The cocktail hour
Powerful and expensive new combinations of drugs can delay the development of AIDS for years. If they don't kill the patient first, warns Tavis Barr of Act-Up New York. According to the mainstream American press, 1996 was the year when AIDS became a chronic manageable illness. "The end of AIDS?" asked a Newsweek cover suggestively in December, while AIDS researcher David Ho,' found his way on to the cover of Time as AIDS research poster extraordinaire and Time's "Man of the Year.
The cause of all this hoopla is a new class
OUTAGE of drugs called protease inhibitors, which, when taken in combination with a regimen of previously available drugs called reverse transcriptaese inhibitors, keep HIV at often undetectable low levels for lengthy periods of time, possibly several years. These combination therapies can consist of up to 20 pills a day, and are referred to euphemistically as "cocktails." For people who are sick, such cocktails probably extend life expectancy by several years. Ho's attainment of poster boy status was spurred not so much by any leading role he held in the development of these drugs? as his advocacy of a "hit hard hit early" treatment strategy. The idea behind such a strategy is that the earlier you counter an HIV infection, the more likely you are to contain the virus entirely inside blood cells;
if you can contain it for a couple of years. those cells will die off, and the infection may disappear completely. High risk
In practice, "hit hard, hit early" is an entirely unproved concept. Researchers made the same claims about AZT (the first reverse transcriptaese inhibitor) when it came out. Subsequent research showed that although AZT makes people with AIDS healthier for longer, it is so toxic that it does not increase people's life expectancy. Those who were "hit hard" and "hit early" with AZT actually saw their life expectancies decrease.
The new cocktails are a bit more promising in this regard: They do appear to be able, in some patients, to disappear the virus for almost enough time. But just as these cocktails are dramatically stronger than AZT, the risks associated with a "hit hard, hit early" strategy are dramatically more dangerous. Already,
AIDS