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January 11, 2010

HIV/AIDS 2010Better Drugs, Better Technologies, and Lingering Problems

Arch Intern Med. 2010;170(1):6-8. doi:10.1001/archinternmed.2009.442

Progress in the treatment of human immunodeficiency virus (HIV) and AIDS has been breathtaking. In the early 1980s, a diagnosis of AIDS was thought to be synonymous with death. Today, with available antiretroviral therapies, the life expectancy of HIV-infected persons nears that of age-matched uninfected persons.1

This extraordinary progress in treatment is attributable not to 1 drug or 1 study but to cumulative improvements over a 15-year period. The first drug approved for treatment of HIV and AIDS was zidovudine (AZT). Still in use today, zidovudine received Food and Drug Administration approval in 1987 based on a randomized study that showed that its use substantially improved survival among persons with AIDS.2 Later studies showed that treatment with zidovudine also slowed the progression to AIDS in persons with asymptomatic HIV disease,3 leading to great optimism about the use of the medication to keep patients healthy. Unfortunately, follow-up studies showed that zidovudine use did not change overall mortality4,5; after a 1- to 2-year period of delayed progression,5,6 disease progressed more rapidly, leading many patients and clinicians to despair. However, importantly, zidovudine therapy had achieved “proof of concept”: treatment with antiretroviral drugs could slow the progression of HIV.

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