In 1987, the FDA approved the first drug to treat HIV/AIDS, the nucleoside reverse transcriptase inhibitor zidovudine (AZT). AZT decreased opportunistic infections and deaths from AIDS, as well as prevented perinatal transmission of HIV. But it was not without side effects, some of which were serious. And, unfortunately, HIV drug resistance developed around 1990.
Other NRTIs became available and were taken with AZT until 1995, when the first protease inhibitor, saquinavir, was approved. Then the first non-NRTI, nevirapine, received an FDA nod. These highly active antiretroviral therapies were game changers, but the number of pills and the many side effects were a burden. And too many were still dying too young.
HAART paved the way for better treatments. Today’s ART not only provides options to patients but has turned a disease that was the second leading cause of death among young men in 1989 into a chronic illness. It’s hard to imagine that AIDS took more lives in young men ages 25 to 44 in 1989 than heart disease, cancer, suicide and homicide (MMWR Morb Mortal Wkly Rep 1991;40[3]:41-44). People diagnosed with HIV now can expect a lifespan similar to people without HIV.
And with the introduction of pre-exposure prophylaxis, it is possible to prevent new infections, although more than 36,000 cases of HIV are still diagnosed each year in the United States alone.
Our cover story (“Are New, Popular Weight-Loss Drugs SAfe for People With HIV?”) about whether clinicians should consider the popular weight-loss drugs, GLP-1s, for their patients just shows how far we’ve come. Weight loss was not a problem after an HIV diagnosis in 1989.
This issue is filled with articles about available ART, as well as new products in the pipeline. Although they offer increased safety, improved tolerability, a lower pill burden and long-lasting effects, none are a cure, and vaccines to prevent or treat HIV seem far in the future.
In addition, in our article “Spotlighting Disparities: Ongoing Challenges in US HIV Care,” Dr. Danilo Bacic Lima reminds us that not everyone, even in the United States, has the access to the quality care they need to manage their HIV appropriately.
We’ve come a long way, but the journey is far from over.
The views expressed here belong to the editor and do not necessarily reflect those of the publisher.
This article is from the June 2024 print issue.