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Additional resources for HIV: 20 Years of Research (Scientific American Special Online Issue No. 7)
Because current treatment plans seem unlikely to cure HIV infection within several years and because of HAART’s various drawbacks—including side effects, complicated regimens and resistance—the search is on for additional drugs. The first entries to reach the market will add new choices within existing drug classes, and some will combine existing drugs into a single pill or will otherwise reduce the complexity or toxicity of current regimens. And at least two custom-designed protease inhibitors in clinical trials appear to work against strains of HIV that are resistant to existing protease inhibitors.
The “real life” experience has also been good but less so. Almost identical results from clinics at San Francisco General Hospital and the Johns Hopkins Medical Institutions reveal that approximately 50 percent of patients given triple-drug therapy achieved the goal of viral loads below 500 copies per milliliter at six to 52 weeks after the start of treatment. JULY 2003 to AIDS within a year. Viral-load measures have therefore replaced assessment of clinical outcome in therapeutic trials, and routine monitoring of viral levels has been incorporated into medical practice.
COPYRIGHT 2003 SCIENTIFIC AMERICAN, INC. The T cell and viral-load thresholds, however, are fairly arbitrary. Because patients in the third group feel perfectly well, certain of them may be quite reluctant to embark on a demanding treatment plan, with its side effects and constant reminder of the disease. Further, if resistance arises and treatment fails, the patients will be left with restricted options later on. Some will therefore choose to delay therapy until tests show signs of progression or until simplified regimens or new drugs with fewer side effects become available.