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December 1, 2009

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Western medicine drugs cocktail

AIDS patient Ralph Li (not his real name), will soon leave the public hospital and hopes that he can stay healthy by taking free antiretrovirals at home. This is the third time the man in his 30s has been treated and discharged from Shanghai Public Health Clinical Center of Fudan University.

Antiretroviral treatment for AIDS is free in Chinese public hospitals and patients are also given free medication to take at home. But they must pay for treatment of secondary infections, such as pneumonia.

Li was diagnosed with AIDS in July after his lung inflammation and respiratory problems did not respond to standard treatment. The doctor recommended a test for the HIV virus that causes AIDS - almost always fatal because of secondary infections that the body's immune system cannot fight.

The test results were positive and he was admitted to the hospital. Because his immune system was damaged he was vulnerable to reinfection and he entered the hospital twice again, the last time in late October.

While AIDS itself doesn't cause death, the HIV virus compromises the immune system and other diseases often cause death.

"The patient may be repeatedly infected as their immune systems cannot defend the body, as in Li's case," says Dr Shen Yinzhong, an AIDS expert in the Infectionus Disease Department of Shanghai Public Health Clinical Center of Fudan University.

There are typically three phases of infection. In the first two to four weeks after infection, a person may suffer high fever or break out in rashes. In the next phase (sometimes as long as eight to 10 years), a person can be non-symptomatic but infectious.

When they start getting seriously ill, their immune system has been seriously damaged and they have entered the actual AIDS stage.

Most patients in public hospitals did not know they had been infected with HIV until they started showing AIDS symptoms, such as stubborn respiratory ailments, says Dr Shen.

"AIDS cannot be cured so far, but it can be treated and thus we can prolong patients' lives," says Dr Shen. This means the HIV virus cannot be eliminated but can be reduced and controlled, while immunity can be boosted with treatment.

With no treatment most patients with AIDS patient will die in 18 months, but proper treatment can prolong life by almost 15 years, says Dr Shen.

The most widely used therapy for AIDS so far is the HAART, or the cocktail therapy, invented in 1996. It is comprised of three or four different anti-virals, out of 32 anti-virals of five categories known today.

The doctor prescribes the appropriate therapy. He or she can choose from 12 medicines in three categories available in China. The therapy limits ability of the virus to multiply. The therapy can only be applied to AIDS patients with a CD4T index of less than 350/ml, who show sharply increased viral count in a short time, or those with severe symptoms.

Before that, there was no hope.

Therapy requires taking large amounts of medicine daily, and there are side effects such as vomiting and influence on the blood and nervous system. Many people resist therapy for this reason.

In addition, the virus becomes drug resistant in time, so doctors need to change medication to ensure its effectiveness.

"Unfortunately, we don't have so many alternatives," says Dr Shen. "Long-term therapy can cause disorders in blood-fat metabolism and cause diabetes, high blood pressure and heart disease.

"The medical field is always searching for more effective treatments. We are still trying, there is always hope."


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