Since the first cases of acquired immunodeficiency syndrome (AIDS) and the related human immunodeficiency virus (HIV) became known in the early 1980s, scientists and researchers around the world have spent billions of dollars and thousands of hours to discover how the diseases are caused and what options are available to stop their progression. International conferences held in the mid-1980s allowed data to be shared on what exactly AIDS and HIV are, and to develop blood tests to diagnose them. Once the disease could be identified, however, the severity of the illness and the extent of the worldwide epidemic became a daunting challenge.
By the late 1980s, treatments for the virus became known throughout the medical community and the collection of horrific infections that prey on the severely weakened immune systems of those with AIDS could be managed to some extent. The death toll internationally was still extremely high, and remained so until the mid-1990s when the research collectively began to identify the best range of treatments for the 11 or more strains of HIV and AIDS. The 11th World AIDS conference held in 1996 in Vancouver, British Columbia, Canada, provided the turning point for treatment when several groups of researchers presented information on a combination of drugs that, when used together, could virtually erase any traces of the virus from the bloodstreams of those infected. A new blood test that could detect HIV much earlier than could previous tests was also introduced, which abruptly changed early treatment options, and established new ideas about how the disease works. Within a year, these HIV and AIDS treatments were being duplicated in medical offices and clinics around the world. By the late 1990s, HIV had moved from a progressively terminal disease to one that could be managed over the long term, at least for those who have access to and can afford these new treatment options.
The combined drugs therapy first introduced at the 1996 conference is now the standard of care for those with HIV. Eleven different drugs that fall into three categories make up the treatment quilt. Five nucleoside analog drugs, including the well-known AZT, are used in combination with four varieties of protease inhibitors and two non-nucleoside reverse transcriptase inhibitors to block the disease's progression. All three types of drugs are considered anti-retroviral treatments that work by interfering with the action of HIV reverse transcriptase inside infected cells, thus ending the virus' replication process. The drugs attack HIV inside the body's immune cells, where it has already established an active infection. The mortality rate has since fallen sharply as more HIV-positive patients are prescribed this three-drug combination. The use of the improved blood test has also been expanded to measure the amount of HIV in the blood during drug treatment, which can help to pinpoint the most effective combination of drugs for each individual. In all cases, the goal of treatment is to keep the level of HIV in the body as low as possible, for as long as possible.
Many questions still remain concerning effective treatment of HIV and AIDS over the long term. The average cost for the three-drug combination treatment is $15,000 annually for each patient, which is exorbitantly expensive for those in developing countries (where the majority of HIV-positive patients live). While these new treatments can almost completely eliminate the virus in as few as two or more years, they do nothing to restore the functionality of the ravaged immune system. Patients may be just as susceptible to other illnesses that their immune systems cannot withstand, and even though the virus is not detected in the body, does not mean it is not present since HIV cells can mask themselves as almost healthy cells. A strict schedule and diet must be maintained for the drugs to be successful. The regimen is difficult for many patients to follow, either because of privacy constraints or the side effects some of the drugs can cause. Perhaps the most basic questions researchers are still struggling with are when to provide treatment, which drugs to begin with, how to identify when alterations are needed in the therapy, and which drugs to try next.
Because more than 16,000 new patients are diagnosed each day with AIDS worldwide, many researchers have also been studying how a vaccine can block HIV's entry into the immune cells. At least 25 experimental vaccines have been created since identification of the disease, but few have proved promising enough to complete the large-scale testing on human volunteers that is required to confirm the vaccine's success.
In June 1998 such a large-scale test began with 5,000 volunteers in 30 cities in the United States, and a smaller group in Thailand. Volunteers were given a series of shots that hopefully stimulate the immune system to resist the two most common strains of the AIDS virus. Previous smaller tests documented that 99.5% of the vaccinated volunteers produced strong levels of resistance in their immune cells, which then target and kill infections such as HIV. The trial was expected to last three years. Also in 1998, a group of researchers at the University of Michigan proposed to develop a vaccine that would prevent someone with HIV from passing it on to someone else. Such a vaccine would be given within the first three months after infection, when the virus is most contagious. Their theories resemble those used to create the Salk polio vaccine in the 1950s, which reduced the polio virus' symptoms and drastically reduced its ability to infect others, virtually eliminating the disease within a decade.
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