HIV Program/Consultation Service
AIDS was first identified as a disease in America in 1981, and though we do not hear as much today about AIDS in this country, the number of cases has not stopped growing.
It is estimated that 40,000 new HIV (the infection that can lead to AIDS) cases occur in America each year. Jack Stapleton, MD, director of the UI AIDS Clinic at University of Iowa Hospitals and Clinics, offers these comments:
What are some of the trends that we're seeing here in Iowa related to HIV and AIDS?
Like the rest of the country, and developing countries around the world, HIV is more frequent, more common. And the reason this has occurred is that the rate of new infections really has not changed over the past 20 years, so that in the U.S. there are about 40,000 new infections each year.
Deadly prevention approaches have not really made a major dent in that. What's changed is over the past eight to 10 years we've had very effective therapies, drug cocktails have become available, and as we modify and refine these, these are much better tolerated by patients, and as a result far fewer people are dying.
The end result of the same number of new infections, drastic reduction in death, is that more and more people are living with HIV and living productive, good-quality lives. So as a result, we have far more patients. My clinic, for example, here at UI Hospitals and Clinics, we've more than doubled our number of patients in the last seven or eight years, and that's true around the state, as well. So, more people are living with the infection.
Do you see any other factors that are contributing to that or is it mainly just the medications?
It's mainly the medications and the access to those medications. One of the factors that's led to improved access is the Ryan White care legislation. Ryan White was the young hemophiliac patient who died of AIDS about 10 or more years ago and a bi-partisan legislation was introduced in his name and that has helped support the making these drugs available to people with HIV and AIDS if they don't have other ways of paying for it.
You've been on the frontlines here of this HIV/AIDS issue for quite awhile now, what are some of the changes that you've seen in your time dealing with this?
Well, it's been a drastic change and there have been two factors that have really led to these changes. The first if that about 1996-97, it became clear that using cocktails or multiple (at least three) drugs against the virus led to far better response. The second was we developed tools to be able to measure if the drugs were effective or not. We have a way of measuring the amount of virus in someone's blood, and if that goes down, then we know that the drugs are working, and in fact it's mirrored by the patient feeling better: gaining weight, having energy, and so forth.
We have great tools now for treating this, much like you do for diabetes. We have a good drug with insulin and a test to see if it's working or not. So we can very scientifically treat people, and as a result, their immune systems are far more active than what we used to see. Ten or 15 years ago, we had half the patients, but they were far sicker and we saw lots of strange and unusual infections in our patients and they were quite ill and suffered and died.
Whereas now, we really manage the medications for the HIV and far fewer of the side infections or malignancies, and we manage the side effects of the medication, so there's increasing risk of diabetes, heart disease, and metabolic problems in patients that we spend a lot of time dealing with now and trying to make sure that we minimize and prevent drug resistance in the HIV itself.
About 10 or 15 years ago was when the talk about HIV and AIDS was really coming about. Do you think since then that we've become a little bit complacent as a society about HIV and AIDS?
I do. I think the fact that people aren't as sick and that they realize we have medications makes them feel like this really isn't a problem anymore and I don't need to worry about it.
In the U.S., of course, there is an element of truth to that but the fact that more and more people are living with the infection means that there's a greater risk of exposure if you're placing yourself in a situation where you'll be exposed to the virus.
Worldwide this epidemic is unchanged and it's driven by developing countries: Africa, southern Asia, Southeast Asia, where the number of new infections continues to go up in the neighborhood of several million each year. HIV/AIDS became the leading cause of death from an epidemic infectious disease in the world 10 years ago, and it's continuing to increase. It's the largest epidemic in the history of mankind.
A lot of the changes we've seen revolving around the medication due to research, what are some of the current efforts that are underway with regards to HIV and AIDS?
The real goal for HIV research now is focused in two areas, and the one that I think has the most potential is to identify ways to eradicate the virus that's sleeping, or latent -- dormant, in people's cells when they're being treated with medications.
The medications stop the virus from growing rapidly, but there is still virus in the blood cells that is not active and because the current approaches and treatment don't get rid of it, then as soon as you stop the therapy, it comes back and there are some very interesting approaches to get those sleeping viruses destroyed, and I think that's the current main focus.
The other is vaccine, and vaccines to prevent infection are certainly being developed. My personal opinion is that current strategies are unlikely to be highly effective in the near future, but I hope that I'm wrong.
What are some of the facts about HIV and AIDS that maybe listeners would be unaware of or would like to hear to keep in mind about these?
The main fact about HIV and AIDS that people need to think about in 2006 and in Iowa is this is not an unusual infection, it's very common. It's spread throughout the United States and the world and it's something that we just have to live with. If you don't have HIV infection, it's out there and taking the appropriate steps to minimize your exposure to this infection is really critical and that would be my plea on World AIDS Day-that we all try and do what we can to stop the spread of this virus. |
