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Keeping alive

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OKLAHOMA CITY (AP) _ Kerry Morrow is 38 years old _ but feels 98.

HIV-positive since 1986 and diagnosed with AIDS in 1998, Morrow can't work, can't drive and can't clean his own house.

He shuffles around his living room in slippers. When he goes out, which is rare, he leans on a cane. His daily routine centers around a plastic tray holding 14 pill bottles.

At prescribed times each day, Morrow takes three pills to help control the virus that constantly attacks his immune system; six pills to minimize side effects from the first three; one pill to keep an oral bacterium at bay; and two more to minimize pain from permanent, HIV-related nerve damage.

The last two pills help fight depression _ which might seem justified.

``Some weeks I don't get out at all. I don't even go to the front porch,'' Morrow said on a sunny, spring day. ``I'm living a vampire's life. TV is my savior.''

Morrow probably would not be alive at all were it not for the pills, especially the three-drug ``cocktail'' that helps his body battle HIV. His back-from-the brink story illustrates the power of combination therapy _ the prescription of three or more powerful drugs at the same time _ to check the spread of HIV through the body.

Before any treatments were available, 90 percent of Oklahomans who were HIV positive progressed to full-blown AIDS and then death, said Chris Rathbun, an associate professor of pharmacy at the University of Oklahoma. Today, fewer than 20 percent of cases progress to AIDS, and Rathbun said that number would be smaller still if everyone took the medicine exactly as prescribed.

Untreated, a new HIV infection takes nine years, on average, to develop into full-blown AIDS, experts say. For Morrow, it was 12 years before he ended up hospitalized, first with a form of pneumonia common to AIDS patients and then with a bacterial infection of the brain stem.

``They told my family to make funeral arrangements,'' Morrow said.

He was down to seven T-cells,the small white blood cells that destroy invading organisms and help other cells make antibodies, per cubic millimeter of blood.

Healthy people typically have 800 to 1,500 T-cells per cubic millimeter of blood. Doctors consider an HIV infection to have advanced to AIDS when T-cell counts drop below 200.

After combination therapy, Morrow's T-cell count rose to a high of 280 but recently dropped again. He said that suggests his strain of HIV may have become resistant to one of the drugs. If so, Morrow's doctor will simply swap out one of the drugs he takes for another.

``I'm only on my second regime, so I'm doing good,'' he said. ``If I can get three or four years out of each, I can make it a long time.''

Doctors now have about 100 drugs with names ranging from Agenerase to Ziagen to mix and match as the virus becomes resistant. And that number probably will keep expanding.

On March 15, the U.S. Food and Drug Administration approved the first in a new class of drugs called fusion inhibitors, opening a whole new therapy option.

Combination therapy works by attacking HIV from various approaches. That means doctors pick three or more drugs from two or more ``classes'' or groups of drugs that interact with the virus in similar ways.

A patient on combination therapy might take three anti-viral pills twice a day like Morrow does. However, doctors often prescribe a blend of three or more drugs in a single pill taken twice a day. Average cost: $12,000 a year.

Cost has been an issue ever since AZT, the first drug to combat HIV, was rushed to the market in 1987. At the time, AZT cost $10,000 a year per patient, making it the most expensive drug to date.

Side effects are another issue with the potent anti-virals used to fight HIV, said Laura DeMars, testing and counseling coordinator at CarePoint, an AIDS service provider.

Nausea, vomiting, extreme diarrhea and neuropathy _ a disease of the nervous system _ are common, DeMars said.

Taking HIV medication exactly as prescribed is critical to its effectiveness, experts say. That was much more difficult in the 1990s, when the typical HIV patient had to take a pill every eight hours around the clock.

Today, Rathbun said, twice-a-day doses are the norm, and it is rare for an HIV patient to take a pill even three times a day.

``We want to avoid that. People remember in the morning and at night, but the afternoon dose is the one that gets missed, and that messes things up,'' Rathbun said.

Although the new medicines have extended life expectancies for people with HIV, a miracle cure is still not available.

About 40 percent of the clients served by the Oklahoma City-based Regional AIDS Interfaith Network die each year, director Jean Ann Van Krevelen said.

``I think we've all decided we can manage (HIV/AIDS) like diabetes, but that's not how it works. For some people, the medicine doesn't work or it takes too long to find the right combination.

``It's not like you get a shot of insulin and you're OK _ not yet,'' Van Krevelen said.
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