Has Anti-HIV Treatment Cut AIDS Deaths?

Since 1995 the number of deaths from AIDS in the United States has dropped from nearly 50,000 per year to less than 17,000. Deaths have dropped in Europe and Canada too. Doctors and scientists believe that fewer people are dying because many have been helped by new treatments which work against HIV, the virus that causes AIDS.

But some people claim that HIV doesn't really cause AIDS. These people, called "AIDS deniers," "denialists" or "AIDS dissidents," say the new drugs haven't reduced AIDS deaths. Some even claim that the medicines actually make people get sick and die.

How Do We Know That the Drugs Used to Treat AIDS Work?

How were the "drug cocktails" developed?

When the AIDS epidemic began in 1981, there were no drugs to fight HIV. When the first drugs became available in the late 1980s, patients generally used only one of them at a time. But in December, 1995, the first of a new kind of anti-HIV drug, called protease inhibitors, was approved. Scientists discovered that they worked best when used together with at least two of the older drugs. These combinations are known as "cocktails" or "HAART," which stands for "Highly Active Anti-Retroviral Therapy." Doctors saw many of their sickest patients get better when they started HAART.

When did AIDS deaths start to drop?

Some AIDS deniers say that AIDS deaths were dropping before HAART became available, so the drugs couldn't be the cause. That is not true. The most AIDS deaths ever in the United States happened in 1995, when almost 50,000 people died of AIDS. The first protease inhibitor was approved for sale that December, and soon HAART began to be used widely. In 1996 the number of deaths dropped below 37,000.

After rising every year since 1981, 1996 was the first year that AIDS deaths ever dropped. The number of deaths dropped again in 1997 and 1998.

Did other things affect AIDS death rates?

Yes, the rise in AIDS deaths began to slow down in the early 1990s for two reasons: First, as we learned more about AIDS in the early 1980s, many people began using condoms or having fewer sexual partners. The spread of HIV slowed, but because HIV takes about 10 years to cause AIDS, it took until the 1990s for safer sex to slow the rise in AIDS cases and deaths.

Second, doctors learned more about how to treat AIDS. Even before HAART, doctors were learning to combine anti-HIV drugs and got better at preventing or treating many of the infections that kill people with AIDS.

These better treatments were already starting to slow down the increase in AIDS deaths. But HAART dramatically added to that improvement

How do scientists decide if medicines work?

Scientists study new medicines in what are called clinical trials: One group of patients takes only their regular medicines, while the other group takes the new drug being tested. Then the groups are compared to see who does better. These trials showed that patients on HAART stay healthier and live longer than those taking just one or two anti-HIV drugs.

What other ways do scientists learn about new drugs?

To better understand what helps people stay healthy, scientists do cohort studies. A cohort is simply a group of people who are alike in some way--such as having HIV infection. Some cohort studies involve all types of people with HIV--young, old, male, female, etc. Others look at certain groups, like women or gay men.

In a cohort study, scientists try to learn as much as they can about people's daily experiences in order to see what helps them. The volunteers come in regularly to have blood tests, and at the same time the scientists ask about things that may affect their health--like what they eat, whether they smoke, drink alcohol or take any medicines.

These studies can be very large, with many thousands of people, and often go on for many years. All the information from these thousands of people helps doctors learn what things help or hurt people over a long period of time.

What do cohort studies say about anti-HIV drugs?

These studies have told us that people on anti-HIV treatment almost always do better than those on no treatment, and people taking HAART live longer and stay healthier than people who take only 1 or 2 drugs.

One of the largest HIV/AIDS cohorts began in 1990. This "Adult/Adolescent Spectrum of Disease Project" has studied over 49,000 people with HIV. By January, 1998, 9,280 had died. Patients on any anti-HIV treatment were less likely to die than those with similar illness who weren't taking anti-HIV medicine. People not taking anti-HIV drugs were 6 times as likely to die as comparable patients on 3-drug HAART combinations.

Another cohort, the HIV Outpatient Study, has followed over 3,500 HIV patients in eight U.S. cities since 1992. In this group, people not taking any anti-HIV treatment were four and a half times as likely to die as comparable patients taking combinations that included a protease inhibitor. Several large studies in Europe have shown the same kind of result.

In San Francisco, the Department of Public Health has kept track of about 95 percent of the city's AIDS patients. Patients taking combinations that included a protease inhibitor were 57 percent less likely to die than people who didn't take any anti-HIV treatment.

The Bottom Line

Anti-HIV drugs are strong medicines that can have serious side effects. And there is still more we need to learn about how to use them to get the best results. But large studies done around the world have all found the same thing: Anti-HIV treatment has helped thousands of people infected with HIV to live longer and stay healthier. The evidence shows that anti-HIV drugs have played a big part in reducing AIDS deaths.