Thursday , June 30 2022

HIV / AIDS treatment drastically reduces mortality and contributes to limiting transmission


There is no cure and no vaccine yet. People are still dying of it. It continues to be broadcast at alarming rates in some parts of the world (Sub-Saharan Africa) and some parts of the United States (South East).

And yet …

No perimeter: HIV / AIDS deaths dropped from the highest in the United States, 41,699 in 1995 to 6,456 in 2015 (the last year for which statistics are available). HIV / AIDS treatment is a success story of healthcare. In 1994, HIV / AIDS became the leading cause of death for Americans aged 25 to 44. About 675,000 people in the United States have died of AIDS since the first report on a mysterious pulmonary infection Weekly report on morbidity and mortality in 1981. Now there is a serious debate about the eradication of the disease in this country, starting with none other than Robert Redfield, CDC director and former AIDS researcher. "I think it could be the next three to seven years if we put it in our minds," he said in March.

Trends in age-related age-related deaths due to HIV, USA, 1987-2015

Source: National Center for HIV / AIDS, Viral Hepatitis, STD and Prevention of Tuberculosis, Slide Slide Mortality through 2015

And on an individual basis, the message to a patient is totally different and optimistic. "We can literally say to some people when they have recently diagnosed HIV that if they take their medication, their survival will be measured over decades, not months or years," says Paul E. Sax, MD, clinical director of the HIV program and the distribution of infectious diseases in the Brigham Hospital and women in Boston. "And that they can live as much as a person who is HIV negative".

The first breakthrough was made in 1987 with AZT, the first anti-retroviral drug approved by the FDA, to show some efficacy against HIV, although it had some serious side effects, including anemia. In 1995 the FDA approved the first protease inhibitor, saquinavir, followed by ritonavir and indinavir. They brought in a time of treatment with very active antiretroviral therapy (HAART). By 1997, HAART became the new standard of care and deaths related to AIDS decreased by 47% in 1997 compared to 1996.

The success of HIV / AIDS has had a fluctuating effect, says David Hardy, MD, an AIDS researcher at George Washington University. The obvious example, he says, are the antiviral drugs for hepatitis C.

Paul E. Sax, MD

Paul E. Sax, MD

So why are there no annual victories? First, the government's slow reaction at the outset of the epidemic means that many people suffered and died. And there is a risk of complacency, Sax notes. "Because with infectious diseases, if you turn your back, you do not offer enough resources and support, they may suddenly come back."

HIV transmission remains an important public health issue. Condoms help. Adhering to HIV / AIDS treatment reduces the risk of transmission by infected people. Pre-exposure Prevention (PrEP) is another tactic that leads to people who are at risk of getting but not yet infected. The PrEP scheme includes taking daily doses of tenofovir and emtricitabine (combined in a pill and sold as the Truvada medicine brand). According to the CDC, it can reduce the risk of HIV infection by 92%.

"You know about the people who regularly attend the clinic and deal with care, keeping is really good," says Sax. For many of his patients, it's like the watch. "They are the kind of people who, when changing time zones, are still taking their medication at the same time, but there is a small group of people who can not take them together to get the medicine, and this is one of the challenges. caring for these people seems to be difficult. "

Another challenge is caring for people with HIV / AIDS in their last years. They have higher rates of heart disease, mainly, but also stroke, diabetes, liver disease and kidney disease. "This may be the result of drugs, or it may be the result of long-term infections," says Hardy. It's a point that made April one Washington Post story about this problem.

More study required. Or, as Hardy puts it, we still do not know for sure.

We do not know for certain that HIV-infected people did not live long enough for providers to substantiate their long-term health needs. And that brings us back to where we started.

"It's really amazing," says Sax, of the progression of HIV / AIDS from a death penalty to a healed, chronic condition. "It's one of the great stories of success in the history of medicine."

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