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Improving treatments
| Last updated: 25.06.04 |
The development of new and improved treatments both for the underlying HIV infection and the opportunistic infections has significantly altered the natural history of HIV and AIDS.
Early estimates of the proportion of people with HIV who will go on to develop AIDS were partly based on the experience of the epidemic in the years before such drugs became widely available. As new drugs against HIV and opportunistic infections have become available, these have had a dramatic impact on estimates of the average prognosis of people with HIV.
Improving treatments for opportunistic infections mean that it is increasingly possible to develop an AIDS-defining illness, such as PCP, and have it successfully treated. Thereafter the individual may, to all intents and purposes, be just as healthy as they were before developing PCP, but nevertheless will now have been diagnosed as having AIDS. In practice, this means that very many people who meet rigid AIDS definitions can continue to lead healthy lives for long periods.
Prophylaxis, to prevent infections recurring or happening even a first time, has also changed the natural history of HIV disease. A number of studies in the early 1990s showed that, compared with the 1980s, people with HIV were experiencing a shorter survival time after they developed AIDS than previously. The reason for this was that prophylactic drugs have delayed the onset of AIDS, so that people are receiving their AIDS diagnosis when their CD4 cell count falls to, say, 75, when earlier in the epidemic they might have developed an AIDS-defining illness at a CD4 count of nearer 200. People with HIV who use prophylaxis are living with HIV without symptoms, and without an AIDS diagnosis, for longer.
The most dramatic developments in HIV treatment have occurred since 1995. Substantial reductions in death rates among HIV-positive people have been reported in many developed countries where infected people have access to the latest therapies. Early use of today's antiretroviral therapies, before HIV-related symptoms develop, may reduce an individual's risk of developing an AIDS-defining illness. Furthermore, many people with very advanced disease, including those with a prior AIDS diagnosis, have experienced remarkable recoveries in physical health, accompanied by rising CD4 counts and a reduction in viral load.