What is in the future for HIV-infected individuals and for those at risk to contract HIV?
Trends continue towards simplifying drug regimens to improve adherence and decrease side effects. In addition, many new drugs are being developed. These new drugs are in both the currently available classes of anti-HIV medications as well as in new classes of drugs, such as those that block the virus from entering cells or from incorporating itself into the human genetic material. Both of these actions prevent the virus from duplicating itself, thereby inhibiting an increase in the viral load. Perhaps even more importantly, researchers are attempting to enhance the body's natural defenses against HIV in order to control viral growth. An example of this approach is the use of an HIV vaccine, with or without antiviral therapy. Also, innovative studies are underway to try to purge or eliminate the HIV from the body. The rationale for purging is to allow for the withdrawal of therapy without a rebound increase in the number of viral particles in the blood. For example, drugs have been developed to stimulate HIV-infected CD4 cells, which then would be expected to undergo viral or immune self-destruction. Although all of this research is exciting and promising, the reality is that in the near future, patients will need to remain on antiviral therapy.
The good news is that the development of antiviral therapy has led to a marked decline in AIDS-related deaths in many parts of the world. The majority of infected individuals, however, do not have access to the expensive antiviral medications. Accordingly, the best hope for limiting the current epidemic of HIV around the world remains an effective vaccine. Unfortunately, despite increasing research in this area, the development of a vaccine continues to lag far behind the progress that has been made in antiviral therapy.
HIV At A Glance
- The human immunodeficiency virus (HIV) is a type of virus called a retrovirus, which infects humans when it comes in contact with tissues such as those that line the vagina, anal area, mouth, or eyes, or through a break in the skin.
- HIV infection is generally a slowly progressive disease in which the virus is present throughout the body at all stages of the disease.
- Three stages of HIV infection have been described.
- The initial stage of infection (primary infection), which occurs within weeks of acquiring the virus, and often is characterized by a "flu-" or "mono-"like illness that generally resolves within weeks.
- The stage of chronic asymptomatic infection (meaning a long duration of infection without symptoms) which lasts an average of 8 to10 years.
- The stage of symptomatic infection, in which the body's immune (or defense) system has been suppressed and complications have developed. This stage is called the acquired immunodeficiency syndrome (AIDS). The symptoms are caused by the complications of AIDS, which include one or more unusual infections or cancers, severe loss of weight, and intellectual deterioration (called dementia).
- When HIV grows (that is, by reproducing itself), it acquires the ability to change (mutate) its own structure. This mutation enables the virus to become resistant to previously effective drug therapy.
- The goals of drug therapy are to prevent damage to the immune system by the HIV virus and to halt or delay the progress of the infection to symptomatic disease.
- Therapy for HIV includes combinations of drugs that decrease the growth of the virus to such an extent that the treatment prevents or markedly delays the development of viral resistance to the drugs.
- The best combination of drugs for HIV has not yet been defined, but one of the most important factors is that the combination be well tolerated so that it can be followed consistently without missing doses.
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