HIV - AIDS TWO DECADES LATER

By Jens Ole Nielsen, M.D.

During the summer of 1981 doctors in New York and California noted highly unusual symptoms of a disease among younger men. At around the same time the symptoms - of what would become AIDS - appeared in Europe.

The disease has since spread around the globe, with around 60 million registered cases of HIV and 20 million deaths from the disease. The incidence of HIV infection continues to rise dramatically in many African nations, China, India and regions of eastern Europe. Information campaigns to curb the spread of the disease have proven effective in countries that have placed AIDS high on their health priority lists. Still, the disease often hits population segments of developing countries during victims' reproductive years, making it not only a health problem, but somewhat of an economic catastrophe in many countries.

Advances In Treatment
At the start of the HIV epidemic - French researchers found in 1983 HIV was behind AIDS -- 20 years ago the prospects for AIDS patients were dim. Until 1986 an average of only one year transpired between diagnosis and death. The arrival of AIDS initiated massive research efforts around the world.

ATZ became the first approved treatment in 1987, but now around 20 preparations have been approved for treating the disease. A breakthrough came in 1995 when research showed the efficacy of using more than one medicine; Combination therapy revolutionized treatment and has greatly extended lives.

Life-Long Therapy
HIV patients must take medicine for the rest of their lives, as it is with other chronic ailments such as diabetes, high blood pressure and other diseases. Aside from daily medication, many patients can lead fairly normal lives.

Persons diagnosed as HIV-positive must regularly monitor the proportion of HIV in the blood and the number of CD4 cells (immune cells). If the volume of the virus in the blood is low and the number of CD4 cells high enough, combination therapy is not necessary. Around one year after infection, the numbers can change and this type of therapy may be necessary. Combination therapy usually lowers the volume of the virus within a couple of weeks in 95% of all cases, and the number of CD4 cells gradually increases.

Combination therapy has drastically cut the number of AIDS fatalities in industrialized countries, despite the fact this treatment is still less than 10 years old.

As patients live longer more focus has been placed on side effects resulting from long-term combination therapy. In some cases the distribution of fat in the body changes, and there have also been observations of increased fat in the blood during treatment. Researchers are uncertain whether this is caused by a single preparation or a combination of the more than 20 medicines used in this type of therapy.

The cost of treatment can be staggering, on the average of around €/$13,000 annually.

Vaccine And Medical Prevention
As it is with other diseases, intensive work has been done to find an effective vaccine for preventing HIV infection. Unfortunately, the 19 vaccines tested to date have proven to be ineffective, so many health professionals question whether it is at all possible to develop a vaccine. For the time being, the old adage holds: "The best vaccine is information"

Even though we have a long way to go in the fight to control the global HIV epidemic, researchers have been able to radically improve the lives of patients.

Medical preparations have not only proven effective, they have prevented infection in some instances. First and foremost, it's possible to prevent transfer of the virus from a pregnant mother to the child. The infection is not transferred during pregnancy, but there is a 25% chance of infection at birth.

It is possible to reduce the risk to 1-2% by applying combination therapy during the final period of the mother's term. Routine checks for HIV among pregnant women, in conjunction with the availability of treatment would be especially effective in preventing newborns from getting the disease, especially in areas of the world where HIV is most prevalent.

Jens Ole Nielsen is a professor of Medicine at Hvidovre Hospital.

Courtesy of IHI Danmark

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