Medication

There is still no cure for AIDS. And while new drugs are helping some people who have HIV live longer, healthier lives, there are many problems associated with them:

• Anti-HIV drugs are highly toxic and can cause serious side effects, including heart damage, kidney failure, and osteoporosis. Many (perhaps even most) patients cannot tolerate long-term treatment with HAART.
• HIV mutates quickly. Even among those who do well on HAART, roughly half of these patients experience treatment failure within a year or two, often because the virus develops a resistance towards the existing drugs. In fact, as many as 10 to 20 percent of newly infected Americans are acquiring viral strains that may already be resistant to current drugs.
• Because treatment regimens are unpleasant and complex, many patients miss doses of their medication. Failure to take anti-HIV drugs on schedule and in the prescribed dosage encourages the development of new drug-resistant viral strains.
• Even when patients respond well to treatment, HAART does not eradicate HIV. The virus continues to replicate at low levels and often remains hidden in "reservoirs" in the body, such as in the lymph nodes and brain.

In the U.S., the number of AIDS-related deaths has decreased dramatically because of widely available, potent treatments. But more than 95 percent of all people with HIV/AIDS live in the developing world, and many have little or no access to treatment.

In addition, several types of drugs seek to prevent HIV itself from reproducing and destroying the body's immune system:

• Reverse transcriptase inhibitors attack an HIV enzyme called reverse transcriptase. They include abacavir, delavirdine, didanosine (ddl), efavirenz, emtricitabine (FTC), lamivudine (3TC), nevirapine, stavudine (d4T), tenofovir, zalcitabine (ddC), and zidovudine (AZT);
• Protease inhibitors attack the HIV enzyme protease and include amprenavir, atazanavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, tipranavir, and darunavir.
• Fusion inhibitors stop virus from entering cells. To date, only one fusion inhibitor, enfuvirtide, has been approved by the Food and Drug Administration.

Many HIV patients take these drugs in combination-a regimen known as highly active antiretroviral therapy (HAART). When taken as directed, anti-HIV treatment can reduce the amount of HIV in the bloodstream to very low levels and sometimes enables the body's immune cells to rebound to normal levels.

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