Acquired Immunodeficiency Syndrome Issues - Essay Example

Your first and sur Your Due Acquired immunodeficiency syndrome (AIDS) is a fatal disease, caused by a retrovirus that attacks the immune system, making the patient susceptible to infection. Due to the syndrome the patient has no means to fight infection. AIDS was first recognized as a disease in 1981, later isolated in 1983 and subsequently labeled human immunodeficiency virus (HIV). Despite progress in the treatment and understanding of AIDS, questions still exist regarding the action of the virus. As a process it is believed that HIV infects the CD4 cells (T4 or T-helper cells) of the body's immune system, cells that are necessary to activate B-lymphocytes and induce the production of antibodies. The body tries to fight back by producing antibodies, but eventually loses the ability to fight infections. (AIDS in Medicine, 2004) The spread of AIDS has been in great part due to the fact that an individual can have HIV for years, without knowing and therefore infect others. An individual may not have any symptoms or may develop flu like symptoms. "Before serious symptoms occur, an infected person may experience fever, weight loss, diarrhea, fatigue, skin rashes, shingles. By definition, AIDS refers to that period in the infection when the CD4 count goes below 200 (from a normal count of 1,000) or when the characteristic opportunistic infections and cancers appear." Numerous conditions are associated with AIDS including malignancies such as Kaposi's sarcoma, non-Hodgkin's lymphoma, primary lymphoma of the brain, and invasive carcinoma of the cervix. Hepatitis C is also common in intravenous drug users and hemophiliacs with AIDS. Infections can cause a variety of symptoms, including coughing, diarrhea, fever and night sweats, and headaches. AIDS may lead to extreme weight loss, blindness, hallucinations, and dementia before death occurs. (AIDS in Medicine, 2004) There is no cure for AIDS. There are medications that may delay the onset of symptoms and the failure of the immune system. Drugs, which are reverse transcriptase inhibitors, have proven to be effective in delaying the onset of symptoms in some individuals. The addition of a protease inhibitor has increased the effectiveness of medications, but still does not cure AIDS or eliminate the virus from the body. Higher rates of success have been achieved with a cocktail of a variety of medications, including both protease inhibitors and reverse transcriptase inhibitors. "Efavirenz (Sustiva), another type of reverse transcriptase inhibitor, must be taken with protease inhibitors or older AIDS medicines. Opportunistic infections are treated with various antibiotics and antivirals, and patients with malignancies may undergo chemotherapy. These measures may prolong life or improve the quality of life, but drugs for AIDS treatment may also produce painful or debilitating side effects." (Muir, 1991) Protease inhibitors, first approved in 1995, were designed for use in combination with reverse transcriptase inhibitors. The AIDS cocktail or triple-combination therapy, consists of a protease inhibitor and two reverse transcriptase inhibitors such as AZT and 3TC. Protease inhibitors work by disrupting the HIV replication cycle. "Protease is another enzyme that is essential in the replication of HIV, but rather than acting on the process of genetic transcription, protease is necessary for breaking down viral proteins into the proper components for the maturation of new virus particles." In the absence of protease, the formation of viral proteins is incomplete, slowing the process of the virus. When taken together, the actions of reverse transcriptase inhibitors work in the early stages of the syndrome, while protease inhibitors interrupt processes in the final stages of maturation of new virus particles. (Henkel, 1999) Clinical trials have demonstrated the effectiveness of this combination therapy and resulted in an advancement in the treatment of HIV. "Clinical trials of combination treatments showed dramatic declines in the amount of HIV present in blood. Within 2 weeks of initiating treatment, patients showed100-fold reduction in the amount of HIV in their bloodstream, with HIV becoming undetectable in some cases." There has also been evidence that suggests that protease inhibitors reduce viral load in lymphatic tissue and possibly semen and vaginal secretions. This does not suggest that the virus is no longer within the system however. Research has demonstrated that combination therapy may reduce infection, but do not appear to reduce the degree to which HIV is transmitted. This risk continues to be unknown. (Mitchell & Linsk, 2004) Compliance with the treatment regimen is critical to the success of the medications, and there is a greater risk of drug resistance with protease inhibitors. Although the virus can become resistant to one of the drugs, other drugs can be tried. "It is believed, however, that if the virus develops resistance to one protease inhibitor, it will be resistant to all. Persons enrolled in early studies of indinavir (Crixivan) were given a lower dose than the one now recommended and subsequently developed resistance to the drug." (Elwood, 1999) The concern with sticking to a strict regimen is directed at keeping a constant level of the protease inhibitor in the body to reduce the possibility of the virus becoming resistant. Protease inhibitors all have been shown to cause side effects that may cause individuals to fail to comply with the regimen. If not taken properly, these medications can cause dehydration, kidney stones, nausea, vomiting, weakness, and diarrhea. (Elwood, 1999) Physicians struggle with the use of protease inhibitors. If prescribed and the patient is unwilling or unable to maintain the regimen, they risk becoming resistant, and therefore risk the possibility of transmission a virus to others, who will also be resistant to the medication. Greater success has occurred when a physician can determine the pat compliance of a patient in taking their medication prior to prescribing protease inhibitors. The wide variety of individuals afflicted with AIDS also complicates issues, particularly when dealing with compliance to take medications. "Physicians may perceive homeless and drug-addicted people as high-risk groups for noncompliance and not prescribe new cocktail treatments for them. Nevertheless, these people are aware of the benefits from the new treatments and may find ways to acquire the medication, including the use of the black market. Those who acquire their treatment via the black market, would be treating themselves without any supervision, increasing the threat of poor compliance and drug resistance." (Elwood, 1999) This combination therapy or AIDS cocktail is costly, averaging about $1,000 per month. Many individuals infected with AIDS are poor and cannot pay for the medication. Very few people could afford this type of cost. A dilemma exists within the healthcare field for health care workers who want to prescribe the cocktails but cannot find funding for this long-term prescription treatment. The rights and responsibilities of health care workers vary from state to state as they are not federally regulated. "A North Carolina adolescent may seek birth control or treatment for sexually transmitted diseases without parental consent. In fact, health care providers are prohibited from disclosing this information to parents without the teen's consent. Thus, many adolescents treated for HIV have not disclosed to their parent(s)." (Elwood, 1999) Some professionals argue that the use of protease inhibitors lead people to a false sense of security, believing that they will not spread the disease because it may no longer be detectable in the blood following treatment. This is dangerous because infected people, even with diminished viral counts, can spread the virus. Additional side effects of the medication can include a type of weight redistribution in which the face and limbs become thin while breasts, stomach or neck enlarges. Research is currently under way to determine if protease inhibitors cause a permanent change in fat metabolism. "There is considerable concern over the long-term effects for patients, including the possibility that the cholesterol increases in some patients who experience fat redistribution could increase the risk for cardiovascular complications such as strokes or heart attacks. FDA has asked each of the makers of protease inhibitors to study these abnormalities." (Henkel, 1999) Research supported by the National Institute of Allergy and Infectious Diseases (NIAID) has demonstrated that in patients with advanced HIV disease the combination of a protease inhibitor plus two reverse transcriptase inhibitors (RTIs) is significantly more effective in reducing the occurrence of AIDS-defining illnesses or death than two RTIs alone. As a result of recent data showing the dramatic effectiveness of protease inhibitors in lowering viral burden, strategies using protease inhibitors in combination with other drugs are being increasingly used. A total of 1,156 HIV-infected volunteers participated in the NIAID study. Participants were enrolled at 33 sites of the NIAID- supported AIDS Clinical Trials Group, and at seven sites of the National Hemophilia Foundation. Participants were studied, on average for a period of 38 weeks, with some patients being followed for up to one year. The long-term effects of this therapy is still unclear. Survival and a delay in disease progression were significantly better in patients receiving triple combination therapy. In that group, AIDS-defining illnesses, including opportunistic infections and cancers, and deaths were decreased by approximately half. "Sixty-three instances of disease progression (including AIDS-defining illnesses and deaths) occurred in volunteers on the ZDV/3TC arm versus 33 in volunteers on the triple combination arm. There were 18 deaths in the double therapy arm versus eight deaths in the triple therapy arm. In addition, the safety of each treatment regimen was closely monitored. There were no major differences in the safety or toxicity of the two treatment regimens and the study medications were well-tolerated." (National Institutes of Health, 1997) There continues to be a need for alternative medications and treatments for HIV/AIDS. The alternatives to the AIDS cocktail, triple therapy is not without risk, and has not been proven to be effective. Protease inhibitors have had the greatest impact on the mortality rate as a result of AIDS, if used on a strict medication regimen. The possibility for resistance can be reduced with psycho-social therapy and monitoring practices that would include the need to determine a patients compliance to the greatest extent possible, and educating patients on the methods needed to reduce the side effects of medication. Based on current research, it is the most effective alternative for the treatment of AIDS. Works Cited "Aids, in Medicine." The Columbia Encyclopedia. 6th ed. 2004. Questia. 8 Mar. 2007 . Elwood, William N., ed. Power in the Blood: A Handbook on AIDS, Politics, and Communication. Mahwah, NJ: Lawrence Erlbaum Associates, 1999. Questia. 9 Mar. 2007 . Henkel, John. "Attacking AIDS with a 'Cocktail' Therapy." FDA Consumer July 1999: 12. Questia. 8 Mar. 2007 . Mitchell, Christopher G., and Nathan L. Linsk. "A Multidimensional Conceptual Framework for Understanding HIV/AIDS as a Chronic Long-Term Illness." Social Work 49.3 (2004): 469+. Questia. 8 Mar. 2007 . Muir, Marie A. The Environmental Contexts of AIDS. New York: Praeger Publishers, 1991. Questia. 8 Mar. 2007 . Read More