Take six pills, four times a day – for the rest of your life.
That’s the prescription Dr. Michael Sension has given his patients living with HIV.
Sension, medical director of HIV Clinical Research at North Broward Hospital, said the heavy dosage of medication needed to battle the virus is one of the biggest obstacles his patients face.
“When someone misses a dose, the virus can mutate and change itself quickly so that the medication no longer works,” said Sension, who has treated HIV-positive patients at North
Broward Hospital since 1993. “We have a group of people with HIV who have grown resistant to the drugs that we have.”
But with new drugs approved last year, Sension said he and other doctors are offering new treatment options to make living with the virus easier for patients, marking a significant stride in fighting the virus that has become an epidemic in the black community.
Although black Americans represent only 12 percent of the U.S. population, they accounted for half of the AIDS cases diagnosed in 2006, according to the Kaiser Family Foundation, a health policy research organization.
Sension said he is trying to educate the black community about the reality of HIV.
“The perception is I'm not at risk, so I don't have to worry about it,” he said. “But the rates of new infection within the black community have been the highest in South Florida. More people are becoming infected here than in any other area in the nation.”
While scientists search for a cure, Sension said the new class of antiretroviral medications offer hope to patients, especially for those who have developed a resistance to previously approved drugs.
“Some patients have no more options for therapy,” he said. “But the new drugs have provided an answer to that resistance to medicine. There is a less number of pills, taken less frequently, with less side effects. There are better treatment options available than ever before.”
One of the new drugs, called Isentress, blocks the enzyme that HIV needs to multiply.
“This is an important new product for many HIV-infected patients whose infections are not being controlled by currently available medications,” Janet Woodcock, the U.S. Food and
Drug Administration's deputy commissioner for scientific and medical programs, said in a statement after the drug was approved in October 2007.
Sension said the fight against AIDS began in the early 1980s when doctors struggled to identify the mysterious, deadly virus.
“We've come so far from where we were 25 years ago,” he said. “When AIDS first came out, we didn't know what caused it. Once we discovered it was a virus, we started understanding how it works and how to block it.”
One of Sension's patients, Richard, 48, of Coconut Grove, has been living with HIV for the past two decades. He asked the South Florida Times not to print his last name to protect his privacy. He was first diagnosed in 1986 while living in New York City, when doctors knew little about the virus.
“There was no medication, you just died,” he said. “There were so many people dying, not a week went by that I didn't attend a [funeral] service.”
The first approved treatment for HIV/AIDS was azidothymidine, or AZT.
“When AZT first came out it was supposed to be the saviour,” Richard said. “Everybody took it because there was nothing else to take.”
Then a new class of drugs called protease inhibitors was introduced, for which Richard was part of a study to determine the treatment’s effectiveness. While doctors did not know the effects of protease inhibitors at the time, Richard said the drug saved his life.
“There's so much doctors still don't know about the virus,” he said. “I've spent years waiting for the next drug to come out. We're all guinea pigs. We don't know what is going to happen 10, 15 years from now.
He said learning how to manage the virus has been key to his survival.
“I'm still around because I took my medications 100 percent,” said Richard, who estimates taking about 65,000 pills since he was first diagnosed. “You have to be really disciplined in taking your medication. If you don't, the virus will sneak its way in.”
With new drug treatments, Sension said doctors are able to lower the amount of HIV in patients to undetectable levels.
“When you can achieve that, the person does not get sick from HIV,” Sension said. “HIV/AIDS has been transformed from a death sentence to something you can live with. If you have the virus, you can manage it. If you are responsible, it doesn't have to claim your life.’’