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By Suzanne Rostler
NEW YORK, Mar 13 (Reuters Health) - Against a backdrop of controversy over access to AIDS drugs in the developing world, a study published Tuesday illustrates just how effective these drugs have been in the US.
According to the report in The Journal of the American Medical Association, Americans who are diagnosed with AIDS today can expect to live nearly 3 years longer than patients diagnosed in the mid 1980s.
The study found that half of all adults and adolescents diagnosed with AIDS in 1995 could expect to survive for 46 months or more, compared with 11 months for those diagnosed in 1984. Survival time increased every year from 1984 to 1987 for all ethnic groups.
The researchers from the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia did not investigate the reasons behind the trend, but they attribute longer survival times to improvements in antiretroviral drug therapy and to more patients using "cocktails" of these drugs.
The biggest improvements in survival were seen after 1995, the year in which the powerful protease inhibitor drugs were introduced.
By destroying the immune systems of infected people, HIV leaves them prone to other diseases, and doctors can define AIDS according to the development of one of these so-called AIDS-defining illnesses. The authors note that preventing these illnesses has also contributed to improvements in survival time.
While the findings are good news for patients in the US, the trend will challenge the healthcare system to meet the changing needs of patients, Dr. Lisa M. Lee and CDC colleagues write. According to one study they cite, the number of people living with AIDS rose 33% between 1996 and 1999.
In an interview with Reuters Health, Lee explained that people with AIDS will need ongoing support to help them avoid risky sex and drug behaviors and to stick to complex drug regimens.
"It will be important to develop strategies to help patients adhere in the long term and to develop regimens that are simpler to take, for example, fewer pills per day and fewer restrictions on taking medications with our without food," Lee said.
While the drugs are accessible to many patients in the US, their high price puts them out of reach for patients in developing nations. At present, the pharmaceutical industry is embroiled in a fierce legal battle with the government of South Africa over access to cheap drugs to fight HIV/AIDS.
But greater access to these drugs would not necessarily benefit the developing world as much as it has industrialized nations, Dr. Paolo Miotti, chief of epidemiology in the division of AIDS at the National Institute of Allergies and Infectious Diseases, told Reuters Health.
"Essentially, this is very good news for the US but we have to be careful about extrapolating the results to other countries," he said. "The availability of these drugs is just the first step."
A complicated drug regimen and side effects that range from diarrhea to metabolic changes make it necessary to monitor patients constantly to make sure they continue to take the drugs, he explained.
"These (side effects) have proven very difficult to handle even in the US," Miotti said.
The findings are based on an analysis of data from the CDC's national HIV/AIDS surveillance system.
SOURCE: The Journal of the American Medical Association 2001;285:1308-1315.
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