Somewhat good news

I am not in the middle of a strip mall wasteland in Rockville, MD. It was a struggle, but I managed to get Internet access, and in the 5 minutes remaining to me before my meeting starts, I'll comment quickly on the approval of Atripla, a 3-drug antiretroviral combination pill, for HIV.

This is certainly a helpful development. The drug regimens that most people with HIV take are hard to follow. They involve at least two pills, that have to be taken two or three times a day, and if you miss even 10% of doses -- just a couple of times a week, in other words -- you risk giving the virus the opportunity to reproduce and evolve resistance to the drugs. Then you have a problem -- you need to switch to a different drug regimen, and if that keeps happening, eventually you'll run out of options. The world has a problem too, because if you pass on your drug resistant strain of HIV to somebody else, that person won't be able to use that particular drug regimen in the first place.

Atripla is one-a-day, which makes it likely that more people will be able to use it successfully. But don't break out the champagne just yet. These drugs still have side effects, which in many cases are quite serious. The protease inhibitor component, in particular, can cause metabolic syndrome and bizarre redistribution of body fat, among other problems. Eventually, many people will still experience failure even on this easy to follow regimen -- we'll see how long it takes, on average, but it will happen. And, the stuff is expensive. $1,100 a month, to be exact. Merck has suggested that it will offer a discount in poor countries, but it would have to be one helluva discount to matter very much in the hardest hit countries, where a dollar a day is a fortune.

A side effect of every advance in HIV treatment is that people end up thinking the HIV epidemic is solved. Realistically, this doesn't make a big difference at all. We're still fighting the same fight.