Jan 19, 2006
Dear Doctor; Thank you for all of your brilliant work here, and your efforts to help people facing calamity.
After reading much of this forum and the website, it seemed that despite its success, HAART is eventually doomed to fail, due to resistances, mutations, adherence issues, that over time, say maybe 10 or 20 or some cases 25 years everyone infected will almost certainly die?? that despite its success in brining down the death rate due to AIDS, all it has managed to do is prolong the process and make it ever so expensive for the patients in the process?? Any thoughts or comments on that? and what you believe the future holds for patients, both newly infected and those already on long term treatment. Also your thoughts on when a cure might be possible? and that would the presence of mutations and resistant virus make a cure even impossible to work for those already infected? Also, would the development of a successful vaccine also mean simultaneously that a cure is also avaialable? One best exemplified "if there is a disease, there exists a cure"
Response from Dr. Young
Thanks for your post and kind words.
I'd differ from you view--- properly selected, adhered-to medications need not necessarily fail. You'll read other replies about some of my patients that have been sucessfully suppressed (without evidence of drug resistance) for upwards of 10 years. This doesn't mean that failure doesn't or can't happen, but rather what's possible.
With ever increasingly potent and better tolerated drug combinations, I firmly believe that the overall prognosis for patients on first- and second-line treatments should be excellent. The newest medications and new drug classess offer the additional hope- even for those who are unfortunate enough to have resistance to current medications.
Prices of medications are worth commenting on-- in the US, prices continue to rise in excess of the consumer price index or inflation and access to care can and may become a problem for many. Generic medications are here and more will undoubtedly arrive in the years to come, so this force can influence and offset some of the cost issues.
As to your query about a cure, I've generated controversy on this forum by stating my belief that a cure for established HIV infection will be a long time in coming. Preventive vaccines, while of critical importance don't necessarily translate into eradicative vaccines for those who are already infected.
But not to dwell on negatives-- in our clinic and across the US , death from HIV/AIDS has largely been eliminated because of effective therapies and access to qualified care. To me, this fact can be interpreted that we have "cured" AIDS deaths.
There's much more to do-- to guarantee access to care not just in the US and the North, but across all parts of the world- many of which don't yet have access to life saving treatments. Medications can still be better tolerated, easier to take and affordable to all--
Thanks for reading. BY
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