How Have the Antiviral Therapies for HIV Evolved?

Read Transcript

It was a gradual process. Sometimes exhilarating and sometimes very painful. So from 1981 until 1983, 84 when we found out it was HIV, we were swimming in the dark, we had no idea, we were just putting band aids on hemorrhages and we were treating opportunistic infections, and since we didn't know what the virus was, there was no way of developing any therapy.

Then as soon as it was discovered in 83 and proven in 84 that it was the cause of AIDS then we developed a combination of screening for drugs that were already made for other purposes and targeting antiretroviral drugs based on what we knew about the viral biology, and we screened a bunch of drugs then finally AZT came along and AZT was a very dramatic clinical trail that was one group got AZT and the other group didn't and you look that the number of deaths in one group verses the other was 19 and the people who didn't get AZT and one, and the group that get it. That was about as much of slam dunk as you possibly could do so there was a great deal of a elation that we now have not a cure, but certainly a treatment. But we soon came to realize that like many other RNA viruses, they have the real easy capability of mutating because they replicate so rapidly, and very quickly, they mutated to become resistant to AZT.

Which then brought us into the next challenge of the way you get around resistance is that you hit the virus with multiple different antiretrovirals aimed at different targets on the virus, and over period of years, culminating in 1996, 97 when the protease inhibitors came a long and we had a really good triple combination of drugs that completely transformed the treatment of HIV totally. I mean it was, people referred to it as the Lazarus effect, where someone was essentially on their death bed, and you would give them this triple combination and they would within a period of a few moths would make a breathtaking transformation in their health.

So that was the turning point and now we're doing even better and better and I think the next big transition was getting drugs from concentration on the developed world that could approve it, to the developing that really needed it because 90% or more of HIV/AIDs is in the developing world and 67% is in sub Saharan Africa, and that's why the PEPFAR program was such an important program in the global fund and other programs.