Why are people still dying?
Nov 13, 2001
If the drugs are so good, why am I still reading so many obits of people dying from AIDS? If someone is 100 compliant with taking the meds, what are the chances the disease will still progress?
Response from Dr. Cohen
Well - people are still dying with HIV infection. Death from AIDS related illnesses are still happening. So what is up with that?
Here is what we see. When we can create a successful combo of meds that someone can take and tolerate -- and which stops HIV from growing - people do very well. The immune system does recover. And illnesses as a result of immune destruction are rare. Not impossible, however - we still do see some cancers that happen even to those with good t4 counts, for reasons still not clear, but keep in mind that cancer happens to those who are also HIV negative...
But there are complications to this simple summary. First -there are too many people for whom these meds aren't working out well enough. Some of this is a problem of resistance - the initial combos weren't strong enough to prevent resistance, and the follow up plan B's aren't always enough. And if that is seen, HIV can still destroy. And while we are searching for newer meds for that circumstance, they may not happen fast enough for some. And there are med toxicities which can for some make it very hard to find a successful combo. In addition, for those who have Hepatitis C infection, this makes it harder to treat HIV - since liver toxicity from HIV antivirals is more common in those with Hep C - and we do see progression of Hep C even in those whose HIV is well controlled... so for some groups of people who have HIV, the number one cause of death is liver failure from the Hep C, despite excellent control of the HIV.
But, if someone is 100 percent compliant with an effective regimen, it is fair to say that we can and do see a prolonged time that HIV, and the illnesses it brings, are stopped. Perhaps for decades when all goes well...
Hope that clarifies.
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