What is a Cocktail Waitress?

Cocktail therapy, originally referred to as "high-efficiency antiretroviral therapy" (HAART), was proposed by Chinese American scientist He Dayi in 1996. It is a combination of three or more antiviral drugs to treat AIDS. The application of this therapy can reduce the resistance caused by a single medication, minimize the replication of the virus, and restore part or even all of the damaged immune function of the body, thereby delaying the progression of the disease, prolonging the patient's life, and improving the quality of life. The therapy uses a combination of protease inhibitors and a variety of antiviral drugs to effectively control AIDS.

More and more scientists believe that mixed drug therapy is the most effective treatment for AIDS, which can prevent the reproduction of HIV and prevent drug-resistant viruses in the body. In recent years, in other diseases, some people have called similar combination therapy as the corresponding "cocktail therapy".

Chinese name: Highly effective antiretroviral therapy
Foreign name: highly active antiretroviral therapy

nickname: Cocktail therapy
Presenter: He Dayi
Presentation time: 1996

Reasons for cocktail therapy

Because the method of drug configuration is similar to that of cocktails, multiple drugs are mixed and mixed by a special method, so they are named ^[1] .

The current approach to AIDS treatment is "cocktail" therapy.

Introduction to Cocktail Therapy

Beautiful cocktails (4 photos)

Since the discovery of AIDS in the 1980s, although countries around the world have invested a lot of manpower and resources, they have developed more than a dozen vaccines and nearly a hundred drugs, but so far no effective drug has been found to treat AIDS. As a new weapon for the treatment of AIDS, the Chinese scientist Professor Dayi He proposed the "cocktail" therapy, which immediately caused a sensation in the entire medical community. Media from all over the world rushed to report it, and scientists from all over the world also gave it a high evaluation. In view of his outstanding achievements, the famous American time magazine selected him as the cover character.

Everyone may be no stranger to cocktails. This is a way of drinking that is highly admired by Westerners. Mixing several different styles of wine together has a special taste. Professor He Dayi vividly named his treatment as "cocktail" therapy, which also has a similar meaning: it is the simultaneous use of 3-4 drugs, each of which targets a different part of the HIV reproduction cycle, thus To achieve the purpose of suppressing or killing HIV and curing AIDS. An important reason why AIDS treatment is difficult is that HIV is not static. During the process of transmission and reproduction, some structural and functional changes often occur. At this time, even if the original medicine may be effective, it does not matter at this time. Used, the virus can continue to multiply in the body. "Cocktail" therapy, which uses 3 to 4 drugs for combination therapy, has greatly improved its efficacy because it acts on all aspects of HIV infection. The effect of clinical treatment is also very encouraging: after a few weeks of treatment, 7 of the 10 patients' physical conditions improved significantly, the persistent low fever disappeared, the ulcers on the body disappeared, and the energy was full, more amazingly, the blood No trace of HIV! So after suffering more than a dozen years of fear and despair, people finally saw a glimmer of hope for governance.

Since the "cocktail" therapy was applied clinically in 1995, many patients have benefited. It can control the HIV in the patient's body, giving the patient's immune system a chance to repair and restore function, but it cannot completely remove the virus from the body and cure the disease. At present, seven antiviral drugs are provided free of charge to patients in China. Doctors use a variety of drug combinations to perform antiviral treatment on patients according to their conditions. The country's free antiviral drugs. As long as patients adhere to standardized antiviral drugs under the guidance of a doctor, they can effectively inhibit the virus replication in the body, reduce the generation of drug-resistant strains, delay the progression of the disease, and reduce morbidity and mortality.

Cocktail Therapy

HIV is a virus that causes AIDS. Since its discovery in the 1980s, 53 million people worldwide have been infected, and more than 20 million people have died due to lack of specific drugs. The worst affected areas of AIDS are in Africa, Central Africa and South Africa. The proportion of infection is as high as 10%. High infection rates and morbidity have reduced life expectancy there, and have brought major disasters to society and the economy. HIV is a retrovirus. It is a small particle with a spherical structure. The virus gene is inside the particle. There are two lipid envelopes on the surface, and gp120 and gp41 are two surface proteins. It plays a key role in virus infection. In the process of virus infection of target cells, these two surface proteins mediate the virus's entry into human cells, and then the viral RNA is transcribed into DNA in the cytoplasm by reverse transcriptase to complete the transfer of genetic material to the cells. Each infected cell can release 10,000 virus particles, killing target cells during the virus release process. After understanding the viral life cycle, researchers have discovered that protease and reverse transcriptase, which inhibit virus replication in the human body, are two key links in antiviral therapy. In the early stages of infection, HIV in the patient's blood plummeted, and the first three or four weeks often showed symptoms of a cold. With the relief of symptoms, the level of virus in the body drops and remains in a relatively balanced state. The level of equilibrium determines whether the onset will occur in the future. Why can the virus's homeostasis be maintained for several years or even more than 10 years? He Dayi believes that the amount of virus production and clearance during the so-called "equilibrium" period should be equal.

Anti-HIV drugs appeared in 1994, which are anti-protease inhibitors. Why this drug freshman provides experimental tools to study anti-HIV activity worldwide. Clinical application found that the virus blocked the infection of new T lymphocytes after administration, the virus's equilibrium state in the blood was broken, and the virus particles in the blood decreased rapidly. One year later, they performed mathematical model calculations on the number of infected or uninfected cells in the blood, and surprisingly found that the half-life of HIV particles in the blood was only 30 minutes, and the infected cells in the body were replaced every day and a half. half. This accurate data explains why the virus in the plasma dropped so fast after taking the drug.

Although the half-life of HIV in the body is very short, each patient produces up to 10 ^ 10-10 ^ 12 of virus per day. A large number of viruses are produced while being cleared, and new viruses will produce a lot of drugs that can escape drug treatment during the replication process. Mutant strain. This led He Dayi to think that single drug treatment can quickly develop drug resistance. Three or more drugs, such as antiviral protease drugs and antiviral reverse transcription drugs, should be targeted at different stages of HIV infection in the human body. That is to improve the therapeutic effect through combined use.

This is how the "cocktail" therapy was born. After the "cocktail" therapy was applied to the clinic, 70% -80% of patients' viruses in the body decreased with treatment, and the whole world was encouraged by it for a while. In 1996, He was selected as the person of the year by the "Time" magazine of the United States; in January 2001, President Clinton of the United States awarded him the "Presidential National Medal".

Cocktail therapy

Limitations of cocktail therapy

The elimination of residual cells in the body has become a key "cocktail" treatment for treatment, which can at least delay the onset of patients for several years, as evidenced by the declining AIDS deaths in the United States in recent years. But they soon discovered that the "cocktail" was not 100% effective, and patients had to take medication for a long time without getting cured. Long-term medication can cause toxic and side effects including lipid malnutrition, abnormal accumulation of fat in the back and abdomen, and abnormally elevated blood lipid concentrations. The most serious of these are liver failure and diabetes. In addition, the high price of about 12,000 US dollars per person per year makes most patients stop.

The limitations of cocktails are mainly: it is quite effective for early AIDS patients, but it is not helpful for patients with intermediate and advanced stages, because the immune system of these patients has been irreversibly destroyed by HIV; in addition, the cost of this therapy is very high, Not for ordinary people. He Dayi himself also believes that drug treatment is very difficult. Not only is the method of taking it complicated, it has side effects, but it is also expensive. Because cocktail therapy is a mixture of various drugs, the size of the side effects depends on the specific medicine the patient is taking. Some medicines can cause patients to have very realistic nightmares during the first few weeks of taking them, and many people are very afraid of this. There is also a side effect called fat loss, where fat tissue on the face and arms of the patient is lost. But if you stop taking the drug, even if 0.001% of the virus remains, the virus will make a comeback. Eventually, an AIDS vaccine needs to be developed.

In addition, although "cocktail" therapy can eliminate most of the HIV in the human body, there are still few viruses hidden in the lymph nodes. According to relevant data, He freshman has found in animal experiments in 2002 that CD8 in T cells of the human immune system can powerfully fight HIV. ^[2] T cells are one of the weapons against AIDS in the human immune system. In previous treatments, doctors only paid attention to the CD4 content in T cells in order to evaluate the changes in immunity of HIV-infected people. "Cocktail" therapy is also the best time to try to catch the patient's infection and try to increase the CD4 in the patient to rebuild or partially rebuild the patient's immune system. However, recent discoveries prove that CD8, another important T cell marker, is a powerful weapon against HIV. Nevertheless, people still see the dawn of hope. Of course, there is still a long way to go to find a way to control the disease, but I believe scientists will not let people wait too long.

Cost of cocktail therapy

In the past, the use of foreign cocktail therapy was very expensive, reaching 10,000 yuan / month. By 2002, through continuous improvement of AIDS medical experts, the cost was reduced to 3,000 yuan / month. By 2009, China produced domestic medicines. The cost Greatly reduced, only about 480 yuan per month. This has made the basic medication of AIDS cocktail medication popular.

At present, China has achieved free treatment for all HIV carriers and infected people with AIDS cocktail therapy. Therefore, as long as it is found to be infected with the HIV virus and meets the nationally prescribed medication standards, an application for medication can be submitted to the local disease control center or hospital.

Cocktail therapy improvements

"Cocktail therapy" has now become the standard anti-AIDS prescription. It consists of two types of anti-AIDS drugs, nucleosides and non-nucleosides, which can be taken daily by patients to suppress the virus and support life. However, this kind of therapy has large side effects, complicated administration, easy to form drug dependence, and high cost.

Previously, some researchers have tested methods such as suspending, intermittently using, and intermittently reducing drugs in order to reduce the amount of "cocktail therapy", but the clinical trials have not been effective. Clinical trials conducted by researchers at the University of Nebraska Medical Center in the United States have shown that the anti-AIDS drug atazanavir, taken daily after synergistic effects, can have a similar effect to "cocktail therapy."

The results of this study will be published in the August 16 issue of the Journal of the American Medical Association. Researchers reported their findings at the 16th World AIDS Conference in Toronto, Canada, on the 13th.

A total of 36 AIDS patients who had received longer-term medications participated in the study. In clinical trials, patients discontinued the "cocktail therapy" drug and only took atazanavir, which was boosted with a small dose of ritonavir, and was tested for virus 24 weeks later. The results showed that the number of viruses in the 31 patients remained low.

Researchers say that atazanavir can be used as a "maintenance drug" for patients who have received other medications and whose HIV levels in their blood have fallen, keeping their virus levels low. Compared with "cocktail therapy", this kind of therapy is simple and low-cost, but its efficacy has to be proved by larger clinical trials.

The efficacy of cocktail therapy is beyond doubt. But with the increase of drugs and the emergence of some new data, treatment for HIV-infected people has become more complicated.

Cocktail therapy in China

At present (end of 2009) China is now able to produce 4 anti-HIV drugs, which can be combined into cocktail therapies with different formulas. China-made cocktail therapy has served AIDS patients in Beijing, Shanghai, Fuzhou, Nanjing and Guangdong, Henan, Yunnan and other places. Peking Union Medical College, Ditan, You'an Hospital and PLA 302 Hospital provide this therapy.

Cocktail therapy supplemented with antibiotics

On March 28, 2010, the international authoritative medical academic journal "The Lancet" published an academic report that in the treatment of AIDS patients, the use of "cocktail therapy" supplemented with antibiotic treatment can effectively reduce the patient's mortality rate.

The report was quoted by Agence France-Presse as saying that the antibiotic compound sulfamethoxazole (Chinese compound name Xinnuoming, SMZ) is a broad-spectrum antibiotic commonly used many years ago and is inexpensive. Combining such antibiotics with antiretroviral therapy commonly known as "cocktail therapy" can effectively reduce the mortality of people with AIDS. The study found that in the first three months of "cocktail therapy", concurrent use of antibiotic adjuvant therapy can reduce the mortality rate of patients by 59% within 3 months; after 72 weeks of "cocktail therapy", the mortality rate of patients treated with antibiotics 35% lower than users.

Cocktail therapy controversy

In recent years, there has been much debate over when to start cocktail therapy, and the general trend is more conservative. Because even if the virus is suppressed for long periods of time in plasma at undetectable levels, current treatments cannot eradicate HIV in the body, and HIV is still replicating at low levels. Current treatments will likely be lifelong. If the drug is taken for a long time or for life, patient compliance is difficult to guarantee. In addition, the side effects and resistance of antiviral drugs must be considered. So we will have to recognise and study when to start this treatment.

Cocktail therapy should be given to patients with acute infection, those with HIV seroconversion within 6 months, and all patients with clinical symptoms of AIDS. For patients in the asymptomatic phase, treatment should analyze its advantages and disadvantages, and doctors are more inclined to delay treatment.

Cocktail therapies need to be standardized for best results and to minimize the occurrence of resistance.