zyme reverse transcriptase, necessary for HIV to rep-
licate following infection. The new generation of
drugs did include new forms of reverse transcriptase
inhibitors, but a variety of additional drugs known as
protease inhibitors, antiretrovirals that blocked as-
sembly and release of the virus, were also developed.
Combinations of these antivirals, produced as cock-
tails, were found to be highly effective in many pa-
tients at inhibiting viral production, allowing the im-
mune system of the patient to regain a semblance of
“normalcy.” The drugs did not cure AIDS. However,
because the drugs allowed the immune system to
function, the patients were less likely to develop life-
threatening opportunistic infections. The eventual
selection of drug-resistant virus placed a limit on the
long-term effectiveness of such drug therapy.
The timing of drug treatment, using chemicals
capable of producing harmful side effects, was
among the issues that had to be clarified: Was treat-
ment equally effective regardless of the state of
the immune system and the concentration of CD4+,
the target cell of the virus, or would concentrations
of the drugs have to be adjusted depending on the
state of the patient? Since some forms of drug treat-
ment required a 24/7 approach, what would be the
effects of “missing” a proportion of doses? No
definitive answers were available at the end of the
decade.
Preexposure Prophylaxis While limiting replica-
tion of the virus demonstrated usefulness in treating
AIDS patients, studies in chimpanzees of the drug
tenofovir, a nucleoside inhibitor, might be effective
in blocking initial HIV infection of exposed patients.
While initial studies on humans provided evidence
(albeit limited) of its effectiveness, longer-term stud-
ies, including one later funded through the Bill and
Melinda Gates Foundation, showed the drug was no
more effective than other nucleoside inhibitors.
Tenofovir was subsequently included among drug
cocktails used during ART. As has also been ob-
served with other forms of ART, significant side ef-
fects such as acidosis, heart problems, and possible
organ failure do take place in some patients.
Impact While nothing resembling a cure for AIDS
was considered as realistic, the introduction of a sec-
ond generation of individual drugs and drug cock-
tails was able to produce an impact on the life span of
HIV-positive patients. Though the number of deaths
from AIDS in the United States increased by a factor
of 1000 percent in the five years after 1985, the num-
ber of deaths during the 1990’s was approximately
300 percent. The numbers themselves may be mis-
leading, as the average span from diagnosis to death
in a significant proportion of these individuals had
more than tripled from the previous decade.
From a decade high in 1995 of 51,000 reported
AIDS-related deaths, the numbers had fallen to be-
low 18,000 in 1999 and continued to drop in subse-
quent years. Clearly in many patients, aggressive
antiviral therapy has been effective in reducing the
viral load, resulting in a lessening of AIDS-related
complications.
Subsequent Events Subsequent research into ART
has resulted not only in new forms of protease inhib-
itors but also in development of a third generation
of drugs that interfere with the infectious process it-
self. Drugs in this category include other forms of
protease inhibitors, as well as drugs that act to pre-
vent actual infection of target cells within the body.
Some two dozen drugs had been approved by the
Food and Drug Administration by the end of the
1990’s, with others undergoing further testing.
While no cure is expected, such forms of treatment
may downgrade AIDS from a death sentence in
many individuals to a more chronic disease that may
be managed for long periods of time.
Further Reading
Barnett, Tony, and Alan Whiteside. AIDS in the
Twenty-first Centur y: Disease and Globalization. New
York: Palgrave Macmillan, 2002. Description of
the impact of the AIDS epidemic on developing
countries in general and Africa in particular. The
authors speculate on the effects of business and
political practices on the origin and spread of the
disease in these countries.
Engel, Jonathan.The Epidemic: A Global Histor y of
AIDS. New York: HarperCollins, 2006. The au-
thor, a medical historian, provides a history of the
outbreak, beginning with its first recognition in
the early 1980’s, to the situation by 2006. An ex-
tensive bibliography is included.
Garrett, Laurie.Betrayal of Trust: The Collapse of Global
Public Health. New York: Hyperion, 2000. The Pu-
litzer Prize-winning writer addresses the impact
of political events in developing countries, and
subsequent breakdown of health care systems, on
the growing epidemic of AIDS in much of the
non-Western world.The Nineties in America AIDS epidemic 19