HIV Treatment: From 25 Daily Pills, to Only 1 a Day

The first 15 years of the HIV epidemic were a nightmare. The discovery of a rare disease took, perhaps too long to raise the alarms. In the beginning, it was believed that only certain groups of the population (gay men, people who used injectable drugs or who had hemophilia), developed it. 

Without a cure or treatment proven to work, physical death added to another decease that had already taken place, social death, as Mexican writer Carlos Monsiváis came to call it. It took some time before we could understand that HIV could affect any person and that it was important to find treatment for the infection, which had escalated greatly and had become a public health problem

The first treatment

The first treatment that showed good results was AZT (or zidovudine), an agent that had been tested before against cancer, without great success. The 20 pills that had to be ingested each day were able to prolong people’s lives for about 6 months, but at a high cost: diarrhea, anemia, sudden hair and weight loss. It was 1989 and the scientific community kept thinking that there should be another way to contain the virus’ advance. 

A new combination

It was until 1991 that the effectiveness of two other medications was proven, from the same family as AZT, called ddl and ddC, in order to control HIV infection. This trio (of the reverse transcriptase inhibitors’ type) allowed experimentation to start with therapies that combined two of the available drugs, and it was in 1992 that the double treatment with AZT and ddC was approved. Still, this new scheme did not drastically change the outlook of people with HIV with regards to what had been achieved a couple of years back. 

The first cocktails

However, the decisive moment that changed antiretroviral treatment forever was in 1996, when results of the integration of new drug families that had been recently approved were presented. During this year, several studies showed that the combination of three medications (then known as “cocktails”) were capable of suppressing and keeping the replication of the HIV virus at a low during the entire time the treatment was taken for. The age of the Highly Active Antiretroviral Therapy (HAART, for short), had begun.

This new treatment scheme managed to save the lives of many people that were already, in an AIDS stage even. And, although it represented a clear difference between losing one’s life and surviving, the road to access these medications for all the people that needed them, was still a long one.  

Treatment complications

Additionally, the treatments were complex. Many pills of one medication, an injection from another and a vial that had to be refrigerated were needed in order to complete the scheme. All this for several times a day, eating certain foods and discarding others. The inherent complications of the treatment, aside from its multiple side effects (vomiting, dizziness, headaches, abnormal distribution of body fat) which made it more difficult for people to stay on the treatment, aside from damage that appeared in different organs in the body which were being affected by the treatment. 

However, the science of HIV continued advancing in two parallel paths. One of them focused on looking for new chemicals that could provide better control of the virus in the body. The other one focused on simplifying the existing medications, containing them in less doses, making them easier to manage and with less undesired side effects. 

One single cocktail in 2007 

It was like this for two decades, until, in 2007, the first antiretroviral “cocktail” contained in one single pill and that required to be taken only once a day, was announced. No more huge pillboxes camouflaged so they wouldn’t be discovered at work, no more mandatory refrigeration, no more four or five reminder alarms to take the medication. Now, everything was easier. 

Additionally, there was a change in paradigm which considered that only people with a low CD4 defense cell count (equal to or less than 200 cells per ml of blood), needed to take antiretroviral treatment. Other investigations had shown that the treatment benefited anyone who was diagnosed with HIV, therefore it was recommended to start taking it as soon as the infection was detected. 

HIV in the 21st Century

And so, people who have lived with HIV in the 21st century have gone through a much less tortuous path. The side effects that they may have are much less drastic than the ones their peers had to go through 20 or 15 years ago. Scientific advancements allowed for HIV to become a chronic condition, with a comfortable treatment and, above all, so effective that the lifespan of people with HIV practically matches with the lifespan of the general population. 

At AHF we offer linkage and accompaniment to treatment. If you already have a positive diagnosis, write to your closest AHF or Allied center to you for more information via WhatsApp. We can help you.