Two decades ago, back when I was a resident in the hospital trenches treating AIDS patients with little more than the anti-viral AZT and hope, I never envisioned the world of today, where HIV patients on anti-viral regimens are rarely hospitalized. Who would have imagined back in the 1980s that Jeff Getty, an AIDS patient who received the first bone marrow transplant from a baboon nine years ago, would die this past month not of HIV-related disease, but of heart failure.
Back in 1995, Getty famously said, "I love life. But I learned with this disease, if you don't take some chances, you won't survive."

Some of these chances were taken—not just by the patients—but by the drug manufacturers, who rushed drugs with significant side effects to the market and risked liability in order to combat this deadly disease.

The discovery of protease inhibitors was a revolutionary accomplishment in the world of virology that has changed the course of clinical disease for HIV patients. Here is how these drugs work: When the protease enzyme is blocked, HIV makes copies of itself that can no longer infect new cells. Studies have shown that these drugs reduce the amount of circulating virus in the blood (viral load) and improve the body's immunological response to viruses (CD4 cell counts). When combined with other anti-HIV drugs in the 1990s, the number of patients who became ill from AIDS infections dropped by more than 70%.

There are seven FDA approved protease inhibitors so far, they are: amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), ritonavir (Norvir), saquinavir (Fortovase) and nelfinavir (Viracept), along with the newest, atazanavir (Zrivada). These drugs are often used in combination to offset drug resistance.

At a time when drug companies are routinely criticized for drug safety violations, it is good to recall the life-saving effects of the HIV drugs.



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