In Their Own Words
BETA asked members of its San Francisco-based Scientific Advisory Committee: "What are your reflections on 25 years of AIDS -- and on the future?"
Paul WisotzkyI was 19 when the first case of AIDS was reported in the New York Times. Three years later, at age 22, I was infected with HIV. Now I am 44. I never thought I would be alive to see age 30, let alone 44. At age 27, I was told by my doctor that I had six months to live. I guess I proved him wrong!
I have lost so many friends, lovers, and colleagues. The losses, at times, have been overwhelming. I often wonder why I am here and they are not. I think my survival is due to a combination of many things, including access to health care and medicines, good luck, loving and supportive friends and family, a positive attitude, and, of course, all of those pills and injections that I have been taking since 1988.
I believe that everyone with HIV, no matter where they live, should have access to all of the things that have helped to keep me alive. My hope for the future is that someday I will be asked to reflect on the anniversary of the day we ended AIDS. I am committed to doing what I can to make sure that happens. I hope you are, too.
Gregory Pauxtis, M.D.Twenty-five years ago, I was a new physician at Bellevue Hospital in New York City. I recall the chaos of those first few years, in which AIDS patients were refused entry to hospital wards because of fears of infection transmission. I had to meet my patients in the hospital lobby and escort them to their rooms. I also recall the bravery of those patients.
In the future, research will produce more information on fat deposition by analyzing the fat cell, the adipocyte. This is a complex cell with its own cytokines and signals. Further research on adipocytes will benefit patients with lipoatrophy syndromes.
Future research on mitochondria will yield further etiology of changes in the white matter of the brain. The HIV-associated white matter changes have been attributed to HIV gp120 protein toxicity in the neurons, but inherited mitochondrial disorders in children have similar MRI and pathological appearances. Repairing the mitochondria -- distinct cell structures with 37 genes of their own -- seems possible.
Also in the future, genomic research will yield DNA analysis of an HIV positive patient to determine disease vulnerability, and even predict responses to proposed treatments.
Lisa Capaldini, M.D.My reflexive reflection is how much improved my patients' prognoses are -- they no longer expect to die from HIV disease.
With regard to the future, we have many important challenges remaining: addressing viral reservoirs, promoting adherence, treating substance use, managing concomitant conditions like hepatitis C, and optimizing quality of life.
I've also been reflecting on how much it means to me to be part of the HIV treatment community -- it's an honor.
Cristina Gruta, Pharm.D.I firmly believe that the HIV/AIDS epidemic is in large part the reason why we are in an age of very informed patients/clients. I love working with informed patients because it often makes my job as an HIV pharmacist a little easier. But I think the best reason why it's so good to work with informed patients is the ownership that they take of their medical care. Our conversations are true dialogues, and the burden around treatment decisions is shared by the patient and provider team.
As we move beyond the first 25 years of the epidemic, we have every reason to look ahead with optimism. The drug pipeline actually looks very hopeful and full. As such, patients have a lot of options to educate themselves about and hopefully bring to the table in discussions with their medical providers.
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This article was provided by San Francisco AIDS Foundation. It is a part of the publication Bulletin of Experimental Treatments for AIDS. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.