years before researchers know if the vaccines now in development are good enough.
"On a more pessimistic timeline if we have to go back to the drawing board and develop whole new strategies then we're talking 10 to 20 years," he says.
Researchers worldwide agree they don't have that kind of time, so work is also focusing on other prevention strategies. One is microbicides.
"Microbicides are products that women can use vaginally to help prevent, or more appropriately, to reduce their risk of acquiring a sexually transmitted infection," says Dr Laneta Dorflinger, Vice President for Clinical Research at Family Health International, an organization that studies contraceptives and sexually transmitted infections. The group's lab in Research Triangle Park tests condoms, and part of Dr. Dorflinger's work involves making sure microbicides will not damage the latex. She says there are several types of microbicides in development.
"Some provide just a barrier," she says. "Some actually can kill the different STIs and HIV, and others that are targeted specifically against HIV can actually prevent its replication when it gets into cells."
Dr. Dorflinger says a microbicide could be on the market within five to seven years and have a great impact on the spread of HIV.
"Women all over the world will be able to access these products and make decisions for themselves," she says. "It's nice when you can negotiate things with your partner, but that's just not always possible, and I think it's very, very important that women have these options that they can use themselves."
|
