Doctors Losing War on AIDS

Article excerpt

Since November, Dr. Roxanne Cox-Iyamu has seen a noticeable rise in the number of deaths among her patients at the downtown Whitman-Walker AIDS clinic.

"We used to be able to go months without seeing someone die. Now it is every few weeks," she said with a sigh. "I saw a women yesterday with four opportunistic infections. One - mycobacterium avium - it was the first time I've seen it in three or four years."

Dr. Cox-Iyamu, an infectious-disease specialist and director of the Whitman-Walker Clinic, oversees treatment of some 2,000 HIV and AIDS patients. She said her patient was experiencing total body wasting, night sweats, diarrhea and fatigue.

The patient had been on a regimen of life-saving drugs, but they were no longer effective.

Dr. Cox-Iyamu, visibly saddened, said at this stage there were few options available to help the woman and dozens of other patients for whom life-prolonging drug cocktails have failed.

The drug cocktails have produced remarkable recoveries in many AIDS patients, but they are beginning to fail in an alarming number of cases.

And that, experts say, limits the medical options for Africa and the rest of the developing world, which are being overwhelmed by the disease.

While activists, health care workers and governments recently shamed 39 pharmaceutical companies into an agreement to provide cheap drugs to treat the 25 million people in Africa with HIV/AIDS, access to drugs is not the end of the problem.

"The drugs are needed, and they will do a lot of good," said Dr. Ronald Gray, an epidemiologist at the Johns Hopkins School of Public Health with 10 years' experience in Uganda. "But, if this is not done properly, we are sitting on a powder keg . . .

"There is no infrastructure [in Africa] to deliver the care, and the nature of this complicated drug regime means that we will see treatment failure and drug resistance. Drug resistance could wipe out the utility of these drugs in just a few years."

He said if drug resistance follows the historical course of tuberculosis and malaria, AIDS in Africa could become resistant to available drugs in one year, followed by massive resistance within five years.

"I'm not by nature pessimistic - but I am a realist, and I am concerned," he said.

At an international AIDS conference in Vancouver in 1996, scientists introduced new "drug cocktails" of protease inhibitors and anti-retroviral drugs that prevent the AIDS virus from reproducing.

After a short time on the therapy, immune systems of even the sickest AIDS patients rebounded and the virus dropped to undetectable levels in the blood.

MISPLACED OPTIMISM

Optimism ran wild. Serious scientists talked of either finding a cure for the deadly disease, or long-term management of the illness as with diabetes.

Thousands of AIDS patients, literally on their death beds, like Lazarus, got up and walked, returning to relative health and a normal life.

The complicated drug therapy requires as many as 30 pills a day, each taken at different times - some to be swallowed with food, some without, some with water, some without. And, within six months of the introduction of the drugs in the United States, the mortality rates for AIDS plummeted - from 40,000 a year in 1996 to just 16,000 in 1999.

But five years later, at the Seventh Conference on Retroviruses and Opportunistic Infections in Chicago in January, the optimism had diminished.

The highly toxic drugs were failing in as much as 50 percent of the infected population. In addition, even where the medication continued to work, it was causing severe side effects, including high cholesterol, liver damage, kidney stones, diabetes and osteoporosis.

One of the most appalling side effects, called lipodistrophy, or body fat redistribution, creates grotesque buffalo humps, distended bellies, sunken cheeks and bone-thin arms and legs. …