AIDS prevention and treatment compliance: Is there new hope?

Posted Sep 1, 2013 by Hugh A. Ostrow
Several factors contribute to the persistence of the AIDS or Human Immunodeficiency Virus (HIV). Highest among them are lack of compliance and lack of prevention.
University of Western Ontario researcher working on the development of an HIV/AIDS vaccine.
University of Western Ontario researcher working on the development of an HIV/AIDS vaccine.
University of Western Ontario YouTube video
Although new prescription medicines and regimens show promise of preventing many high risk patients from ever acquiring the disease, this benefit cannot be obtained without diligent compliance. According to the Huffington Post one AIDS patient for years appeared to be winning his personal battle against the HIV virus while he took his medicines regularly. Then his Pentecostal minister convinced him to rely solely upon prayer and faith in a miracle for a cure. After the patient’s minister convinced the patient to stop taking all HIV medicines, the patient’s health quickly declined and he is now near death. The former attending physician agrees that faith or other non-medicinal options may provide great comfort and benefit to patients with currently un-curable conditions. He wonders what the effect will be upon us all if other patients are given advice to stop all medical treatment for less controversial illnesses such as diabetes or hypertension Huffington Post.
It is thought that an ounce of prevention is worth a pound of cure but in fact an ounce of prevention might be worth a ton of cure in high risk individuals such as those having unprotected sex or sharing needles for IV substance abuse. Although many believe incorrectly that HIV is only an affliction among male homosexuals, worldwide the truth is very different. In Africa HIV is primarily a disease of heterosexual men and women while in Asia and Eastern Europe IV drug users make up most of victims of this disease. Bloomberg News recounts that several AIDS drugs demonstrate the ability to greatly reduce or totally prevent the transmission of the HIV virus between individuals who engage in high risk activities. A dilemma exists because many high risk individuals find it difficult to obtain the medicines which can prevent the transmission of the virus. In several studies of African women the prevention treatment program failed because the women were unable to be compliant and take the pills every day as instructed Bloomberg News.
Probably one of the most common and effective drugs for both HIV treatment and HIV prevention is Viread or tenovofir. Positively Aware outlines that unlike many other HIV drugs, this nucleoside analogue antiviral is generally well tolerated by most patients, Viread is not metabolized through the liver, and it is also effective for treating the Hepatitis B that many AIDS patients also have. Side effects of Viread include a decline in kidney function, exacerbation of diabetes or triglycerides/lipid abnormalities, and substantial bone loss. The cost of Viread was initially very high but has now been reduced so it is much more affordable.
There are also other concerns related to using Viread as a treatment for HIV or as a treatment preventative. The author was a participant in the original clinical drug trials of Viread (tenofovir) and is perhaps one of the longest living survivors on this drug. It is known that the AIDS virus itself may cause premature senescence or aging, neurocognitive impairment, and susceptibility to cardiovascular disease or cancer. According to AidsMap the actions of all nucleoside analogue antivirals include permanent damage to mitochondrial DNA. Recent studies show that in the test tube Viread also damages the telomere length of all chromosomes more than other drugs and this may possible greatly increase the aging process. This may mean that long-term use of Viread as an HIV treatment or HIV preventative will have to be weighed against these serious potential side effects.
In Africa, as in a many other countries, cultural and social constraints mean that many women are unable to insist upon their male partners wearing condoms or engaging in other preventative measures during sex. In many situations inadequate screening and testing mean that many individuals are totally unaware they are carrying the virus and are therefore unable to take precautions to avoid spreading it to others. Many individuals may have their judgment impaired by alcohol, drugs, or social pressure and make poor choices which will result in a lifetime burden of living with the AIDS virus. Individuals need to be mindful if they ever as much as once engage in unprotected sex or share needles with anyone with an unknown sexual history, their personal health history will be indelibly linked to someone who also inadvertently shared the AIDS virus with them as well.