About AIDS
Fri., Aug. 22, 1997
Not long ago, Newsweek's cover had, in huge type, the phrase "The End of AIDS?" The words certainly reflect the present hope and enthusiasm, based on significant advances in treatment. But people overlook -- both on the magazine cover and in real life -- that there is a punctuation mark with those words: a question mark.
Certainly, the new therapies have postponed disease and reduced death rates for many, both nationally and here in Austin. Even so, the drugs have serious limitations which must be kept in mind by HIV+ people, their clinicians, and everyone else.
In June, a world-level research conference held in Florida examined the issues of drug resistance, treatment techniques, and eliminating the virus from the body. The theme was clear: keeping HIV under control remains, as the journal Science put it, "a daunting challenge."
Too often, folks misinterpret the phrase "undetectable viral load" as "virus is gone." Actually, "undetectable" just reflects the limits of current commercial lab technology, a limit below which HIV can no longer be counted in a small sample of blood. New technology becoming available permits counting even smaller quantities, and sure enough, the virus is still there.
Even small quantities of HIV present and reproducing allows it a chance to form resistance against any given drug combination. That chance is greatly increased if the patient does not absolutely stick to the dosing routine, daily taking handfuls of pills absolutely on schedule.
What if the right "drug cocktail" does succeed in keeping virus load undetectable longterm? Restoring an already damaged immune system is challenging, too. Although T-cell counts generally can be improved, quantity doesn't exactly equal competency. Such an immune system may have serious holes in it, able to offer only partial protection.
The ultimate outcome of the new therapies is unknown because our experience is too short. Some of us remember other developments which bred optimism, sometimes warranted and sustainable, sometimes not. Personally, I am glad that we've had some good news for a change, but it would be unfortunate for anyone -- especially HIV-infected people -- to have their hopes raised unrealistically high, only to suffer disappointment as a more sobering complexity emerges. Let us proceed chin up, but with eyes fully open.
-- Sandy Bartlett
Information/Education Coordinator, ASA
