thoughts on the occasion of the final ever issue of HIV treatment update (HTU), from Professor Brian Gazzard, chair of the Department of Health’s Expert Advisory Group on AIDS and research director of the St Stephen’s AIDS Trust. Brian's comments form part of a feature article, All change.
It must be very unusual for a doctor to see a brand-new disease developing which is almost uniformly fatal and during his working career to see the same disease become a manageable condition with a good chance of people with it living a normal lifespan.
I have given much thought as to why this miracle happened. Firstly, we were very lucky. Had the AIDS epidemic started 20 years earlier, which it might well have done, we would have had little knowledge of retroviruses, of the function of lymphocytes, or had much of a technology to allow such rapid advances in treatment and care.
Secondly, it is a tribute to a National Health Service (NHS) which, despite our impoverished state, remains the envy of much of the developed world. We must ensure that the organisational changes in the NHS do not destroy this.
I am hopeful. During my 30 years as an NHS consultant, we have survived numerous re-organisations and will do so again. I would also like to pay tribute to the voluntary sector and to constructive activism, particularly in the UK and the USA, which has involved some of the brightest minds in pushing new treatments, for care and for a relatively non-prejudicial framework in which treatment and care could be provided.
The revolution in HIV care has been a wonderful example of basic science and the pharmaceutical industry collaborating to produce drugs that attack the virus, though recognition that lifelong treatment needed to be both convenient and tolerable may have been somewhat belated. While not perfect, present treatment does offer relative freedom from serious side-effects for the vast majority.
Many challenges remain. I think there are some glimmers of hope that a preventative vaccine might become available. Personally I think this is a more realistic prospect than a cure for HIV infection, though people would obviously like to be cured of their infection rather than merely controlling it. A cure is an unbelievably difficult and long-term goal – but then I would have said the same thing about treatment in 1983.
When you look at patients on the ward now, the primary problems are patients who come without realising they were HIV positive until a late stage, and a few individuals who cannot tolerate any of the medications available. We need to be much more proactive in involving the social scientists in determining how best to test for HIV at appropriate times and in environments which the patients find acceptable, and also to understand more clearly why some people just cannot tolerate taking medication.
Finally, of course, we should not forget that, despite rapid advances, nearly half the HIV-positive population in the world are denied treatment and some still get drugs with side-effects no longer seen in richer countries. Continuing medical, activist and political advocacy will be needed to continue to make inroads into this epidemic.
For more information
final issue of HIV treatment update
is out now and available online at: www.aidsmap.com/htu
Professor Brian Gazzard is chair of the Department of Health’s Expert Advisory Group on AIDS and research director of the St Stephen’s AIDS Trust.