HIV/AIDS: Progress in Treatment
Guest: Dr. Preston Church – Infectious Diseases, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Preston Church, who is Associate Professor of Medicine and a specialist in epidemiology and infectious disease. Dr. Church, you have a lot interest in many different illnesses, but let’s focus, now, on HIV, which, unfortunately, is not an illness that has gone away. On the other hand, there are some new drug treatments available. What are some of the new approaches with this illness?
Dr. Preston Church: I think some of the things that are really exciting for us in treating HIV fall into two distinct categories. One of those categories includes some of the things we’re able to do now in the treatment of new patients, or newly recognized patients, who have not been treated for their HIV infection before. We have, now, at our disposal, some therapies that are considerably simpler than some of the therapies of old.
We’re not looking at starting somebody out on what looks like a diet of 24 pills a day to treat their HIV. In fact, there are some patients that are appropriately treated with a multiple drug regimen that is all contained in a single pill taken once a day. Why is that exciting? Well, we know that medications have side effects, certainly. But, some of the issues with medications are having to keep up with each and every one of them; keep up with all their special requirements. And, let’s face it. I mean, for many people, taking something once a day is sometimes a serious enough challenge. When you have to take multiple things multiple times throughout the day, it really thwarts therapy that is otherwise very demanding, and frequently very unforgiving, if it’s not properly taken. So, we’ve learned that, actually, we can achieve much higher success rates for patients with much fewer side effects, with much more agreeable therapies, with some of these simpler types of treatment regimens.
The other area where we’re really making some advances is, in the last couple of years, we now have at our disposal medication that is attacking, or directed against, totally new parts of the HIV virus. These are compounds that are really unrelated to any of the drugs that we have used previously. One of the challenges that we have faced with our patients is that over periods of, really, decades, for many of our patients on therapy, for certain reasons, some of our therapies may fail, or they just become intolerable, or result in other types complications that compromise quality of life. So, the opportunity to use drugs that go after new targets eliminates the problem that the virus is likely resistant to those drugs. In other words, gets around some of the problems associated with failure, because these are totally different kinds of compounds, unlikely, perhaps, to generate some of the problems that we see arise with either short or long term use with some of the therapies that we currently have.
In fact, it’s better for patients. In some ways, it’s more of a challenge for physicians because we can’t just follow a script. In fact, we have many more options that allow us to tailor things for specific patients, but also allows to get around some of the failures that we’ve had in the past. So, even for patients with advanced disease, even for patients who’ve been on therapy for a long time, or who failed multiple therapies, we have ways to treat them, and treat them very successfully. And that has really generated a huge amount of excitement in the last couple years.
Dr. Linda Austin: What are survival rates these days for HIV?
Dr. Preston Church: Well, I’m not if I would consider it a rate per se. But, if I see somebody newly diagnosed who I can start on therapy, I expect them to be here when I retire. And I consider that 20 years away. Many people would estimate that, particularly for somebody who has a virus not resistant to any of the currently available medications, their expected length of survival is 30, 35 years. If you’re only 18 or 20, that still seems to fall a little short of where you want to be, and I would agree with that. But, still, it’s a huge advance compared to where we were 10 years ago. Obviously, HIV, untreated, from the time it’s acquired, to death, is, on average, 10 years. But that can be, for some people, much longer; but, for some people, as little as 18 to 24 months.
Dr. Linda Austin: Depending on when it’s diagnosed, I would think, as well as other factors.
Dr. Preston Church: There are a number of factors that play in.
Dr. Linda Austin: Your typical patient, then, who is treated, can that patient expect to live a normal lifestyle, by which I mean normal energy, free to travel, can play sports, exercise, those sorts of things?
Dr. Preston Church: The answer to that is, yes. Obviously, everyone brings to the table what their underlying health is to start with. It’s very interesting to see how antiretroviral therapy changes things for a lot of people. And, interestingly, I have a number of patients who, 10 years ago, maybe, were not doing all that well, were starting to think about their plans for their final resting place, if you will, and what they were going to do on their last year or two of disability, who, now, are working, productive, enjoying life. And, really, for many people, it’s almost been a renaissance.
Yes, we have people who can travel. We have people who own their own businesses. We have people who are fully active. We have people who are activists. So, yes, there are lots of people with lots of energy out there leading vigorous lives.
Dr. Linda Austin: Thank you so much.
Dr. Preston Church: Sure.
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