PHYSICIAN VOICES

The History of HIV Treatment

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HIV, or human immunodeficiency virus, attacks the body’s immune system and makes it more likely for someone to develop infections or infection-related cancers. If untreated, HIV develops into AIDS, the last stage of the virus. Fortunately, since the beginning of the HIV/AIDS epidemic in the 1980s, treatment for HIV has come a long way. Today, people with HIV can live long, full lives if they follow their treatment regimen.

Prior to the development of effective treatment, HIV infection was, for most patients, a fatal disease. However, in the mid-1980s, a massive worldwide research effort began, first to identify HIV as the cause of AIDS, and then to find medicines that could treat this virus. Eventually, scientists began to figure out how to slow the AIDS epidemic. In March of 1987, the first HIV treatment drug, zidovudine (AZT), was approved by the United States Food and Drug Administration (FDA). While this single medication helped slow the progression of HIV infection for some people, it did not work well on its own and was quite toxic at the high doses used—it was originally designed to be a chemotherapy drug. Ultimately, the HIV virus inevitably and rapidly developed mutations that were resistant to AZT; in essence, the virus learned to create another version of itself that couldn’t be treated with AZT, so this key treatment was no longer effective for many patients. Other medications similar to AZT were created, but many of these had severe and crippling side effects. It was clear that more and better treatment options were sorely needed.

The golden age of HIV treatment occurred in the mid-1990s with the emergence of a class of medications called protease inhibitors (PIs). PIs were more robust and effective then the medications that came before them, and they were generally better tolerated, though many still had serious long-term effects. However, there were now enough different medications available to allow for combination treatment of HIV: the use of multiple different HIV medications at once. This combination strategy turned out to be the key to treating HIV. While HIV rapidly developed resistance against a single medication, and over time would become resistant to a two-drug therapy as well, the virus was very unlikely to develop resistance when faced with three effective medications at once. Though taking three different drugs (and dealing with the various side effects) was a burden to patients, the approach worked, and people began surviving HIV infection. HIV was no longer a death sentence.

By the mid-2000s, newer medications became available that were easier to take, less toxic, and more effective. However, people still had to take multiple pills, often several times a day, in order to stay alive. This all changed in July of 2006 with the release of Atripla, the first effective “one-pill, once-a-day” HIV treatment regimen. Atripla, a combination of three drugs in one pill, revolutionized how HIV was managed; from then on it was possible, at least for some people, to treat HIV with a single pill. This solved a big problem—managing multiple medications was one of the reasons people with HIV didn’t follow their treatment regimens, which led to treatment-resistant strains of HIV developing. The one-pill regimen made it easy for those with HIV to follow their treatment plans and stay healthy.

Today, there are four highly effective, safe, and well tolerated single-tablet regimens available to treat HIV. Plus, many other multi-pill treatment options still remain and are just as effective—in some cases, they are preferred over single-tablet regimens, depending on the strain and progression of the infection. Now, people newly diagnosed with HIV who begin their treatment soon after diagnosis are expected to live as long and full a life as if they never had HIV–assuming they take their medication as prescribed and communicate regularly with their doctor.

The most recent development in the battle against HIV occurred in 2012, when a new style of therapy, called pre-exposure prophylaxis, or PrEP, was introduced. By following a PrEP regimen, it’s possible for HIV-negative people to reduce their chances of contracting HIV by 90%. PrEP is only recommended for people at high risk of HIV, like those in relationships with HIV-positive partners and those with multiple sex partners. A pill called Truvada, originally developed to treat HIV, is the only approved form of PrEP at this time. The presence of the medication in the bloodstream blocks the virus’s ability to take hold and spread, which is why it’s important to take PrEP every day. People taking PrEP must also stay away from unsafe behaviors that raise the risk of HIV, but the therapy is a giant step towards banishing the HIV virus for good.