Perspective: Information, Inspiration and Advocacy for People Living with HIV/AIDS

..........W1mi ~ ILUI ii

Board of Directors
Gregory Horowitt, Chair
Susan Brautovich, Vice Chair
Ken Turner, Treasurer
Tom Downing, Secretary
Diane Cenko Martin Delaney
Brenda Freiberg Linda Grinberg
Steve Hutnick Curtis Ingraham
Tom Kelley Barry Krost
Peter Minichiello Rod ONeal
Bill Sprick Tim Wu, Esq.
National Board of Governors
Steering Committee: Brenda Freiberg,
Linda Grinberg, Barry Krost and Rod O'Neal

Percival Beacroft
Thomas Blount
Don Davis, MD
Rebecca Denison
Robert Gallo, MD
David Ho, MD
John S. James
Sharon Lee, MD
Jerry Moss
Betsy Fels Pottruck
Mike Saag, MD
Robert Schooley, MD
Paul Volberding, MD
Jason Winters

Suzanne Benzer
Ernesto Caldeira
Lynda Dee, Esq
John Dwyer, MD
Michael Gottlieb, MD
Suzanne Ildstad, MD
Cleve Jones
J. Michael McCune, PhD
Gwyneth Paltrow
Adan Rios, MD
Nava Sarver, PhD
Erik Sterling
lrv Weissman, MD

Staff
Founding Director
Martin Delaney
Executive Director
Annette Brands
In formationAdvocacy
Brenda Lein Ben Cheng
Dawn Averitt David Wood
Hotline
Eric Whitney Hunter Morey
Public Policy
Anne Donnelly Ryan Clary
Outreach & Education
David Evans Judy Hogan
Constituent Services
Sabine Dolle Reuel Sherwood
Program Services
Ben Collins
VolunteerServices
Mark Owens

good response on a second protease inhibitor after the first one succumbs to
resistance. There is significant cross-resistance between all the protease inhibitors released thus far, no matter what
drug company representatives claim. But
when there is only a modest return of
measurable virus, we needn't think of resistance as a simple, on-off thing. It comes
in degrees from highleveltresistance,
which will cripple a drug, to low level
resistance, which might be overcome by
increased doses of the drug or changes
in the companion drugs. Some level of
resistance might be low enough to be
overcome by a quick change to more aggressive therapy. Sometimes it can be overcome simply by finding two or more new,
highly potent drugs that aren't cross-resistant. And sometimes, viral load only
reappears temporarily, likely in response
to a secondary infection, and soon becomes undetectable after the infection has
been cleared.
Beyond these points, there are a number of
new drugs in the pipeline, some of which
might be useful despite current resistance.
For example, two new protease inhibitors
in early clinical trials (GW141 in Phase II/
III from Vertex/Glaxo Wellcome and PNIJ140690 in Phase I from Pharmacia and
Upjohn) are different from all current protease inhibitors anddmight offer the potential of being active despite resistance to the
earlier drugs. Also, efavirenz (Sustiva@, previously known as DMP-266), a powerful
new non-nucleoside reverse transcriptase inhibitor which seems to work particularly
well with protease inhibitors, is already
available in small expanded access programs
and should become generally available next
year. There are also several new classes of
drugs now in clinical trials. These include:
T-20 (a fusion inhibitor which has already
shown activity against protease inhibitor
resistant virus), integrase inhibitors and zinc
finger inhibitors. Some new research is also
re-emphasizing the potential of combinations which employ hydroxyurea. Of course,
there's also the whole field of immune restoration which should not be forgotten in
our battle against this disease.
Is There a
BottOmI Line?
For those just contemplating therapy or
currently using it successfully, the bottom
line is to resist any tendency to swing back
in the direction of hopelessness. Instead, this
is a time to re-emphasize the importance of
adherence and using therapy aggressively
enough to fully suppress viral replication.
Maintaining a positive attitude and taking

decisive, informed and effective action are
the only proven ways to get the greatest
* possible benefit from the available therapies.
* For those already facing the prospect of
* "treatment failure," however one chooses
to define it, the bottom line begins with a
staunch commitment to hope. It must include an aggressive pursuit of new options
and inventive uses of old ones (see the article "Strategies for Protease Inhibitor Fail* ure" page 4). It means never succumbing
to the defeatist notion that "there's nothing I can do." There is always something
you can do - new therapies, new combinations, new trials and new outlooks. We may
or may not ever find a true "cure" for HIV
disease, but with each passing year, it is increasingly reasonable to expect to see successful lifetime management of the disease
achieved within the current generation.
For the general public, HIV-infected or not,
the bottom line here must be to take realistic stock of the imperfect but still advancing state of AIDS research. Everyone must
understand that AIDS is not cured, notmone
person has seen his or her virus "eradicated," and the fight is bound to go on for. many more years. Excessive optimism and
overselling the current state of therapy can
harm people just as surely as HIV disease
itself. It can diminish public support for
research and funding for care. It can invite
reckless behavior by people who falsely perceive the threat of HIV to be reduced. It
can diminish the willingness of the pharmaceutical industry to invest in new and
better solutions. And it can drive people to
despair when all they hear is how well everyone else is doing, while their personal
experience isn't so rosy. Even when the new
therapies work well, they add great challenges to the lives of those who must use
them. Dealing with AIDS is far from simply
taking pills.
* Finally, until lasting and universal solutions
are found, we must all recommit to prevention, which has at times been left on the
sidelines in the wake of talk about "undetectable virus" and "morning after medica tions." Those who today have come to.think HIV disease "isn't so bad" have an
*awful shock coming should they ever let.such a misguided belief cause them to cross.over the line to HIV sero-positivity.
* Perhaps this new awareness of the limita*tions of treatment will be a good thing. It.may ultimately help us get on with the
Sbusiness of making sure that better, safer
* and easier to use therapies become avail-.able as quickly as possible, and that every-.thing that can be done to prevent new inSfections is being done. U

Development
Thomas Teasley
Accounting
Barry Harrison
Administration
Ellen George

David Mills
Camilla Dickinson

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PI PERSPECTIVE NUIVIBER 23 NOVEIVBER 1 997

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