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HIV – From Death Sentence to Manageable Chronic Condition
Posted By Horizon NJ Health on July 15, 2014
Tags: HIV
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Pius Chikezie, MD, MPH, FACP, Medical Director, Horizon NJ Health

Q. I can remember when the HIV virus and AIDS (acquired immune deficiency syndrome) first became known in the early 1980s. It was very frightening to hear about this disease that killed people quickly, but for which doctors couldn’t find a cure or treatment. And when Earvin “Magic” Johnson announced that he was HIV-positive in 1991, we all feared that one of the most celebrated athletes in this country would also die of AIDS. But today, 23 years after that announcement, Magic Johnson is still alive, healthy and successful. And it seems that most people who have the disease are also able to survive nowadays. How did this happen?

A. As a society – as a planet, really – we have really turned things around when it comes to dealing with HIV and AIDS.  It is, frankly, amazing, compared to the time in the early 1980s when patients were reporting the same array of fearsome symptoms. They told doctors they were experiencing flu-like symptoms, fatigue, and strange, damaging skin conditions. Many patients died within weeks or months. It was frightening for society in general and just as much a very scary time for the medical profession as well. Doctors of that era were confronted with a virus of which the origin was uncertain and whose properties were hard to ascertain. 

But now, a quarter of a century later, at least in this country and much of the world, AIDS is no longer a death sentence. It is a chronic disease that can be managed much like diabetes or heart disease. It is a testament both to the tenacity of doctors and patients, and the advances in science that have resulted in this change in prognosis for HIV. 

After all these years, we have to explain what exactly the HIV virus and AIDS is. HIV is the human immunodeficiency virus. The virus is of the type known as retrovirus, which kills or damages cells from the body’s immune system. This makes it very hard for the body to resist infections and certain cancers that, taken together, are known as AIDS. Left untreated or not adequately treated, AIDS will almost certainly kill those who suffer from it. 

Today, the initial symptoms of HIV infection have not changed, but treatment of it has. More than three decades after the disease first came onto the scene, doctors now can diagnose and begin a patient on a regimen of antiviral drugs that can immediately dull the effects of the virus and slow down or retard their physical decline. 

The first significant HIV/AIDS drug, AZT, came to the market in 1987. Another, even more important milestone in HIV treatment came in 1995, when a class of drugs called protease inhibitors signified a major breakthrough in the treatment of the disease. Now, when a person contracts the virus, he or she is given a comprehensive physical examination and tests that determine how their virus should be dealt with. Patients are also given, if needed, mental health and other lifestyle-related support to help them deal with a condition they will have to tightly manage for the rest of their lives. In terms of medicines, a person who contracts the virus is usually prescribed a regimen known as highly active antiretroviral therapy (HAART). This involves, among other measures, giving a “cocktail” usually consisting of a combination of three antiretroviral drugs. These are powerful medicines that have strong effects on the body, but in combination they work together to retard the spread of the virus and maintain the patient’s health. 

It is true, then, that in most cases we have made enough progress in treatment that people who contract the HIV virus do not progress to full-blown AIDS, and that these people can enjoy a fairly high quality of life and live a virtually normal lifespan despite their chronic infection.

But even though we have greatly improved treatment of HIV/AIDS in this quarter-century, we have not cured the disease. Right now there are more than 40 million people worldwide who are living with HIV (more than 35,000 in the state of New Jersey as of 2011), and more than 35 million people who have died of AIDS since the beginning of the epidemic. This disease has been especially problematic and devastating in sub-Saharan Africa, where more than 70 percent of people in the world with the virus live. It is particularly devastating to countries such as Swaziland (26.5% of the population was infected as of 2012), Lesotho (23.1%), Botswana (23%) and South Africa (6.1 million people – 17.9% of the population). So we must still put resources into finding a vaccine that would, upon taking it, assure every person that they would never have to endure this disease.