BY Steve Weinstein

December 03 2009 4:45 PM ET

In the five years since he was infected with HIV, Larry Reigel has had a virtual systemic breakdown. Most recently hospitalized for epileptic attacks and severe neuropathy (nerve loss in extremities like hands and feet), he’s been sluggish, had no sexual appetite, and feels dried out. He also suffers from diarrhea, hair loss, and chronic indigestion.

“It’s all the effect of the AIDS medications,” says Reigel, who lives in Philadelphia. But even unpleasant interactions are better than going without medicine. He adds, “My doctor said I went though the gamut of HIV meds, so I’m on my last reprieve.”

Across the continent in San Francisco, Rob Rosen has been living with HIV for at least 24 years. Rosen is gay and a former drug user, and suffers from a double whammy of HIV and hepatitis C. Diagnosed in the 1980s, he was asymptomatic for years and only started taking meds in 2001. Since then, he’s watched his T cells (the white blood cells that fight HIV, counted as a general indication of how sick a patient is) go down, although his viral load (the amount of the virus in a blood sample) remains low.

“I’ve been on the protease cocktail since 2001,” he says. “I’ve begun a new regimen with Isentress, a new class of drugs, integrase inhibitors. It’s an alternative to doing protease inhibitors, which have a huge gastrointestinal effect. This is no picnic for me.”

These two men have two entirely different stories, two wildly different experiences living with HIV. There are nearly as many responses to medications as there are people living with the virus, and therein lies the challenge. With no new meds coming down the pike, researchers are looking to existing drugs for new ways to fight a disease that has already claimed 25 million people.

Now, 14 years after the introduction of protease inhibitors — the first class of effective AIDS fighters — the emphasis has shifted, in the words of Rowena Johnston, Ph.D., vice president and director of research at amfAR, the Foundation for AIDS Research, to “shifting drugs around to see what works best.” Similarly, after years of despair, a recent large-scale clinical study in Thailand (more on that below) has shown that the same combination approach may bring a long-awaited vaccine to prevent HIV infection.

Like everyone else, amfAR is ultimately interested in a cure, but until then, the goal is to bring a patient’s viral load down to undetectable levels.

“There has been concern about the fact that the near-time pipeline for investigational medications is not very robust right now,” says W. David Hardy, MD, chief of the infectious diseases division at the David Geffen School of Medicine at the University of California, Los Angeles. But Hardy, who was treating patients before the advent in 1987 of the first AIDS drug, AZT, sees the new approach to fighting HIV as a cause of optimism.













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