HIV/AIDS Is Not The Death Sentence It Once Was: Here’s Why
There was a time in the not-so-distant past when a diagnosis of HIV/AIDS was considered a death sentence. Treatments were in their infancy, and nothing was coming close to a cure on the horizon.
From the early 1980s to the end of the 1990s, over 448,000 people died of AIDS-related illnesses. The advent of the first medication to treat AIDS, AZT, in 1987 slowed the progression of the disease, but it was still considered a terminal diagnosis.
“Today, the advancements that have been made in the treatment of HIV/AIDS have turned the tables on the view of the diseases as certain death sentences,” says Lisa Barr, Executive Director of the Hope and Help Center of Central Florida, Inc. “People are living longer, healthier lives with both diagnoses, and it is all thanks to the hard work of scientists and medical experts who have dedicated their lives to seeking out the best care solutions.”
The history of HIV/AIDS treatment
When the first reports of an unrecognized illness started cropping up in the media and CDC reports around 1981, all doctors that were treating early patients and the CDC knew was that the symptoms mimicked those of a rare type of pneumonia. Additionally, some patients were coming down with a rarely-seen version of cancer called Kaposi’s Sarcoma, which generally only affected much older males. There seemed to be little to go on as to where this strange new illness had originated and why it had appeared to target the gay male population of larger cities such as New York and San Francisco.
It took over a year from the first reports of AIDS for the disease to be given a name, but by that time, over 2,000 people had died from the disease. It was clear to those tracking this new condition that bold steps were necessary to identify the source of the disease and to develop treatments and, hopefully, a cure.
“In 1983, French scientists uncovered the virus that causes AIDS,” Barr says. “The human immunodeficiency viruses, or HIV, are two species of Lentivirus that can infect human beings. Over time if untreated, HIV develops into AIDS, which attacks the human immune system.”
With HIV and AIDS spreading unabated worldwide at the time, there was immense pressure to develop workable solutions for treatments. AZT became the first anti-HIV retroviral drug in the United States in 1987.
“It would take four more years for another treatment, Videx (ddI), to gain approval and hit the market,” Barr explains. “By this time, doctors were conducting early clinical trials of multi-drug treatments — commonly referred to as cocktails. The FDA kickstarted an accelerated approval process for HIV and AIDS treatments, hoping to get more treatments to the people who needed them the most.”
It was a time of confusion and chaos but also innovation and promising developments. As the 1990s wore on, more treatments — most notable being the first anti-HIV drug in the protease inhibitor class, Saquinavir (Invirase) — hit the market. By 1997, the onslaught of new treatments started to make a dent. For the first time, the CDC was able to report that the number of deaths due to AIDS-related illness had decreased.
A formidable foe
The fight against HIV/AIDS has been long and arduous because HIV itself has proven to be hard to kill, as it attacks the very helper cells that are supposed to protect the body against opportunistic infections. As a retrovirus, HIV tricks the body into making copies of the virus, causing an illness that is in it for the long haul.
“The breakthrough of AZT was outstanding and increased the life expectancy of many of those who had been diagnosed with HIV or AIDS in the early days of the disease,” says Barr. “However, the side effects of AZT are significant, and while it was a suitable treatment for HIV, it was not a cure, as the drug itself could cause liver complications and low blood cell counts.”
Additionally, in the early days following FDA approval, it was found that AZT did not work very well on its own. The drug was also very expensive, keeping it out of reach for many people living with HIV/AIDS.
“As new retroviral drugs were introduced throughout the 1990s, and doctors discovered cocktail combinations that seemed to slow the development of HIV and AIDS symptoms, people began living longer, healthier lives,” Barr notes. “It was a new era in combination therapy for HIV/AIDS, one that was giving people hope.”
According to Barr, highly active retroviral therapy, or HAART, became the new standard for those living with HIV and/or AIDS. Studies showed that patients who began a HAART regimen were living 10 or more years after the onset of AIDS. Comparably, those who did not take HAART only survived two years after the onset of AIDS on average.
The introduction of PrEP/PEP
No discussion of the advancements made in the treatment of HIV/AIDS would be complete without the mention of PrEP, a daily regimen that is highly effective in preventing people from acquiring HIV when taken as directed. In 2010, it was discovered that not only did a daily dose of antiretrovirals help those living with an HIV diagnosis, but it could actually protect healthy people from getting infected with the HIV virus.
“PrEP stands for “pre-exposure prophylaxis” and has been considered by many to be the next best thing to an HIV vaccine,” Barr explains.
The FDA approved PrEP (under the name Truvada) in 2014, and in the years following its inception, PrEP use contributed to a marked decline in HIV infections in major cities such as New York and San Francisco, which had once been the epicenter of the early AIDS crisis. PrEP has been shown to be 99% effective with daily use, making it a game-changer for the most high-risk communities.
“However, there is still work to be done where PrEP is concerned,” Barr affirms.
Studies show that many in the most high-risk demographics are living in “PrEP deserts,”meaning access to the treatment is more than thirty minutes away. In addition, despite the existence of affordability programs for those who do not carry insurance or are under-insured, the adoption of PrEP among low-income populations has been slow.
Activists and non-profits in the HIV/AIDS space have been working hard to increase access to life-saving treatment and ensure that everyone can benefit from it. A government program called Ready, Set, PrEP has been introduced to make PrEP free nationwide. It is the hope of those on the frontlines of seeking innovative treatments for HIV/AIDS that programs designed to make treatments more accessible will help eliminate the virus altogether in the very near future.
Equally exciting is the preventative “post-exposure prophylaxis” (PEP) medicine that prevents HIV after a possible exposure. PEP must be started within 72 hours (3 days) after a recent possible exposure to HIV to be effective.
Continued education and early detection
Two of the key components that work together with highly effective drugs in the fight to end HIV/AIDS are comprehensive education and early detection initiatives. Even though many people are aware of the continued existence of HIV/AIDS, the information being disseminated is not nearly as widespread or constant as it may have been during the anxiety-fraught early days of the epidemic.
“Some people may believe that because HIV/AIDS is not in the news and people have largely stopped wearing the red ribbons that were ubiquitous in the 1990s, HIV and AIDS are no longer concerns,” Barr says. “Education campaigns are needed to keep people informed on the latest in treatment and prevention and to let them know that HIV and AIDS still exist. However, the real disease at work here is the stigma that has historically surrounded the virus and, in many communities, still does. Had HIV testing and treatment not been initially stigmatized, we may have been able to end the virus once and for all before it reached epidemic levels.”
Early detection is a crucial part of HIV treatment. With early detection of the virus, antiretroviral treatment can begin immediately, suppressing the virus’ desire to replicate and slowing the progression of the disease. Early detection of the virus also prevents transmission because when people are unaware of their status, they can unknowingly pass the virus on to others.
Lastly, early detection leads to a longer lifespan for people with HIV/AIDS. Studies show that early detection leads to a longer life expectancy and better quality of life than those who get a late diagnosis.
Modern HIV/AIDS treatment
Today, through the use of HAART and PrEP, doctors have been able to get most patients with HIV infections to undetectable levels as long as they are in treatment — a milestone that was unthinkable 20 years ago — as the virus being undetectable essentially equates to it being untransmittable, or “U=U.”
“This means that many of those living with HIV can do so without the worry that they can pass the virus on to others,” Barr explains. “This has led to a significant mindset shift for many of the communities that were most at risk of getting HIV or AIDS.”
Communities are no longer living under a dark shadow of impending doom. There is hope — a proverbial light at the end of what has been a very long tunnel.
“Looking back, we can see that the journey from the early, darker days of the HIV/AIDS epidemic to today is nothing short of remarkable,” says Barr. The decades of research, advocacy, medical intervention, and innovations have taken an HIV diagnosis from terminal to treatable.”
There is a wide range of highly effective treatments today, with more than 30 HIV medications available for people living with the disease. Along with education and early detection, these medications have ushered in a new era of HIV, one where people are living longer, healthier lives without the specter of fear and imminent death that used to accompany a diagnosis.