As we observe World AIDS Day on Dec. 1, there are more than 1.2 million people in the United States living with HIV, human immunodeficiency virus, and more than 35,000 new infections each year. HIV causes acquired immunodeficiency syndrome (AIDS), a chronic and potentially life-threatening condition. More than 40 years after HIV was first discovered, Steward Health Care sits down with Dr. Jorge Fleisher, infectious disease expert, to discuss how far treatment has come and what is on the horizon for patients who live with this medical condition.
More than 40 years after the first case of HIV was discovered in 1981, what promising advancements are there in the treatment of this condition?
There are many cool things going on with HIV. The first one that I think is impressive is the new medications. Some patients come every two months for an injection, and they do not have to take anything in between. We have medications that are injectable now, so patients do not have to take pills.
What is the expected lifespan for someone living with HIV?
In 2021, we received the results from a study that has been going on for the past decade that shows that the average life expectancy of patients with HIV is only a couple of years lower than patients without HIV, and patients with HIV are living longer than patients with diabetes or heart disease.
Ever since HIV was discovered, the goal has always been to find new medications – medications without side effects, medications that can keep the virus under control without it becoming resistant. At first, HIV medications were really harsh on the body. They were tough to tolerate and the side effects, in the long run, really affected people’s quality of life and overall health. But research into developing new drugs has found HIV medications with minimal side effects and no long-term problems, but they’re so powerful that as long as patients take them regularly, the virus is completely suppressed.
As long as people take their medication as prescribed, it’s almost like they don’t even have the infection. The virus isn’t replicating at all, allowing a patient’s immune system to bounce back to a level very close to what it was before they acquired HIV. The virus is suppressed so low that even the Centers for Disease Control and Prevention (CDC) acknowledges that patients who are undetectable can’t transmit the infection anymore. The CDC has a program called U=U, which stands for “Undetectable Equals Untransmittable.” Unlike insulin for diabetes or blood pressure medications, when HIV medications are started on a patient, they can so efficiently block viral replication that for most patients, their immune system can return to almost normal. So, people can live long, healthy lives as long as they keep taking their HIV medications.
Are there new developments in the prevention of HIV?
Yes, there have been strides achieved in pre-exposure prevention. For those who may be at risk for developing HIV, there is now medication that can help reduce their risk of developing HIV. By taking 1 tablet a day, patients can reduce the chance of infection by 70-80%.
We also have new medications that work in patients who have been treated for a long period of time and have very resistant virus, which is very positive news.
When HIV treatment became available in pill form, the side effects were the main problem. It was very hard for patients to tolerate the medications. When many of my patients began taking HIV medication, we had to give them medication to prevent the side effects. That has changed. Now there are no side effects.
In January of 2021, the Food & Drug Administration also approved the first and only complete, long-acting HIV treatment regimen which is administrated as a one-a month treatment for HIV-1 in adult patients whose HIV is virologically suppressed, meaning that when tested, the amount of virus they have cannot be detected on a test. That is also a significant step in treatment.
Is there a vaccine that will prevent HIV infection?
Currently there is no vaccine, however work to develop one continues. I don’t yet know what the role of vaccines is going to be, but if it can reach more than 80% effectiveness, it will be much better for patients than taking a pill every day. The National Institute of Health continues to work on a number of approaches to prevent HIV, including the development of a vaccine. I continue to be hopeful that we will continue to make advancements and help patients live their highest quality of life.
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