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Take one deadly virus with no cure. Add a cocktail of drugs that can suppress the virus.
The result? A spike in the habits that spread the disease.
That’s what doctors are finding as they care for patients with HIV in the new millennium. As advanced therapies stretch out the lives of HIV-positive patients and help them to keep AIDS at bay, the immediate specter of the virus may be receding from public consciousness. And the safe-sex practices that help prevent contagion may be eroding along with it.
“There is a belief now that HIV is easily controllable,” says Keck School of Medicine associate professor Robert Bolan. “People believe that even if they get HIV, there are medications out there to control it, so it’s not as important to be careful about preventing it.
“That is an unfortunate, serious misperception.”
The medical community is caught in a double-bind: it tries to convey the promise of scientific research to those who are HIV positive.
“We try to give hope,” as Bolan puts it. But as those messages of hope are widely disseminated in the general culture, they’re sometimes distorted into the message that there’s no cause for alarm anymore.
That’s far from true. Some 16,000 Americans died of AIDS last year and 40,000 were infected, according to the Centers for Disease Control and Prevention. As many as 5 million Americans, whether heterosexual or homosexual, engage in behaviors that place them at high risk of contracting the virus, the CDC reports. The key risky behavior, Bolan says, is intercourse without a condom and not knowing one’s partner’s HIV status.
In Los Angeles County, health officials declared an outbreak of syphilis in March after discovering a rapid spread of the sexually transmitted disease. Cases of another venereal disease, gonorrhea, climbed 9 percent in the United States in 1998 after 12 straight years of decline. The jump in VD infections lends statistical support to the anecdotal evidence that physicians and community health workers hear daily. It also gives health professionals and advocates a push to renew and expand critical HIV prevention efforts.
Part of the problem may be the way people deny the risks of unsafe sex. Though the dangers are proven, some may delude themselves into thinking they are immune.
Another source of complacency, particularly in gay communities, is the decline in AIDS deaths. Fewer people personally knew someone who has died of the disease, Bolan says. That may remove some of the fear surrounding AIDS.
But those who take the complicated regimen of pills needed to keep HIV in check – and those who administer it – know the virus is still spreading and still deadly.
COCKTAIL INGREDIENTS
AIDS drugs come in three classes with somewhat intimidating names:
-nucleoside analog reverse transcripase inhibitors (for short, NRTI drugs or nucleoside analogs)
-non-nucleoside analog reverse transcriptase inhibitors (NNRTI drugs)
-protease inhibitors
The well-known drug AZT is an example of an NRTI drug. It's made up of chemicals similar to part of normal human DNA. HIV needs a certain enzyme to keep making copies of itself, and AZT blocks that enzyme's success.
NNRTI drugs do the same thing, but chemically don't resemble DNA.
The last class, protease inhibitors, blocks the enzyme called protease - essential for the virus to activate.
Highly active anti-retroviral therapy - or HAART - usually teams two NRTI or NNRTI drugs with a protease inhibitor. On this regime, the amount of HIV in a person's blood can drop dramatically, and the immune system gets a boost from more active virus-fighting cells within the body.
"They've clearly been effective in boosting the quality and length of life," says USC AIDS expert Alexandra Levine. "But," she adds, "these drugs are not a cure."
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