Dr. Pierone,

Not to let you down, but i got a bit concerned when i saw on Cnn that "Hiv deaths are on a rise again." Is this true, are more people dying of AIDS related complications today then 5 years ago. What was made clear that people, hiv infected, more and more cases are starting to run out of options due to resistance, intolerance, etc. The question is will this turn around again, are there new drugs soon to approved that will turn this around, what do you think?

Sebastian

When one looks at the worldwide HIV pandemic, the death rates are relentlessly climbing with about 8000 people per day are dying of AIDS (and 15,000 getting infected daily). In the United States about 15,000 people die per year of AIDS. So our domestic problems pale in comparison with the global situation.

In the United States there may be signs of an increase in AIDS death rates, but there are certainly not more people dying of AIDS now than 5 years ago. There are more people living with AIDS, so the overall burden of disease in the U.S. is going up. And yes, there are more people running out of treatment options because of development of viral resistance and medication intolerance.

Will we turn this around and get the death rates moving lower again? I do think that the new drugs will work for many people with drug-resistant virus and allow them to get viral replication under control. Many will also have significant immune reconstitution do very well for the foreseeable future. I am optimistic that salvage therapies will get better and work well.

The death rate reduction is a different issue. In our practice many patients that are dying with AIDS are not on treatment at all. They have mental health issues and substance abuse issues that result in them not seeking medical care unless they are extremely ill. We admit them to the hospital, patch them up, and often they don't return until they are near death again. These patients that are receiving sporadic or emergency only care account for a disproportionate number of our AIDS deaths, and our experience is not unique among HIV practices. I wish I knew the solution for this problem, but the mental health and substance abuse services are woefully inadequate to meet the special needs of these patients.