Antiretroviral Drugs and AIDS - The Medical News 

                           According to the New York Times both China and
                           South Africa have announced plans to distribute a triple
                           cocktail of life-prolonging antiretroviral drugs free to
                           all who need it. Until recently, South Africa's top
                           officials have resisted these drugs because of a deep
                           belief, shared by others, that antiretroviral drugs are
                           really "poisons." Bowing to enormous international
                           pressure both countries have decided to invest fortunes
                           in drugs that do nothing to cure Aids. Lost, even to the
                           international press, are the lessons from California
                           where the history of fighting this immune disease is
                           oldest. "I have a large population of people who have
                           chosen not to take any antiretrovirals," says Donald
                           Abrams, M.D., director of the AIDS program at San
                           Francisco General Hospital. "They've watched all their
                           friends go on the antiviral bandwagon and die." A study
                           published in the New England Journal of Medicine in
                           1995 showed that one of the things that long-term AIDS
                           survivors had in commo n was that they didn't take
                           antiretroviral drugs. 

                           According to the Times "both countries have now taken
                           a courageous and essential steps." It's comforting to
                           know exactly where the Times sits on this issue but
                           medically a case could be made that "both countries
                           have now taken fearful, costly, and deadly steps that
                           will insure AIDS suffers' will die quicker and in
                           increasing numbers as certain drug companies rack in
                           fortunes. As the market for these drugs have diminished
                           in the US the pharmaceutical companies have to find
                           other markets where the people are vulnerable to
                           marketing campaigns that push these drugs as a
                           "solution."??? 

                           Doctors who are proponents of early treatment say the
                           goal of antiretroviral therapy is to reduce the number of
                           infected cells, preserve HIV-1-specific immune
                           responses and possibly lower the viral set point in the
                           long term. What they do not commonly point out is that
                           such treatments serve to dramatically weaken the
                           immune system. Medically it makes sense to address the
                           risks of antiretroviral therapy including drug toxicity,
                           development of resistance, acute retroviral syndrome
                           during viral rebound and super infections that occur
                           during treatment interruptions. 

                           Treatment of HIV infection is at best a complicated
                           balancing act between the benefits of attempted HIV
                           suppression and the risks of drug toxicities. More than
                           half the patients switch therapies within the first few
                           months because of side effects and roughly 20% of all
                           patients refuse to even begin aggressive anti viral
                           medical regimes due to concerns regarding the side
                           effects. Gastrointestinal problems are the most common
                           side effects of almost all antiretroviral drugs -
                           nucleoside analogs, NNRTIs and particularly protease
                           inhibitors. Typical symptoms include abdominal
                           discomfort, loss of appetite, diarrhea, nausea and
                           vomiting. Heartburn, abdominal pain, meteorism and
                           constipation may also occur. Nausea is a common
                           symptom with zidovudine-containing regimens; diarrhea
                           occurs frequently with zidovudine, didanosine and all
                           PIs, particularly nelfinavir, as well as with saquinavir
                           and lopinavir. In addition to the often-considerable
                           impact on everyday life, gastrointestinal si de effects
                           can lead to dehydration, malnutrition with weight loss
                           and low plasma drug levels and this is especially
                           critical in places like South Africa and certain parts of
                           China where malnutrition is already a main factor in
                           immune system failure. A number of medical people
                           who originally endorsed the cocktail withdrew their
                           support when long-term damage to the liver began
                           showing up and others threw in the towel when the heart
                           and kidneys were being damaged. 

                           Dr. Mohammed Al-Bayati, a pathologist, said, "The
                           medications currently used to treat patients with AIDS,
                           such as AZT, protease inhibitors, and glucocorticoids,
                           are highly toxic. They can even cause AIDS in
                           asymptomatic patients, and make the disease worse in
                           patients with AIDS. These drugs do not have any
                           therapeutic value." The South African governments
                           resistance to these drugs was rational though not an easy
                           one to defend when ganged up on by the international
                           medical community backed to the hilt by the press.
                           These 'triple cocktails' are extremely toxic like
                           chemotherapy is for cancer patients and anyone who
                           reduces the reality of the tremendous risks in taking
                           them, even under ideal conditions, is playing people for
                           fools. Worse they are playing doctor, the kind with no
                           ethics, training or discipline. Perhaps the New York
                           Times should have its medical license taken away from
                           it since it assumes to practice medicine so
                           irresponsibly. It does seem that the?health departme nt
                           at the Times has?become?a marketing department?for
                           drug companies. 

                           Medical News Editorial
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