The names saquinavir, indinavir and ritonavir may not mean much to most people. But these new drugs have drastically changed the way AIDS is managed and have allowed thousands of patients to make dramatic recoveries.
Called protease inhibitors, they stop the AIDS virus from replicating in the body, and today some patients who were seriously ill have almost undetectable levels of the virus in their blood.
Along with this good news about AIDS comes a downside: the grim stories of those who haven't been helped and a concern that people may be returning to unsafe sex practices, thinking that doctors have found a cure for the disease. "I feel let down," said a 42-year-old man from St. Louis. "I guess it is just my luck." The man, a carpenter and the father of two teen-agers, received a diagnosis of AIDS almost 10 years ago. He was doing quite well until the week before Christmas when he was hospitalized for lymphoma, cancer of the lymph nodes. He's tried all the available protease inhibitors and even two in combination. But none has helped him. "The media have overplayed" the advantages of such drugs, said the man who asked that his name not be used. "They don't work for everybody." That's something that more and more physicians are discovering in St. Louis and nationwide. And they worry that people may mistakenly think the AIDS scare has ended. It hasn't. The disease remains the leading cause of death among men ages 25-44 and the third leading cause of death among women ages 25-44 in the United States. Mark Pickering, executive director for the St. Louis Effort for AIDS, said: "We have concerns about people who think they don't have to take precautions now because it is over. They think, `I will just take a pill, and it will be all right,' and it is not that way." The message about the need to practice safe sex has been overshadowed by the dramatic stories surrounding protease inhibitors, Pickering said. These drugs were rushed to the market and approved for commercial use by the Food and Drug Administration in record time because of their dramatic results. Some patients literally went from their deathbeds to what appears to be a complete recovery. Patients experienced a dramatic lowering of the amount of virus in their blood, said Dr. William Powderly, who's with the AIDS Clinical Trials Unit at Washington University School of Medicine. The virus isn't even detectable in some patients. Powderly and many other infectious disease experts agree that protease inhibitors have made a dramatic improvement in the way AIDS is managed. …