By Hannah Clark, MedTech1 Staff
In the eighties, when scientists and doctors were first beginning to learn about HIV and AIDS, many thought they would develop a vaccine in a few years time. But HIV is not an ordinary virus.
HIV replicates faster than Superman flies—millions of times a day.
The process it uses to replicate, called “reverse transcriptase," is a scientist's worst nightmare. Most viruses replicate by making a copy of their DNA. The copy is called RNA, and the RNA is then used to make proteins and form a new cell. But HIV starts out as RNA, converts to DNA, and then converts back to RNA. There is only one other known organism that replicates in this way. And it’s messy—each time it replicates, HIV mutates. No single person has the same strain of HIV, and each individual hosts a new strain every six weeks. There’s a good chance that each new strain is stronger, more aggressive, and more resistant to treatment than its predecessor. Research has shown that 26 percent of newly infected patients already carry drug resistance.
HIV does not just destroy the immune system. It destroys CD4 lymphocytes, or helper T-cells, which are, in essence, the directors of the immune system. Once they are gone, the immune system is even more helpless to react to the invading virus.
"It seems that every time we discover something new about [HIV] and think that we've found a way to stop it, it comes up with another way to surprise us," says Sister Mary Elizabeth, founder and director of the AIDS Education Global Information System (AEGIS), the Internet's largest HIV/AIDS information database. About five years ago, for example, scientists thought they had discovered that a certain part of the virus, called GP41, did not mutate. If they could stop GP41, they thought, they could stop the virus altogether. Only recently it was discovered that GP41 does mutate after all, and so could adapt to any attempt to attack it.
HIV kills 3 million people a year, including 500,000 people under the age of 15. More than 36 million people are living with HIV or AIDS worldwide; 25 million are in Sub-Saharan Africa, and one million in the United States. Heterosexual sex causes more than 80 percent of adult HIV infections.
Despite these formidable obstacles, progress has been made in HIV treatment, and many patients are living longer, healthier lives. Marty Howard is a case in point. Howard, who in 1994 founded one of the first HIV/AIDS related Web sites (www.marty-howard.com), was infected and diagnosed in late 1985. Treatment philosophy was different then, Howard says. “Ten years ago, people thought you should hit it and hit it hard as soon as you find out about it,” Howard says. Now, doctors are more cautious, to delay the virus becoming resistant to medication.
Drugs are also more effective and less toxic than they were ten years ago. In the early nineties Howard was using a class of medications known as the “D drugs.” “That gave me my first attack of pancreatitis,” he says. He’s struggled with pancreatitis ever since, and still has bouts when he doesn’t follow a strict low-fat diet. Since then, Howard says, doctors have learned to stay away from the D drugs whenever possible.
Sister Mary Elizabeth notes, however, that progress has been limited. "The treatments have improved from the standpoint that people are living longer," she says. "I wouldn't say we've developed better treatments in terms of stopping the infection, but we've developed better treatments in terms of managing the infection."
Despite his struggles with medication, Howard’s story can give hope to others living with HIV. The only way the virus has truly affected his lifestyle, he says, is the changes he and his wife have had to make with their sexual activity. He cooks much of his own food to stay under his fat intake limit. “You name it, I can cook it for you, you will love it and it will have less than five grams of fat,” Howard says. He has never had an HIV-related infection—the pancreatitis was the result of the drugs, not the virus itself. He is having no problems with his current cocktail (a cocktail is a combination of drugs).
Treatment has come a long way—but a vaccine is still miles down the road. And a cure is not even on the radar screen.
One of the most important technological tools for fighting HIV is not actually medical—it’s the Internet. The more people who know about the virus the closer we come to a cure. "I think the Internet is one of our best resources," Sister Mary Elizabeth says. It takes six months or more for a researcher to get a paper published—and by the time the process is finished, the information may be obsolete. But now researchers can post their findings online almost immediately. It is easier for doctors to stay up to date. And patients can use the Internet to find out more about the disease and the progress being made fighting it.
