FFWD Weekly
Copyright © 1997. All Rights Reserved.
HIV battle continues
Drug cocktail offers new hope, but it's not a cure
by Maureen McNameeDecember 1 will mark another World AIDS Day as the medical community and those infected continue their fight to overcome the virus.
When the general public first became aware of AIDS over 10 years ago, a positive test was considered a death sentence - very little was known about the disease and how to treat it. Recently, the development of new medications has created conflicting reports - depending on what you read, the drugs are a virtual cure and the danger is past, or the drugs aren't working and the virus is spreading.
The reality is a combination of the above, according to Dr. M. John Gill, medical director of the Southern Alberta HIV Clinic (SAC).
"We're getting more drugs and better drugs than we've ever had before," he says. "Some people are going to do incredibly well, some will have a major benefit and some will not benefit as much."
Gill, an infectious disease specialist, has run the Calgary clinic since it opened in 1989. He says past experience shows that without intervention, an HIV patient will most likely develop the severe illness known as AIDS within about nine years, followed by death within one to two years.
"We believe that we can significantly improve the average, adding an unknown number of years or even decades onto that," he says.
"As part of the treatments we've seen a major decrease in patients progressing to AIDS and patients dying.
"This doesn't mean the battle's licked, but we've delayed progression significantly."
People with HIV who take the drugs properly are receiving the most benefit, especially those diagnosed recently. However, other factors also have an impact.
"Some people don't benefit at all. Either they're not interested in taking the drugs or they have side-effects that preclude them from taking the drugs or they don't react," Gill says.
"Those are a minority, a very small minority."
And, Gill points out, it is not known whether the results are sustainable over a long period and what the side effects will be.
"These are brand new drugs. We don't know what will happen after five years of treatment."
SAC pharmacist Nora MacLeod says the new protease inhibitors are combined with earlier classes of drugs and additional medications to treat the infections associated with HIV to create a "cocktail," which has the potential to reduce the levels of the virus in the bloodstream to an undetectable amount. She explains that the patient is not cured, but the drugs bring the virus down to a level where it's not as able to harm the immune system.
The quantity and type of pills is different for each patient, ranging from three to 30 or more - one SAC patient takes 86 pills per day. The cost of the drugs is covered by the province for any Alberta resident with Alberta Health Care.
"There isn't going to be, 'Tequila Sunrise is the answer for everybody,'" says Gill. "It will be a Bloody Mary for some people and a tequila for someone else... it's not that easy."
Some drugs must be taken with food, others on an empty stomach. One type may damage the liver, so a patient must drink two litres of fluid per day.
He acknowledges that the regimen can be very complicated - a person who has been thrown out of their home or who is addicted to intravenous drugs has little chance of being able to stick to the schedule.
For many patients, though, the drugs are a lifeboat - their only hope to stay alive.
Gill says more than a few patients have experienced a remarkable recovery - people who thought they would be dead in six months have been able to return to work.
"Will they still feel as well in a year or two years or three years?" he asks, shrugging his shoulders. "You're buying time, but it's time that's precious because they'd be dead...."
Despite the advances in treatment, one Calgary man says people with HIV should maintain a healthy skepticism.
"I think that we have to be very cautious in our hope, if for no other reason than past history." says Craig, 31, who is HIV-positive.
"This is definitely not a cure.... These drugs may turn out to be what insulin is to a diabetic - it's a control agent."
Craig contracted the virus from his first boyfriend at age 17, before anyone understood what it was. He was tested in his early 20s and says the result came as no surprise. Following a period of depression and denial, he become active in the HIV/AIDS community and now works in a community house for people living with the virus.
He says there is still a lot that the medical community doesn't know about the disease or the treatment.
"AIDS is a very young disease, as far as diseases go. Part of learning about a disease is seeing how it affects the population over the long-term."
He warns HIV patients not to set themselves up with false expectations, noting that the new drugs have only been available for one year and AZT certainly didn't live up to early expectations.
"Yes these drugs look wonderful. Yes they've had a lot of success.... Will they continue to do so? We don't know yet."
Whether or not to take the drugs can be a difficult decision, according to Craig. Some of the drugs are toxic and have negative side effects, so a person may have to choose between quality of life as opposed to duration. "There are a lot of issues people have to struggle with."
Craig, who has now been infected with HIV for almost 15 years, recently decided to stop taking the cocktail. He explains that at this point, he feels healthy and does not think his virus level warrants the effects of the drugs.
"I'm healthy, healthy, healthy. I'm one of those medical mysteries - and they're finding more and more of us."
He is not suggesting that anyone else discontinue their medication, but says it's important for people infected with HIV to become informed and participate in making decisions.
"I think people need to be in control on all levels.... They need information, they need to know what's going on."
Unfortunately, while the medical community makes inroads in its effort to prolong the life of people with HIV, the virus continues to spread. According to Health Canada, there are more than 3,000 known and 5,000 estimated cases of HIV infection, with as many as 5,000 new cases being added each year.
Locally, there are approximately 550 confirmed cases of HIV infection in Southern Alberta - and an estimated 400 to 500 unknown. Gill says the province averages about 100 new patients every year.
"Sometimes it goes up and sometimes it goes down. That's been a fairly stable number, but the mix on those changes."
Craig is concerned that the public is becoming complacent about prevention, partly because of advances in the treatment of HIV. There is also the misconception among young people that HIV is an older gay man's illness which, combined with a tendency for youth to believe it can't happen to them, increases the risk.
"People who should know better are getting infected," he says, referring to young gay men. "We're starting to see those numbers climbing again."
Gill confirms that people are still being infected through casual unprotected sex and suspects the public is becoming more relaxed about it - a trend which is very disturbing. He says the "safe sex" message is still valid unless people are in a monogamous relationship and both partners have been tested. "You don't do it with anyone... and if you do, do it protected."
However, he adds that the most significant growth in HIV infection has shifted.
"Historically, 10 years ago, the vast number of HIV infections were in gay males. Clearly, in the last three to four years, this has changed dramatically with the number of infections through needle use... and straight sex."
Vancouver currently has a huge problem, he adds, with an estimated two new HIV infections per day. "It's inevitable that some of their problem will spill into Alberta."
Another area where infection is reportedly rising is among Aboriginals, but there isn't a lot of data. "We do not have a good grip at the present time on what could be happening with our Aboriginal communities," Gill admits, adding that the medical community is trying to establish links for support and prevention.
Despite the growing number of people with HIV, Craig says it appears there are no plans to increase the current level of funding, The federal government is expected to make an announcement on World AIDS Day regarding a five-year extension of the current $200-million AIDS strategy.
Craig is aware that groups representing other diseases feel some resentment about the amount going towards HIV and AIDS, but says it's necessary.
He explains that watching AIDS patients suffer during the final stage of the disease has made him painfully aware of why money for research and support is imperative - he's seen patients in diapers, hooked up to several machines, not knowing anyone, high on morphine, etc.
"There are very few diseases that will ravage a person as much as AIDS...," he says. "AIDS affects every part of your body towards the end."
But, he's also seen people like himself, who have not become sick, and remains optimistic about the future.
"On the other side, people are understanding that you can live with (HIV) for a long time."
Back To Main Contents
Back To This Issue Table of Contents