I started my project to learn about the what is the future of HIV/AIDS effective therapies.Hence I formulated my question, “What is the future of HIV/AIDS medication and which therapies will be effective?”
I connected with Sirika Pillay, a Stanford Researcher. She holds a PhD in Immunology and MSc in Molecular and Cellular Biology.She inspired me during our interview, when she mentioned, ““Antiretroviral drugs are effective medication against HIV, and have made HIV no longer terminal. People can still live healthy lives and live with HIV.”
In order to learn about the future treatments and medication of HIV, we first need to learn about the history of HIV treatment.AZT was the first drug approved by the FDA, that interferes with virus replication. After the first year, HIV becomes ineffective.Another option is Drug Combination or Drug Cocktail. A drug cocktail is a dose of medication that includes several different drugs, and these have proven to be more effective lately.
Coming to the current event, it has been proved in South Africa, that patients who start the antiretroviral drugs will improve their life expectance to around 80% of the general population. This affirms Sirika’s statement, at the beginning, about HIV patients living healthier lives.
March 3, 2013 was a major breakthrough in the battle against HIV. Medical advancements have helped to eliminate HIV infection in a child. The first functional cure is a beacon of hope to future medical researchers.July 2012 was also a major month for HIV treatments. PrEP and PEP, which are the currently used drugs, are approved by the FDA.
My main experience event was attending the SF HIV Prevention Planning Council meeting, where I gave my own public comment. I listened to several council member and discussed with board members about the future advancements in HIV.
Among the board directors that I discussed with, Frank Strona helped my project a lot. He helped set up meetings with other important HIV experts in San Francisco. I met with Charles Fann and Robert Blue who are PrEP and PEP experts. I also met with Erin Atunez from LINCS, a partner service in San Francisco.
Since I was unable to volunteer at LINCS, I found a non-profit organization- ACRC. AIDS Community Research Consortium provides services such their food service, needle exchanges, and their stretching exercise. I was however only able to volunteer at their food services and help set for the stretching exercise class.
At ACRC, I packed canned food that would be later distributed for HIV/AIDS patients who can not afford them.
When I was packaging a bag, an AIDS patient walked in and I handed him a bag of healthy meals. I knew that in the long run, I would help that patient maintain a healthier lifespan by providing a whole balanced diet.
After I had met with Robert Blue, I decided to make a list of all HIV drugs approved by the FDA. When I met with Robert Blue the second time, he had informed me the at last three drugs on the list are PrEP/PEP drugs, along with Truvada. In order to be classified as PrEP/PEP a drug must contain Tenofovir and Emtricitabine.When I showed the list of PrEP/PEP drugs to my service coordinator, Milton quickly pointed out that Atripla has many side effects, mainly by the third drug in the combination. Efavirenz has many side effects, as shown by the table on the left. This has helped me to answer my essential question, that while PrEP/PEP are effective drug combinations, a patients should be careful in their selection.
So my answer so far is not complete yet. My prior knowledge still the best suggestions: practicing safe sex and using sterile needles. My research confirmed that drug cocktails are the best preventive medications, among which PrEP and PEP are the most effective. Patients who enter the AIDS stage should maintain healthy lifestyles by eating whole balanced meals, and exercising daily.
I hope that one day, these images of HIV virus will no longer be associated with fear among researchers and patients. Thank you for listening to my presentation.
+The Futureof HIV/AIDS:Treatment &MedicationQUESTTestimonyMay 14, 2013Mr. CanaveroMr. PhillipsAkash ModyID # 142104EQ: What is the future ofHIV/AIDS medication andwhich therapies will beeffective? What servicesare available to HIV/AIDSpatients in the SanFrancisco Bay Area?
+Essential QuestionWhat is the future of HIV/AIDSmedication and which therapies will beeffective? What services are available toHIV/AIDS patients in the San FranciscoBay Area?
+Sirika Pillay Stanford Researcher PhD in Immunology and MSc in Molecular and CellularBiologyPillay, Sirika. Personal Interview. November 20, 2012“Antiretroviral drugsare effectivemedication againstHIV, and have madeHIV no longerterminal. People canstill live healthy livesand live with HIV”(Pillay).
+HIV Treatment: History AZT 1st drug approved by FDA. AZT interferes with virus replication. AZT can control HIV for a year, after that it will become ineffective. Drug Combination/Cocktail A drug cocktail is a dose of medication that includes several differentdrugs. Clinical studies have shown that in most cases HIV infection is moreeffectively treated with a combination of drugs. This has led to thedevelopment of different anti-viral cocktails. The medical drug class for these drugs are called Fixed-DoseCombination.DiSpezio, Michael A. "HIV Transmission." The Science, Spread, and Therapy of HIV Disease: Everything You Need toKnow, But Had No Idea Who to Ask. Shrewsbury, MA: ATL, 1998. 52-65. Print.
+HIV Treatments: The Currents May 2, 2013 – New Drug Therapy Researchers recently discovered that syntheticanti-inflammatory substances distantly related to theactive ingredient of marijuana may be able to takethe punch out of HIV while inside one of its majorhideouts: immune cells called macrophages. April 9, 2013 – Connection to Consultant In South Africa, people with HIV who start treatmentwith antiretroviral therapy have life expectanciesaround 80% of that of the general population providedthat they start treatment before their CD4 count dropsbelow 200.Public Library of Science. "Treatment leads to near-normal life expectancy for people with HIV in South Africa." ScienceDaily, 9 Apr. 2013. Web. 10Apr. 2013.Temple University Health System. "Scientists weaken HIV infection in immune cells using synthetic agents." ScienceDaily, 1 May 2013. Web. 2 May2013.
+HIV Treatments: The Currents (Cont.) April 2, 2013 – Self-Testing A new international study has confirmed that self-testing for HIV is effective and could be the answer tocontrolling the global epidemic. This systematic review shows HIV self-testing removes muchof the fear and stigma associated with being tested for thedisease. This study could pave the way for early detection andtreatment around the world, thereby reducing transmission. March 3, 2013 – First “Fully Functional Cure” A team of researchers from Johns Hopkins Childrens Center,the University of Mississippi Medical Center and the Universityof Massachusetts Medical School describe the first case of aso-called "functional cure" in an HIV-infected infant. The finding, the investigators say, may help pave the way toeliminating HIV infection in children.McGill University Health Centre. "HIV self-testing: The key to controlling the global epidemic." ScienceDaily, 2 Apr. 2013. Web. 10 Apr. 2013.University of Massachusetts Medical School. "Researchers describe first functional HIV cure in an infant." ScienceDaily, 3 Mar. 2013. Web. 10 Apr.2013.
+ July 2012 – PrEP and PEP The FDA approved a combination medication for useas PrEP among sexually active adults at risk for HIVinfection. PrEP is short for Pre-Exposure Prophylaxis. It is anew HIV prevention method in which people who donot have HIV take a daily pill to reduce their risk ofbecoming infected."Pre-Exposure Prophylaxis (PrEP)." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Aug. 2012.Web. 8 Jan. 2013. http://www.cdc.gov/hiv/prep/.HIV Treatments: The Currents (Cont.)
+Potentials to Lower HIV/AIDS Rates1. Continued Research: HIV Interactions Structure Diagnosable Solution- After you are diagnosed with HIV Drug Combinations Prevention- Before you are actually diagnosed from HIV Vaccinations2. Education- What we already know. Abstain from activities that involve blood-to-blood contact Practicing safe sex Use sterile needles Know your HIV status
+Continued Research on HIV April 17, 2013 – Understanding HIV Structure Researchers have discovered how the protein that blocksHIV-1 from multiplying in white blood cells is regulated. HIV-1 is the virus that causes AIDS, and the discoverycould lead to novel approaches for addressing HIV-1 “inhiding” – namely eliminating reservoirs of HIV-1 thatpersist in patients undergoing antiretroviral therapy. April 4, 2013 – Update on Vaccination Therapy Observing the evolution of a particular type of antibody inan infected HIV-1 patient, a new study has providedinsights that will enable vaccination strategies that mimicthe actual antibody development within the body.Albert Einstein College of Medicine of Yeshiva University. "Discovery may help prevent HIV: Insights into eliminating reservoirs of HIV-1."ScienceDaily, 17 Apr. 2013. Web. 29 Apr. 2013.DOE/Los Alamos National Laboratory. "Antibody evolution could guide HIV vaccine development." ScienceDaily, 4 Apr. 2013. Web. 10 Apr.2013.
+ October 2009 – First Vaccine Test Vaccination tests conductedin Thailand, among 16,400participants had a 31% rateof protection. While the rate of protectionshowed historic results, itwas negligible since 69% stillcontracted the virus. Therefore doctors are unableto use this vaccine onpatients.Porter, Lance, ed. "Thai HIV Vaccine Trial Produces Historic Positive Results." HIV Positive Oct.-Nov. 2009: 42-44. Print.Continued Research on Vaccinations
+SF HIV Prevention PlanningCouncil (HPPC) Public Comment Listened to council andother county members Discussed with boarddirectors.
+Serving the AIDSCommunity ACRC (AIDS Community Research Consortium) Food Service Needle Exchange Stretching Exercise
+Gratification Packed canned food forpatients diagnosed with HIV orAIDS, who can not affordthem. Bags included wholebalanced meals. I talked with patients living withAIDS.
+Contribution Volunteered at a non-profitorganization to help pack meals. Distributed packed meals for walk-inAIDS patients, who can not afford topay for these meals. Helped lengthen the lifespan ofpatients by providing health options.
+PROTEASE INHIBITORS (PIs)BRAND NAME GENERIC NAME COMPANY DATE APPROVEDInvirase Saquinavir Roche Dec. 6, 1995Norvir Ritonavir Abbott Mar. 1, 1996Crixivan Indinavir Merck Mar. 13, 1996Viracept Nelfinavir ViiV Healthcare Mar. 14, 1997Kaletra Lopinavir/Ritonavir Abbott Sep. 15, 2000Reyataz Atazanavir Bristol-Myers Squibb Jun. 20, 2003Lexiva (U.S.)Telzir (Europe)Fosamprenavir ViiV Healthcare Oct. 20, 2003Meltrex Formulation Lopinavir/Ritonavir Abbott 2005Aptivus Tipranavir Boehringer Ingelheim Jun. 22, 2005Prezista Darunavir Tibotec Jun. 23, 2006Protease Inhibitors (PIs) A protease inhibitor is a chemical that hinders the actions of protease. “PIs [Protease Inhibitors] block the protease enzyme and prevent the cell fromproducing new viruses” (“Protease Inhibitors” par. 1). By meddling with this enzyme, proteins essential to the virus replication are notreproduced. In this way, the HIV virus fails to take over the host cell. Using a single protease inhibitor is not effective, as the HIV DNA will form aresistant strain; using multiple protease inhibitors as drug combinations areeffective because when one drug fail, the other drugs kick in terminating theresistant strains."Protease Inhibitors (PIs)." AIDS Meds. N.p., 14 Nov. 2012. Web. 22 Apr. 2013. <http://www.aidsmeds.com/archive/PIs_1068.shtml>.
+Nucleoside/Nucleotide ReverseTranscriptase Inhibitors (NRTIs) Nucleoside/Nucleotide Reverse Transcriptase (NRTIs) slows the replication process of HIVDNA. “NRTIs, sometimes called „nucleoside analogues‟ or „nukes,‟ contain faulty versions of thebuilding blocks (nucleotides) used by reverse transcriptase to convert RNA to DNA. Whenreverse transcriptase uses these faulty building blocks, the new DNA cannot be builtcorrectly. In turn, HIVs genetic material cannot be incorporated into the healthy geneticmaterial of the cell and prevents the cell from producing new virus” (“Nucleoside” par. 2). In this way, the HIV will infect a cell but will not be able to make a new virus from that cell. AZT, mentioned previously, falls under the drug class NRTI."Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)." AIDS Meds. N.p., 31 Jan. 2012. Web. 22 Apr. 2013. <http://www.aidsmeds.com/archive/NRTIs_1082.shtml>.NUCLEOSIDE/NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)BRAND NAME GENERIC NAME COMPANY DATE APPROVEDRetrovir Zidovudine (AZT) ViiV Healthcare Mar. 19, 1987Zerit Stavudine (d4T) Bristol-Myers Squibb Jun. 24, 1994Epivir Lamivudine (3TC) ViiV Healthcare Nov. 17, 1995Ziagen Abacavir ViiV Healthcare Dec. 17, 1998Videx Didanosine (ddI) Bristol-Myers Squibb 1999Videx EC Didanosine (ddI) Bristol-Myers Squibb Oct. 31, 2000Viread Tenofovir Gilead Oct. 26, 2002Emtriva Emtricitabine (FTC) Gilead Jul. 2, 2003
+NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)BRAND NAME GENERIC NAME COMPANY DATE APPROVEDViramune Nevirapine Boehringer Ingelheim Jun. 21, 1996Rescriptor Delavirdine ViiV Healthcare Apr. 4, 1997Sustiva (U.S.)Stocrin (elsewhere)Efavirenz Bristol-Myers Squibb Sep. 17, 1998Intelence Etravirine Tibotec Jan. 18, 2008Edurant Rilpivirine Tibotec May 20, 2011Non-Nucleoside/Nucleotide ReverseTranscriptase Inhibitors (NNRTIs) NNRTIs work similar to NRTIs, but activate a different protein toprevent the DNA from replicating into a new virus. Nucleoside and Non-nucleoside analogs are drugs that targetthe copying of genetic information by HIV. “NNRTIs, also known as „non-nucleosides‟ or „non-nukes‟ forshort, attach themselves to reverse transcriptase and preventthe enzyme from converting RNA to DNA. In turn, HIVs geneticmaterial cannot be incorporated into the healthy geneticmaterial of the cell, and prevents the cell from producing newvirus” (“Non-Nucleoside” par. 1)."Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)." AIDS Meds. N.p., 22 June 2011. Web. 22 Apr. 2013. <http://www.aidsmeds.com/archive/NNRTIs_1612.shtml>.
+Other Drug Classes Fusion Inhibitors, CCR5 Antagonists, and Integrase Inhibitor area allEntry Inhibitor Drugs. CCR5 and Integrase are the proteins located on the cell wall of hostcells, to which the HIV virus attaches to. “Entry inhibitors target the CD4 protein or the CCR5 or CXCR4receptors on a CD4 cells surface. If entry inhibitors are successful inblocking these proteins, HIV is unable to bind to the surface of CD4cells and gain entry into the cells” (“Entry Inhibitors” par. 2). In this way, the HIV virus is unable to gain entry into the host cell at alland unable to create a new HIV virus. “HIV-positive people who have become resistant to PIs, NRTIs, andNNRTIs will likely benefit from the entry inhibitors because they are adifferent class of drugs” (“Entry Inhibitors” par. 4).OTHER CLASSESBRAND NAME GENERIC NAME COMPANY DATE APPROVEDFuzeon Enfuvirtide (T-20; Fusion Inhibitor) Roche/Trimeris Mar. 13, 2003Selzentry (U.S.)Celsentri (elsewhere)Maraviroc (CCR5 Antagonist) ViiV Healthcare Sep. 18, 2007Isentress Raltegravir (Integrase Inhibitor) Merck Oct. 12, 2007"Entry Inhibitors (including Fusion Inhibitors)." AIDS Meds. N.p., 16 Sept. 2011. Web. 22 Apr. 2013. <http://www.aidsmeds.com/archive/EIs_1627.shtml>.
+FIXED-DOSE COMBINATIONSBRAND NAME GENERIC NAME COMPANY DATE APPROVEDCombivir Zidovudine/Lamivudine(NRTI)ViiV Healthcare Sep. 27, 1997Trizivir Zidovudine/Lamivudine/Abacavir(NRTI)ViiV Healthcare Nov. 14, 2000Epzicom (U.S.)Kivexa (Europe)Lamivudine/Abacavir(NRTI)ViiV Healthcare Aug. 2, 2004Truvada Tenofovir/Emtricitabine(NRTI)Gilead Aug. 2, 2004Atripla Tenofovir/Emtricitabine/Efavirenz(NRTI/NNRTI)Gilead/Bristol-Myers SquibbJul. 6, 2006Complera Tenofovir/Emtricitabine/Rilpivirine(NRTI/NNRTI)Gilead/Tibotec 2011Stribild Tenofovir/Emtricitabine/Elvitegravir/Cobicistat(NRTI/Integrase Inhibitor)Gilead 2012Drug Combinations/Fixed-Dose Combination Fixed-Dose Combinations are the drug class for drug combinations/cocktails. Fixed-Dose Combinations are “capsules or tablets that contains two or more drugs. Thistype of drug formulation allows a patient to take multiple drugs at on time to decrease pillburden and increase adherence” (“Fixed-Dose Combination”). The last four drugs in the fixed-dose combination, Truvada, Atripla, Complera, andStriblid, are considered PrEP and PEP. These drugs include Tenofovir and Emtricitabine."Fixed-Dose Combination." Health HIV. N.p., 2013. Web. 21 Apr. 2013. <http://www.healthhiv.org/modules/info/glossary_of_hiv_terms.html>.
+So, what is the future of HIV/AIDSmedication and which therapies willbe effective, and which service areavailable in the SF Bay Area? Education is the best prevention from a non-medical aspect. Practicing safe sex and using sterile needles will lower the HIV/AIDSspread. From my research, I have found that drug cocktail is the best method ofmedication. PrEP and PEP seem to be the most effective. Administer antiretroviral drug therapy before the CD4 count drops 200. Patients who are diagnosed with AIDS should try to maintain healthierlifestyles that includes eating whole balanced meals, exercising daily, andsleeping the required 8 hours of sleep.
+The Future Continued research of the interactions between blood cells and theHIV is required, although new research on the “proteins that blocksHIV-1 from multiplying in white blood cells is regulated” and “observingthe evolution of a particular type of antibody in infected HIV-1 patients”seem promising. Vaccination is a near possibility from a “prevention” method aspect, asopposed to drug “treatment” method.Services in SF Bay Area San Francisco provides a free partner service to potentially new HIV patientsas part of the LINCS Service. This service allows patients to know their HIV status, which can allownew HIV patients to stop the spread of HIV before they infect otherpartners. ACRC, in San Mateo, provides free whole balanced meals to AIDS patientsthose who cannot afford them. They also offer free stretching class to improveoverall fitness and needle exchanges to prevent further spread.