Treatment: hopeful: newer drugs and fewer pills are helping people with AIDS maintain their health. But HIV "is no picnic," a leading AIDS physician emphasizes.

Kenneth Mayer, MD, has been treating gay men with AIDS since the early 1980s. Today, he's research medical director at Fenway Community Health in Boston and director of the Brown University AIDS Program in Providence, R.I. In the days before the International AIDS Society's conferenve on disease progression and treatment in Rio de Janeiro at the end of July, the good doctor fielded The Advocate's questions about the latest medicines available.

What are the most promising drugs on the market right now?

Of those that are currently available, the [new] ones that are most promising are those that reduce the number of pills you take, drugs like Truvada, which combines two other anti-HIV medications-in this case, tenofovir and emtricitabine--into a single pill. That makes treatment much easier. Since Truvada works in combination with other drugs, this means that some people are taking as few as two pills a day.

Are there any promising new drug trials at the moment?

At the conference in Rio we are likely to hear a lot about two different categories of drugs now being tested--entry or fusion inhibitors, which prevent HIV from getting into the body's cells, and integrase inhibitors, which prevent HIV from integrating with the cell for the purpose of replicating itself. Currently, there is only one type of entry inhibiter available, called Fuzeon, but since it has to be injected with a syringe twice a day, it hasn't become a very popular option for people. But new entry inhibitors, which will be taken orally, should be available very soon. And while we are also looking into new drugs, we also want to know how they act together, in combination with each other.

Drug treatment, particularly protease inhibitors, received a great deal of attention in the 1990s. Has research hit a plateau since then?

It did plateau a few years ago, but it is picking up now, particularly on the issue of simplifying treatments. Taking fewer pills is a big advance for a lot of people. There are three sets of issues that we are looking at right now: simplifying regimens, lessening side effects, and treating those with drug resistant strains of the virus. For some people, for example, the fear of lipodystrophy [including lipoatrophy, the loss of body fat, often in the face] and other side effects is a stumbling block to treatment. So research is looking at ways to lessen those effects.

Is HIV/AIDS truly becoming a treatable disease like diabetes?

For some people it is, but others are having a hard time with their medications. HIV/AIDS is no picnic and it's hard to predict. You can't say to somebody, "Take this pill and don't worry about it." Treating this disease is a lifelong commitment. I wish it were a lot simpler, but it's not.