The history of HIV therapy “cocktails”

AIDS was declared an epidemic in the early 1980s, but the first reasonably effective treatment, AZT, was only released in1987. Since then, treatment has evolved and improved and today let’s briefly look at HIV and AIDS treatment up until the present day.

AZT was not a very good solution, and it was not until the mid-1990s that truly effective treatments became available. The “protease inhibitor” class of drugs was developed and soon researchers began combining various types of anti-HIV drugs together into the so-called “HIV treatment cocktails”.

These drug combinations are called “cocktails” because—while in 1990 there was basically only one drug available—now there are about 36 different brand name HIV medications. The challenge for HIV specialists is to look at each patient and mix together, prescribe, typically two or more medications into the best “cocktail” of drugs that will both control the virus and result in the least side effects for that person.

Finally with the advent of these “cocktails”, HIV and AIDS patients were given a good chance to slow, even stop, the advance of the disease. The earliest cocktails, made during the 1990s, were difficult to take and side effects were common and often severe. Patients had to take many pills throughout the day and night, at specific times, some with food, some without, and side effects such as severe nausea and vomiting, diarrhea, headaches, rashes, allergic reactions, and numbness in arms and legs, were common.

But fortunately the drug companies, working with AIDS researchers, developed many different effective medications, and today there are five basic classes of HIV medications (with names such as “Non-nucleoside reverse transcriptase inhibitors”), and each works in a different way against the HIV retrovirus. They all have a common goal: prevent the virus from replicating or, in the current technical jargon,  “making copies” of itself.

But none of the current drugs, even in “cocktail” combinations, will cure a person with HIV or AIDS. But even to just repress the virus is not easy; it mutates very quickly, becoming resistant to older medications. So HIV drugs need to be given in combination, with each drug working to slow or stop the replication of the virus, each acting on a different part of the replication process.

In most patients, the cocktails are highly effective, so over time, with continued treatment, their “viral load” (count of virus in the blood) becomes “undetectable”. That means that most current lab techniques cannot even find the virus in the body if the cocktail is effective.

But unfortunately, the virus is still there, hiding, waiting for a chance to replicate, or copy itself. So, if the drugs are stopped, the viral load increases, and the patient’s own “T cell count”, which is a count of the number of healthy antibodies that fight infection in the body, decrease. So if someone starts a cocktail, to stay healthy they must commit to being on the cocktail for life (or until a cure or better treatment is found).

Next post: When should HIV positive people start treatment?

See also in ProcuraMed:

*An at-home HIV test now available in U.S.

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