Since the early 1980s researchers have been hard at work searching for a cure for a cure for HIV and AIDS. Even though a cure for AIDS may be many years away there have been major advancements in the treatment of HIV. Throughout the years researchers have been successful in identifying the cells that HIV attaches itself to when it enters the body. With their efforts researchers have developed such drugs as AZT. Zidovudine, or AZT is an anti-viral drug that stops the ability of reverse transcriptase. AZT and other drugs in combination form a therapy known as HAART. HAART, highly active antiretroviral therapies, has been able to successfully drop HIV below detectable levels and has given hope to many individuals living with HIV. Although the outlook on these drugs is promising they still have many drawbacks. The demands of these drugs pose very challenging psychological demands. Effectiveness of HAART requires strict adherence to drug regimens that individuals often neglect. Many individuals have to change their lifestyles in order to adhere to these regimens. Non-compliance with these regimens can often result in drug-restitant strains of HIV.
Today's best form of treatment of HIV and AIDS is HAART. HAART can vary but usually consists of two nucleoside analogues and a protease inhibitor. The first category of drugs, nucleoside analogues, help inhibit reverse transcriptase, an enzyme that is essential to HIV replication (Appendix 1, Figure 4). Among the drugs in this category are: zalcitabine, didanosine, stavudine, lamivudine, and the most widely used drug, AZT (Appendix 1, Figure 1). The second category of drugs, protease inhibitors, also work to disrupt the replication cycle. Protease inhibitors work to block the protease enzyme and without this enzyme replication becomes incomplete (Appendix 1, Figure4). The current available protease inhibitors are: indinavir, nelfinavir, ritonavir, and saquinavir (Appendix 1, Figure 1). Combining these two categories into one regimen provides the user with a greater chance of success. The initial results of HAART can be very promising. Within weeks viral loads usually show a considerable decline and after a few months viral loads may reach undetectable levels (Bartlett and Moore, 1998). This type of success can help an HIV infected person lead a longer and healthier life.
These current drug regimens have given many HIV infected individuals hope for the future, but they also have many drawbacks and side effects that can be potentially dangerous. HAART, for example, consists of as many as twenty pills per day. ìThe complicated regimens required of HAART contribute to potential treatment non-adherence. Optimal therapeutic effects of indinavir, for example, require that the drug be taken every 8 hours, not simply three times a day. Indinavir must also be taken on an empty stomach, at least 2 hours after and 1 hour before meals.î(Kalichman, Ostrow, and Ramachandran, 1998) This is only an example of one of the drugs that HAART consists of. There are also two more drugs in HAART that each have their own specific regimens. Timing these drugs around meals can often be troublesome for most patients. Many people lead very inconsistent lives making it impossible to follow these regimens. Sometimes patients become convinced that their regimes arenít helping so they neglect or even sometimes discontinue usage. ìAs many as one third of people taking AZT discontinue it use altogether, and an additional one third of persons intentionally alter their prescribed dosing.
People who refuse to take antiretroviral medications commonly state that they believe the drugs are ineffective and toxic (Kalichman, Ostrow, and Ramachandran, 1998) All of the drugs in HAART have reported some very severe side effects such as: nausea, diarrhea, anemia, vomiting, and blurred vision (Appendix 1, Figure 1). People will often times alter their dosages to try and avoid some of these side effects. Even though these regimens are complicated and can have severe side effects they are ultimately beneficial to the patients health. Patients who neglect to adhere to these drugs are unknowingly putting their bodies at an even greater risk. For whatever reasons patients have for missing dosages, the consequences may be disastrous. Current anti-HIV drugs, or antiretrovirals, bind to specific HIV enzymes and impede their activity. Gene mutations can alter these HIV enzymes in ways that diminish this binding or otherwise undermine the pharmaceutical attack (Richman, 1998). These altered HIV enzymes eventually create strains of HIV that are resistant to drug therapy. Once the patient develops a resistance to drug therapy the medication then becomes useless. Not only will resistance effect the drugs they are currently using, but it will also make other variations of similar drugs useless. Once resistance sets in, the patient cannot ëstart freshí with the same plan; it will not work. Regrettably, incomplete adherence to treatment plans accounts for about half of treatment failures (Bartlett, 1998). The creation of drug resistant strains is not only dangerous to the patient, but can also be transmitted to other individuals. There have been cases reported of infected individuals with no history of drug therapy that were resistant to all of the current drugs. When this phenomenon was further studied it was discovered that the patients partners had been treated with anti-HIV drugs and had developed drug resistant strains of HIV that were sexually transmitted to their partners. (Stephenson, 1998) These cases have not been widely reported but it does pose a potential problem and stresses the importance of strict adherence to drug regimens.
Even though a cure for HIV and AIDS may be many years away, the current drugs on the market can be very successful in slowing the progress of HIV and the onset of AIDS. These drugs require strict adherence to dosages which many patients are unaware or uncapable of doing. Doctors need to make users of these drugs more aware of the consequences of misuse. Follow-ups need to be implemented with patients so that their progress can be closely monitored (Appendix 2). Until simpler treatment regimens or possibly a cure is found these drugs need strict adherence. Creating additional strains of HIV will only lengthen the already costly process of finding a cure.
References
Kalichman, S., Ostrow D., Ramachandran B. (1998) Protease Inhibitors and the New AIDS Combination Therapies: Implications for Psychological Services. Professional Psychology: Research and Practice, Vol. 29, 349-356
Bartlett, J., Moore R. (1998) Improving HIV Therapy. Scientific American July 1998, 1-14
Richman, D. (1998) How Drug Resistance Arises. Scientific American July 1998, 1-3
Kelly, J., Otto-Salaj, L, Sikkema, K., Pinkerton S., Bloom, F. Implications of HIV
Treatment Advances for Behavioral Research on AIDS: Protease Inhibitors
and New Challenges in HIV Secondary Prevention. Health Psychology
Vol. 17, 310-319