An era of unprecedented medical optimism has dawned in the treatment of HIV/AIDS, while alternative therapies thrive

[Part II of a two-part series]

BY PETER DELVECCHIO

While far from knocked out, HIV is increasingly on the ropes, pummeled from more directions all the time.

“The last six to nine months ... have been a record-breaking [period] in new therapeutic developments becoming available for the treatment of HIV infection,” Dr. David Hardy (310/423-3896), director of the Division of Infectious Diseases at Cedars-Sinai Medical Center and professor of medicine at UCLA’s David Geffen School of Medicine, told Frontiers.

Three recently approved breakthrough medications have ushered in what renowned Los Angeles-based HIV/AIDS expert Dr. Tony Mills (310/550-1010; www.tonymillsmd.com) calls “probably the most hopeful time that we’ve ever experienced for HIV treatment.” With these new drugs, Mills said, “I think we have the means in our armament now to probably get 98-99% of people undetectable.”

The three new pharmaceutical roundhouse punches are Selzentry, Intelence, and Isentress. Each attacks HIV at a different stage of the infection process.

Selzentry is the first in an entirely new class of drugs. It works by “blocking the virus’ ability to attach to a receptor on the outside of a human T cell and therefore stops the virus from being able to infect the cell,” Hardy said.

Think of the receptor as HIV’s door into the cell. Selzentry “makes the doorknob such that the virus cannot hold onto it anymore,” Hardy explained, effectively locking it out. Selzentry is effective against most HIV strains prevalent in North America.

Intelence is a new drug in an existing class called “non-nucleoside reverse transcriptase inhibitors,” or NNRTIs. Once inside a human cell, HIV converts its own single-strand genetic material, RNA, into the familiar double-strand DNA in a process called “reverse transcription.” NNRTIs prevent this from happening.

The older NNRTIs’ have an “Achilles’ heel,” as Hardy puts it, “the virus can become resistant to [them] with a single mutation.” The mutation that makes HIV resistant to the older NNRTIs, however, has no effect on Intellence because the virus must accumulate three other separate mutations to become resistant—a far less likely scenario.

Like Selzentry, Isentress is the first drug in a new class, known as “integrase inhibitors.” After the RNA-to-DNA conversion, HIV “integrates” its DNA into that of the human cell in a process Hardy likens to film splicing. Isentress derails this integration.

The new drugs offer hope for those with dwindling treatment options—resistance to all three seems very low. So far, they also appear to have few side effects.

“They’re incredibly well-tolerated,” said Mills, which means patients are more likely to stick with their regimens.

The three medications are available, are being widely prescribed, and have not run into any coverage issues with private insurers, Medicare or ADAP, said Racquel Sperrazzo, manager of the L.A. Gay & Lesbian Center’s pharmacy. The Center offers HIV/AIDS treatment through its Jeffrey Goodman Special Care Clinic. (323/993-7400; www.lagaycenter.org.) AIDS Healthcare Foundation also operates an increasing number of pharmacies, including a new one in West Hollywood. (888/AIDSCARE; www.aidshealth.org.)

More new treatments lie on the horizon. One, a “monoclonal antibody infusion,” will, like Selzentry, block HIV’s access to human cells, said Dr. Homayoon Khanlou, chief of medicine at AIDS Healthcare Foundation. But it will be “much broader” than Selzentry, blocking more viral strains, Khanlou said.

Beviramat, a drug in a third new class, is also being tested. Once the virus has integrated into the human cell, Khanlou explained, “it has to come out of the cell and in that process has to do some maturation” before it can infect other cells. In effect, Beviramat prevents HIV from growing up.

Acupuncture and herbal approaches to HIV/AIDS are also flourishing. Acupuncture is based on the principle that there’s “energy moving through the body,” explained Russell Brown of Evolve Wellness Center, which provides acupuncture and other traditional Chinese medicine services in West Hollywood. (323/822-9030; www.evolvewellness.com.)

The virus creates imbalances in this energy flow, which acupuncture helps re-establish. Acupuncture is effective for “basic promoting of wellness” as well as relief from chronic pain, from HIV-related damage to the peripheral nervous system, and from the digestive side effects of HIV/AIDS drugs, Brown explained. Being Alive in West Hollywood also offers acupuncture. (310/289-2251; www. beingalivela.org.)

More people living with HIV/AIDS are also trying herbal therapies, usually in conjunction with a drug regimen.

Herbs supplement the pharmaceuticals and are used mostly “to treat the side effects of the meds” and “strengthen the patient’s constitution,” Brown said.

Sales of herbal products, including new Japanese mushroom-based compounds said to boost the immune system, are growing by “leaps and bounds,” said Nancy Richeimer, a kinesiologist and herbal practitioner at Capitol Drugs in West Hollywood. (310/289-1125; www.capitoldrugs.com.) But the Center’s pharmacist, Sperrazzo, cautions to anyone taking HIV/AIDS drugs: consult your doctor before starting any herbal regimen.

The one shadow cast over the new HIV drug treatments is the misperception that HIV/AIDS is now just another manageable disease—Mills reports more diagnoses in men under 25 who did not see the epidemic’s early years and in older men suffering from “safer-sex fatigue.”

In fact, HIV/AIDS remains deadly. Preliminary statistics report 153 AIDS-related deaths in L.A. County in the second half of 2007 alone.

The National Institutes of Health have “[wasted] billions of dollars in approaches that we know are failing rather than investing in medication and prevention,” Khanlou said. On a March 25 teleconference call, he and AIDS Healthcare Foundation President Michael Weinstein urged the suspension of U.S. funding for an HIV vaccine.

Mills and Hardy do not rule out an eventual cure, however, which Hardy called a “lofty goal, but one certainly that is worth pursuing.”