An ongoing regimen of HAART (highly active antiretroviral therapy) keeps HIV from exploding into AIDS. In the clinic, where patients precisely follow the HAART program, it wipes out detectable virus in more than 90% of patients. In the real world, where patients forget a pill here and there, the success rate falls to 50% or 60%, says Dean Hamer of the National Cancer Institute. In addition, HAART itself creates problems.
Few, if any, patients could stay with HAART forever. "There are lots of problems with it," says Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. HAART attacks organs. It can trigger metabolic problems, including diabetes, high cholesterol, and more. Worse still, even supposedly resting HIV replicates a bit, maybe enough to develop drug resistance while escaping the medication's detection. In a study of just 377 subjects, Susan J. Little and her colleagues at the University of California, San Diego, found that the number of HIV strains resisting one or more drugs increased by more than three times from 1995 to 1998.1
Rounding out this unsavory list of complexities is HAART itself, which includes a variety of daily pills. The combination of complicated pill schedules and the therapy's adverse effects cause some patients to take time off from it. David Abramson and Peter Messeri of Columbia University examined the so-called drug holidays of 887 patients who had HAART at some point. Of these patients, 26% had stopped taking the medications during the previous six months; about one-third of the 26% stopped HAART in consultation with their doctors. Abramson says, "We don't capture how many people stopped taking HAART for 'health reasons,' which could encompass a number of different mechanisms, including drug resistance, unpalatable side effects, clinical comorbidities, et cetera." No one seems to have data showing just how many patients fail on HAART.
Currently, some HIV researchers see an uncertain future, at least concerning the value of HAART, but making judgments is difficult because it's been around for only a few years. Nonetheless, Hamer says, "Wait another five or 10 years and you're going to see a lot of people failing on their drugs and dying terrible, slow, awful deaths."
- Mike May