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Is there a future....?
Aug 6, 2006

Hi Ben.

I have read many of your answers over the last few years as regards expected life span for those diagnosed with HIV.

In many instances, you state that you believe that those diagnosed in today's climate will go on to lead a normal, or near normal life span, assuming they have access to anti-retroviral medication.

My concern regarding your statement is this (And I am trying not to sound too pessimistic) - if HAART was only really established approximately 10 years ago, and some of those who stated on it around this time are now exhausting their treatment options, how can you be sure that those diagnosed today will go on to lead a normal/near normal life?

Are there drugs in the development pipeline that really lead you to believe that HIV will become less and less of a problem over time to those infected? Or, is HIV as a virus weakening over time (I saw a report in a British medical publication recently that stated that over the past 20 years, the strains of HIV currently in circulation appear to be becoming less aggressive)?

Also, do you believe in time that there will be a therapeutic vaccine, which will eradicate the need for HAART, and thus allow people to lead a normal lifestyle?

I would very much appreciate your comments on some of the questions I have asked above. Like many of other HIV'ers who post on this web site, I think the service you provide is extremely valuable and you have given hope to many people, who would otherwise have given up.

Many thanks and regards.

Tom.

Response from Dr. Young

Thanks for your post.

Here's my take- you're correct in that any forecast into the future is just that, a forecast and not a contract that guarantees. Indeed, you're also correct insomuch as we've only had effective HAART since 1995-6.

What we can definitely say is that many persons with once-terminal AIDS complications (like PML, with a life expectancy of less than 6 months) are now back to work, back to life because of medications-- many now 8-10 years from that terminal diagnosis; that the causes of death among large cohorts of patients (including our analysis from the CDC/HOPS group) have shifted from AIDS causes to non-AIDS causes. This later point suggest that many patients are now living to their so-called non-AIDS life expectancy.

There are lots of medications in the pipeline (some recently approved, like darunavir (Prezista) that can offer viral suppression even for those with resistant virus. I don't think that HIV will ever not be a "problem" for those infected, but will not be a major determinate of quantity or quality of life.

Last, I see no evidence that HIV is becoming less virulent (this might have been an over interpretation about decreased viral fitness when the virus is drug resistant); also therapeutic vaccines, like all drugs in the pipeline remain speculative. Personally, I already believe that we have the potential to prevent (or if I dare say, "cure") death from AIDS. This isn't a perfect, (or as I said above, guaranteed) situation and requires access to medications, diligence and adherence. However, we have a variety of first- and even second-line regimens that can be well tolerated, potent and durable-- my hundreds of patients are testimony to the ability of HIV'ers to live normal and active lifestyles.

Thanks for your thoughtful comments. They are a bright moment in the grey sky, summer monsoon of the Colorado mountains. BY



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