The director of the 360 Positive Care Center at UCSF talks about new therapies and drugs for the treatment of HIV/AIDS.
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Over the years, what changes have you seen in treating HIV/AIDS?" Well, I have been practicing since 1997, so its been about 10, 11 years and before that I was in training, and I have to say just within a short period of time, starting just before the Protease Inhibitors came in the market, I saw as a resident and an intern, people who were dying frequently from opportunistic infections with HIV/AIDS and then, since 1995, 1996, with the new medications triple-drug therapy or HARD as well call it today, Highly Active Antiretroviral Therapy, we don't see as many opportunistic infections, PCP or bad Tuberculosis or Meningitis and so forth and instead we are seeing people being able to live longer, healthier lives if they get into care and are able to get appropriate medications. New Drugs I think it's an exciting time in HIV. There are so many new drugs coming out every year, that I think patients who are infected should -- even if you don't know you are infected, you should get tested and you should get into care, if not treatment, at least into care, so that you can hear about what's going on today. It's really encouraging. We have new classes of drug, Entry Inhibitor, something called CCR5 Inhibitor and Integrase Inhibitor, drugs that we didn't think would be possible five years ago, and they are having great results in patients who have gone through multiple treatment strategies. So it really means if you have failed or had broke through previous treatments strategies, your response rates can be extremely high today with these newer agents, which seem to be very well tolerated. And there are new generations of those already in the pipeline, that are going to be coming out. What's interesting is going to be how we combine those different classes of drugs, whether they are going to be able to suppress the virus even more than we have in the past, and whether that translates into a different clinical picture for patients in the long run, meaning the long term side effect of HIV, meaning the long term side effects from the drugs, may be when people get infected earlier, and if they get treated earlier, they might have changed their clinical course every time. So it's really actually a very exciting time. Advice for Patients I think when they come in, they should be asking what are their options. What are the pros and cons of their options, meaning when to start when not to start, which drugs and why, what are some of the treatment side effects, they are willing or not willing to tolerate. Often times, that's one of the first questions I ask them when I am about to start. Okay, what side effect is a deal breaker? If diarrhea is deal breaker, I need to know that. If Nausea is your deal breaker I need to know that. And so that's important because we have so many options now, you really can't tailor the medications, and in fact that's another interesting piece that's coming up, it's the whole field of Pharmacogenomics, where you are able to genetic tests of certain patients to predict, whether or not they are likely to get certain side effects and it's not just an HIV, I saw in the paper, they are doing that with Warfarin 03:18 essentially any risk for having bad outcomes from that. So I think that's a growing field that's in HIV, it will be at the forefront of what we do for several drugs, including one of the newer agents that I mentioned earlier, so I think it's important.
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