The AIDS cocktail
turns 10

The AIDS cocktail
            turns 10

December marks
the 10th anniversary of the first truly effective approach
to treating HIV: combination therapy or highly active
antiretroviral therapy (HAART).

These powerful
medications have saved the lives of thousands of people
living with HIV/AIDS, including many gay men across the
country. This important anniversary reminds us of the
tremendous progress that has been made in AIDS
treatment over the past decade as well as how much remains
to be done to improve HIV/AIDS care for those living with
the disease.

The approval of
the first HAART regimen was truly historic. Many of us
remember how remarkable it was to believe for the first time
that those we loved might survive HIV/AIDS. A disease
that was once considered a death sentence gradually
transformed into a serious yet potentially manageable
condition for many. For the first time in years, obituary
sections in community publications like this began to

In the decade
since combination therapy was introduced, deaths from AIDS
have dropped by more than 60% in the United States, falling
from a peak of more than 48,000 in 1995 to
approximately 18,000 in 2003. Almost overnight, HAART
created a generation of HIV survivors. Yet survival came
with a price.

Patients on early
HAART therapies often had a terrible time with
medication schedules. Many treatment regimens were taken
five times a day and carried complex meal
requirements. A typical patient would roll out of bed,
swallow a handful of pills on an empty stomach, take more
pills later with food and grapefruit juice (to aid
with absorption), eat two hours later, then begin the
process anew with dinner. Many also experienced
serious side effects such as severe fatigue, diarrhea,
nerve-related pain, and the stigmatizing body-altering
syndrome known as lipodystrophy.

Patients demanded
improvements, and medical science produced something
unprecedented in infectious-disease medicine—a
stunning array of new and better drugs. Today, HIV
treatment is much less complex than a decade ago,
requiring fewer pills and fewer doses, often with fewer side
effects. Treatment advances are helping people with HIV to
live and plan for more normal lives. Progress in HIV
research is likely to continue—the world's
first complete HIV regimen in a single once-daily pill is
expected in 2006.

Of course,
treatment hurdles still remain, including side effects and
drug resistance. In a recent study of modern HAART, up to
89% of patients had experienced at least one
drug-related side effect. That needs to improve.
Ongoing research is currently underway to develop additional
therapies in new drug classes in order to better treat those
with advanced or highly resistant strains of HIV.

Another huge
challenge is reducing the rate of new infections. Forty
thousand more people are infected with HIV in the United
States every year. Optimism about improving treatment
should not lull anyone into believing that HIV is not
still a serious disease, one that is still better
avoided than treated.

Access and timely
treatment is also still a challenge for many. While
therapy options have greatly improved, not everyone is
benefiting from quality HIV/AIDS care. Too many people
are being diagnosed with AIDS-related illness in the
emergency room at a late stage in their disease and
are missing the benefits of earlier treatment. This is
particularly true for the poor and people of color,
including African-American and Latino gay men, who
traditionally have experienced barriers in accessing
health services. Globally, greater efforts are needed
to treat the millions of people living with HIV disease in
developing countries.

The good news is
that the next 10 years are likely to see significant
advances in treatment for HIV/AIDS. HAART's evolution will
continue, providing more palatable options for all
people living with HIV/AIDS. Awareness of HIV testing
and treatment services continues to grow, as does
access to information and improving therapies. In recent
years the international community has made significant
progress in expanding global access to HIV treatment.

The challenges
ahead are daunting. But physicians, scientists, health
care workers, and activists can be proud of the significant
improvements they have made over the past decade that
have enhanced the lives of people living with
HIV/AIDS. Our work continues.

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