January 29, 2011
Hey HIV. Yes, I'm talking to you HIV. You found me exactly 20 years ago today! Do you remember how when I was performing a procedure on Mr. X, a gentleman with advanced-stage AIDS, a myoclonic jerk of his leg caused a deep hollow-bore needle stick and nasty laceration in the palm of my hand? I certainly do. I also remember my first thought (expletives deleted), quickly cleaning the wound, and promptly popping an AZT (one of the only antiretrovirals available in 1991).
My baseline HIV-antibody and hepatitis tests were negative that day, but a few weeks later, when I developed a fever, rash, swollen lymph nodes and flu-like symptoms, I suspected I was now sleeping with the enemy. As you coursed through my veins, seeded the lymphatic tissue in my gut, and then progressed on to other targets -- lymph nodes, brain, resting memory cells, genital tract -- I hoped and even prayed it was just a cold and that I wouldn't be the 1 in 300 to win the HIV lottery jackpot and seroconvert as a consequence of an occupational needle stick.
A few short weeks later, a repeat HIV-antibody test confirmed what I already knew: I had not dodged the HIV bullet. Seeing "positive" on the lab slip was beyond surreal. Had I really so easily crossed the line from one who provides care to those with HIV/AIDS and become someone with HIV who would eventually need care? What was going to happen to my medical practice, my partner, my family? Being an HIV physician specialist, I was fairly certain what was going to happen to me. In 1991 the prognosis for the virally enhanced was grim. You, HIV, would plant me six feet under within a decade.
Ten years was the average survival statistic. Because there were no effective antiretroviral medications available at the time, for the first five years that we cohabited, I ignored you while you slowly, but persistently, began to dismantle my immune system, destroying one CD4 T-cell after another. By 1996 the damage you had wrought had become too obvious to ignore. You had not only decimated a good portion of my immune system, but you had also wiped out my energy. I was forced to retire from my clinical practice as medical director of the Immunology/Oncology Treatment and Research Center at a large medical subspecialty group. I refocused my remaining energy on teaching at Stanford University Medical Center and promoting HIV/AIDS awareness.
In February of 1996, when I retired from my clinical practice, we still did not have effective antiretroviral therapy (protease inhibitors didn't become widely available until the second half of 1996). Assuming it would soon be time for me to find my place in the universe, I divested much of the wealth I had accumulated and began working on my bucket list. One top-of-the-agenda item was to attempt to raise a million dollars for the battle against the virus that was killing me. Check! Mission accomplished. I began a not-for-profit tax-exempt charitable organization, The Robert James Frascino AIDS Foundation, whose mission is to provide crucial services for men, women and children living with HIV/AIDS worldwide and to raise awareness of the HIV/AIDS epidemic through advocacy and education. To date the foundation has raised over 1.5 million dollars for AIDS service organizations worldwide.
Next was a trip to the land down under with my life partner (and now legally married spouse) Steve (Dr. Steve, the expert in TheBody.com's Tratamientos forum) to frolic with koala bears, kangaroos, kookaburras and Aussie surfers. Check! Mission accomplished (and very much enjoyed).
Another item on the list was to promote various novel approaches to a potential cure for HIV, including immune-based therapies. Despite my training as a clinical immunologist, this item remained unchecked on my list. HIV was far more clever than any of us realized early on. In 1996 we didn't have the basic scientific knowledge or tools to effect a cure.
At the International AIDS Conference in Vancouver in July 1996, news of HAART (highly active antiretroviral therapy) was announced. Combining the newly developed protease inhibitors with other antiretroviral agents could reduce HIV replication to undetectable levels. I immediately jumped on the HAART-bandwagon. In retrospect we now realize that the Highly Active Antiretroviral Therapy in 1996 would have more accurately been named Fairly Active Antiretroviral Therapy, but that would have lead to a most unfortunate acronym: FAART. However, even FAART was a significant improvement over what we had for the first 15 years of the epidemic. In the years since, more potent, less toxic, more convenient antiretroviral agents have continued to be developed. FAART has indeed become HAART.
And so dear HIV, here we are, you and me, two decades and several hundred thousand pills (yes, that's an accurate pill count!) later, still coexisting, albeit far from peacefully. This year, just in time for our 20-year anniversary, the search for a cure for HIV has been dramatically invigorated. Consequently, HIV, I hopefully may finally be able to check that unchecked item on my bucket list. You remember, the one about novel immune-based therapies that would not only evict you from my T-cells, but would eradicate you from the planet. Yes, HIV, it may well be time for you to go!
Want to get in touch with Dr. Bob? You can reach him through his "Ask the Experts" forum, by sending a message to the Robert James Frascino AIDS Foundation, or by leaving a comment for him below. (If it's a private message, or if it includes personal info such as your e-mail address or phone number, we won't post the comment, but we will send it along to him.)