Field of Science

Once-a-day cocktail for HIV

One of the biggest problems with AIDS treatment always has been patient compliance. Viral levels can be reduced in a patient and maintained at that level only if you hit the virus early, hard, and repeatedly so. But because of the number of times that one has to take the drugs, many patients fail to keep up with this strict routine. There was a point when patients had to take drugs as many as 18 times a day, a grotesque regimen. If this fails to happen for even a couple of days, not only does the virus come back with a vengeance, but the diabolically chimeral creature develops resistance to that drug combination by clever mutations. After this, even the same previously highly effective treatment fails to have any efficacy.

The usual combination therapy of drugs consists of two drugs that inhibit the viral enzyme called reverse transcriptase which codes for viral DNA, and one which targets an enzyme called HIV-protease, which is reponsible for processing viral proteins into a form suitable for forming the viral coat. Both enzymes can rapidly develop resistance to these drugs through mutations, in an exquisite though unfortunate example of Darwinian evolution (People who think evolution is necessarily a slow process and therefore cannot be observed need only to look at HIV among other things)

In what I see as a major advance in HIV treatment, the FDA has finally approved a once-a-day capsule with a combination of three best selling drugs. The treatment still costs 1000$ a month, but this is assuredly affordable for well to do people in the developed world. The problem of making it available in India and Africa still persists, and I don't know if there's any easy way out, because given the income levels of many HIV patients especially in Africa (which are essentially none), there is no difference for them between paying 1000$ and paying a million dollars. Short of making the treatment free to at least some, I don't see any easy way out for pharmaceutical companies and governments.

In any case, this is an important new development, and I am proud that one of the three drugs (Emtricitabine®) is the one that was co-discovered by my advisor. Does this mean he will be away even longer than usual? Boo hoo.

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