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medical students question
Sep 6, 2003

As a medical student hoping to major in HIV medicine and treatment whether in the states or with the WHO I would like to know your realistic assesment of the life expectancy of HIV patients with access to HAART and near perfect adherence? Some of my professors have pointed to the Cornell test (16years)as a bench mark while other researchers and professors have argued that the introduction of powerful new HAART era drugs have considerably altered this equation meaning that as future doctors we are looking at treatments for patients that approach normal life expectancy (30years+) as opposed to 8-10 untreated and 16 in Cornell study. What are your thoughts?

Also with continual development of new more potent retrovirals my professor argued that even if we assume exhaustion of current regimens and resistance thru mutation that even a gradual growth of new drugs (assuming limited side effects) will contribute to the near normal life expectancy that we are hoping to nurture. Would you agree?

Also do you believe we are closer to making HIV a chronic disease condition (as observed in diabetes etc) and no longer a fatal illness?

Your sight is a great resource for medical students who wish to help eradicate this disease.

thanks for the inspiration

Response from Dr. Pierone

Hello, it is great to hear that you interested in HIV medicine and treatment. New energetic doctors are needed in this field to replace the practitioners that are aging (rapidly) and leaving for pharm company jobs or the "quiet life".

But on to your questions. Yes, HIV is now is a chronic manageable disease like diabetes. Actually, diabetes is a good example because, as you know, some of our patients get diabetes from the HIV medications.

In the past, much of HIV treatment revolved around prevention and treatment of opportunistic infections. Now, we see so many fewer opportunistic infections that I need to look up dosages of medications to treat them. I used to know them by heart from constant use (or perhaps it's my aging brain, who knows).

The challenges of contemporary HIV treatment are twofold. First is anticipating and managing the side effects of medications. Second is dealing with development of viral resistance to the medications.

The future is bright (for those with access to medications). The newer medications will certainly be less toxic and more potent. We will develop superior strategies to facilitate adherence. Better and more rational sequencing of antiretrovirals will lead to improved outcomes for those with resistance. Finally, immune-based therapies will also be developed and will play an important role in HIV management.

Life expectancy for HIV infection should be close to normal for those with perfect or near perfect adherence to medications.



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