A positive HIV result is not a death sentence thanks to advances in drug treatment. David Labanyi reports
'When we diagnose someone with HIV, the first thing we say is that 'you are going to be very well and your life prospects and job prospects are not diminished'."
So says Prof Fiona Mulcahy, consultant physician and director of the HIV clinic at St James's hospital, which has about 2,200 HIV-positive patients. Someone diagnosed with HIV can now expect to live for at least 30 years, if they diligently adhere to a daily regime of taking antiretroviral medication, she says.
The development of the triple-therapy in 1996 was a significant advance in the management of HIV. Previous treatment regimes based around the drug AZT failed because the virus mutated, rendering the drug ineffective.
The solution was to use combinations of three drugs. "We now give three drugs, so we are attacking the virus on three different areas."
There are many variants within each of the three drugs which allows doctors to tailor treatment to an individual's needs.
However, all drug combinations rely on the patient taking the drugs every day. "With the best will in the world it is hard to keep patients taking tablets for the long haul," says Mulcahy. "But if the patient has less than 90 per cent adherence, you are going to run into problems."
The use of alternative medicines by HIV-positive patients can also create difficulties. A doctor in the St James's clinic recently discovered that St John's Wort interacts with retrovirals used to suppress HIV, rendering them ineffective.
"Our major concern with alternative medicine, apart from the cost to the patient, is that there would be an interaction rendering drugs we know to be highly efficacious, ineffective. So they have to tell us what they are using, " says Mulcahy.
The St James's clinic has also been at the forefront in developing treatment regimes for disadvantaged groups. Intravenous drug users had very poor adherence to their medication regimes.
It was subsequently found that some antiretrovirals interact with drugs of abuse, and with methadone, resulting in patients not taking their medicine. Following studies, staff at St James's found which medicines were affected and drew up internationally used guidelines for treating marginalised groups.
Mulcahy says a cure for the virus remains remote. "Researchers are working on refining the multiple drug strategies. We can now control the virus.
"The next step is looking at side-effects and a 'magic pill' combining all three drug classes."