AIDS treatment - HIV protease inhibitors - not a cure

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AIDS prevention works - we can stop the spread of HIV - lessons from Uganda - Video

Comment by Dr Patrick Dixon to audience in South Africa about how corporations can help stop AIDS. HIV prevention can produce huge falls in infection rates in teenagers


HIV protease inhibitors offer new hope of a combined approach to HIV infection. Results in some cases have been spectacular with undetectable levels of HIV achieved for long periods. This has raised talk of perhaps even being able to eradicate HIV altogether, based on the fact that many infected cells have a limited life-span. By preventing viral replication one could in theory reach a situation where all infected cells had died.

In the past drugs like AZT have been used to block the enzyme reverse transcriptase which HIV uses to convert viral genes

into DNA messages inside the nucleus of white cells. This is only partially effective, even with combination therapy using several reverse transcriptase inhibitors, and resistance is common. The new approach blocks HIV protease, used by the virus in assembling virus particles from building blocks made inside infected cells. When combined with AZT one study found that levels of HIV fell a hundredfold. However resistance to HIV protease inhibitors can develop rapidly for reasons that are uncertain, but may be linked in some cases to gaps in taking the correct medication.

While this news is encouraging, we are still nowhere near a cure and the cost of the combined treatment is huge - perhaps £10,000 - £20,000 a year per person, for life. Thus like AZT, this new step even if it works is likely to be science fiction for those in developing countries. In places like Uganda the total health spend per person per year is around £2 and a doctor can earn as little as £25 a month. Even in countries like the US and the UK, governments are reeling at the prospect of a further £10,000 per person per year, for many years. Health budgets will feel the strain if as is expected by some experts, HIV protease inhibitors become widely accepted. However if the drugs only need to be taken for two years or three, the costs begin to compare favourable with the costs of hospitalisation and community care. In the meantime... time is running out for millions.

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