23 July 2007

HIV no longer a death sentence

HIV infection is no longer a death sentence, with patients likely to have a “fairly robust” life expectancy if given the right drugs.

HIV infection is no longer a death sentence, with patients likely to have a “fairly robust” life expectancy if given the right drugs, a major HIV/AIDS conference in Australia heard Monday.

Michael Lederman, of Case Western Reserve University, has been treating HIV patients for more than 20 years and said he has seen such improvements that he believes the world could be on the cusp of ending the pandemic.

”I have been doing HIV care since 1983,” he told a press conference at the fourth International AIDS Society Conference in Sydney. "And in those days I would regularly see my patients die. Life expectancy was short.

"I wouldn't even tell my patients who enjoyed cigarettes to stop smoking because it didn't seem to make a lot of sense if we were talking about survival in terms of months and a few years.

"But now we are talking about a fairly robust life expectancy."

A robust life expectancy
While the life expectancy for a person infected with HIV was not quite the same as normal, the major health risks for his patients were the same as those facing the general population such as heart disease, Lederman said.

"So the future is a little uncertain but it is so bright, so bright compared to what it was 10, 15, 20 years ago," he said.

Lederman's comments echoed those of other high profile speakers at the conference, who have said that powerful antiretroviral drugs now in use can prevent people from dying from the disease for decades.

"I think we are done with the mortality of AIDS in treated people," the head of the Global Fund to Fight AIDS, tuberculosis and malaria, Michel Kazatchkine, told the conference on Sunday.

"Only five years ago hope was an abstract notion, now hope is a reality."

The possibility of eradicating HIV emerged in the mid-1990s when powerful antiretroviral therapies first became available but optimism faded because of the toxicity of the drugs.

Improved drugs have greatly reduced the toxic side-effects while two new classes of medications are being developed to treat patients who have developed resistance to the antiretrovirals.

Developing world is the greatest challenge
Lederman said the challenge would be seeing lifesaving drugs made available in the developing world where less than 28 percent of those infected with HIV receive treatment.

"The challenge is huge. But I'm actually pretty optimistic that things are going in the right direction. I am looking at the cup as being more than half full," he told AFP.

Pandemic has claimed more than 25 million people
Brian Gazzard, founder and chair of the British HIV Association, agreed that HIV patients who a decade ago would have died were now living long enough to have to manage the normal consequences of ageing, such as heart disease.

But he said it would be wrong to believe the world was close to ending the devastation of the HIV/AIDS pandemic which is estimated to have claimed some 25 million lives in the past quarter century. "I don't agree at all. I think the HIV epidemic is essentially uncontrolled. It is uncontrolled in Africa, it is uncontrolled completely in Asia at the moment," he told the press.

"I think the scale of the endeavour to actually beat this epidemic, nobody has started to really conceive of yet."

Craig McClure, executive director of the International AIDS Society, said it seemed that while there were now more resources for HIV and AIDS than ever before, it was no guarantee that the disease would be overcome.

"There is a possibility that we could overcome this disease," he said.

"We are at a point where we could begin to begin ending the epidemic or we could begin to go down a very negative track where people assume that there are enough resources now and the problem is over. And it certainly isn't." (SAPA, Madeleine Coorey, July 2007)

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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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