May 29, 2003
More people than ever living with HIV infection
Back in the ‘80s and early ‘90s, most people thought they knew what the face of AIDS looked like. On the streets of big cities and less frequently in small towns, people, mostly young men, could be seen literally wasting away in front of their neighbors. Fund-raising for their care and for the search for medical treatments and a possible vaccine was intense. Despite a decline in recent public attention, that effort continues. Dr. Bob Wood, director of the AIDS Control Program with Public Health — Seattle and King County, wishes that level of intense concern would return, especially among those at the greatest risk.
“AIDS is actually a worse problem in many ways than it was in the past,” Wood says. “There are now more people living with AIDS in King County, Washington state and the world than there have ever been. Globally the pool of infected people is expanding because more people get infected than die each year. Death rates have gone down precipitously since the new combination medications came out.”
The use of the new medication cocktails, often including three or more drugs, doesn’t mean that life after HIV/AIDS infection goes on as it did before. At-risk people, who now don’t fear catching the human immunodeficiency virus as much because of the availability of treatment, are not familiar with the effects of the ailment and the considerable difficulty of taking the medications and their side effects.
“The person who gets HIV will be better for a while because of medicines, but he or she will probably have a shortened life,” Wood says. “That person will also be a lot sicker because he or she will have a chronic illness that can be potentially disfiguring. Lipodystrophy – the loss of fat under the skin on the limbs and face and excessive accumulation in the abdomen – is one potential problem some patients will have for which we don’t have a solution.”
Other medical complications include drug-induced hepatitis, osteoporosis so severe that patients need hip replacements and potential early cardiovascular disease.
“The easy work has been done in AIDS control. Now we’re dealing with harder populations,” Wood says. “Globally the cases are in undeveloped countries. Across the United States, the new cases are mostly in disenfranchised populations: people who are more often homeless, mentally ill or heavily into substance abuse and people who more often lack health insurance. Also, we’ve got evidence of increasing resistance to the medications in newly infected people, telling us that some of these people got infected by people who were being treated and may not have been taking their medications properly, so their virus was becoming drug-resistant.”
Wood says the news isn’t all bad, despite the decline in funding for HIV/AIDS prevention and care from both government and private sources.
“We’re gradually learning more about medications and making the treatment regimen simpler and easier for people with AIDS to manage,” Wood says. “There are new kinds of medications coming along and many people with AIDS will live a long time, but it won’t be the most pleasant existence that one could have without HIV. It’s better to avoid infection in the first place.”
Everyone can avoid HIV/AIDS by abstaining from sexual activity or using latex barriers to prevent transmission and by not sharing intravenous needles or other injection equipment. The virus that causes AIDS can also be transmitted from mother to infant during birth, so it is important for pregnant women who may be at risk for HIV/AIDS to be tested during pregnancy, to assure that they and their children receive appropriate medical care.
