If you were to believe the medical literature, you'd think that modern medicine had licked the AIDS virus.

A spate of articles during the summer proclaimed "recovery of the immune system with antiretroviral therapy" and "HIV/AIDS in 1998 Gaining the upper hand?"

The reason for the self congratulation is the development of potent protease inhibitors. These are drugs which work by inhibiting the enzyme protease, which is crucial to HIV's ability to reproduce.

Stories are being circulated about patients whose symptoms disappear overnight as soon as they take one of these drugs. So confident is medicine about PIs that the Journal of the American Medical Association in July published the recommendations of a panel of top AIDS researchers, who now advise people who test positive for HIV to take these new therapies even before they get ill (JAMA, 1998; 280: 78-86).

PIs are used in combination, usually via a complicated regimen, including some of the older class of AIDS drugs such as AZT. Currently there are 11 anti HIV medications on the American market and between two and six to be reviewed for approval in the near future. There's no doubt that there's big business in the AIDS drug market; one pharmaceutical company has been said to have synthesised 800 tons of the stuff, in readiness for a stampede of AIDS patients.

There is no doubt that there are some success stories. However, according to Joseph Sonnabend, a veteran AIDS physician in New York, these are thin on the ground or short lived. "Most people don't benefit, because it doesn't work or they can't tolerate it, and in the people for whom it works, it stops working for a while."

The reason for the chopping and changing regime of drug switching is supposedly to "fool" the virus into not mutating and becoming drug resistant. The current theory in vogue for why these drugs don't work for long is that the HIV virus replicates so rapidly that it can develop mutant forms of protease which can resist these inhibiting drugs.

However, according to David Rasnick, a Californian scientist who designs protease inhibitors, "To this day, no one has ever found a resistant HIV protease in any patient." The only ones ever identified have been produced in the laboratory via genetic engineering, and they were, he says, "non functional" that is, incapable of producing viruses.

According to Dr Stephen Byrnes, author of Overcoming AIDS with Natural Medicine, the temporary lift experienced by AIDS patients taking PIs has more to do with "lymphocyte trafficking" that is, the body responds to what it views as a foreign invader by producing more leukocytes.

In the media blitz surrounding these drugs, no one mentions the considerable side effects, particularly of taking the drugs in combination. In preliminary trials with ritonavir, one of the most acclaimed of the PIs, more than one sixth of the volunteers had to give up treatment because of adverse side effects.

Of Dr Byrne's clients who have taken PIs, "Most of them were consistently voiding bloody urine with constant pain in their lower backs a clear indication that the drug was hurting their kidneys. I have heard of some people dying of total renal failure from their use of PIs."

Powerful financial interests control the advancement of AIDS research. Of the International AIDS panel, which made the recommendations in JAMA, all but one had received financial support from AIDS drugs manufacturers. Until medicine recognises that AIDS is a multi factoral disease, and cuts itself loose from the tight grip of the pharmaceutical industry, doctors will continue to lick AIDS about as well as they've licked cancer.

!ALynne McTaggart