AIDS is Back

By SAM URETSKY

AIDS (acquired immunodeficiency syndrome) is back, and there is both good news and bad. The condition, now properly called HIV Disease (human immunodeficiency disease) first appeared in the early 1980s, and has been essentially incurable. Properly, the condition commonly called “full blown AIDS” was a combination of an HIV infection, which reduced the effectiveness of the immune system, and one or more opportunistic infections, such as Kaposi’s Sarcoma on the East Coast and Pneumocystis carinii on the West Coast. Over time, additional infections were added to the definition until it reached a point where it was understood that virtually any infection acquired by a person with HIV infection was potentially lethal.

There is no vaccine for AIDS, and no single drug that is reliably effective in controlling the virus although there are now six classes of drugs that are effective at inhibiting the viral infection, and used in combinations containing between two and four of these drugs, the progression of the disease can be inhibited, at least for a long time. The reason for using combination therapy is that HIV, like all viruses, is prone to mutation. Treatment with any single drug was limited by the ability to mutate so that the virus became resistant – but in combinations, the virus had to mutate again and again. This treatment bought time to find better treatments, and for some patented drugs to become available generic and less expensive. With improvements in treatment, it became possible for HIV infected persons to engage in what would have been high risk activities in the past. According to the CDC, at the end of 2019, an estimated 1,189,700 million people aged 13 and older had HIV in the United States, including an estimated 158,500 (13%) people whose infections had not been diagnosed. AIDS is also one of the most expensive diseases to treat over a lifetime, although the Affordable Care Act and other programs have reduced costs dramatically.

But, in The Lancet, August 2020, there was a report “Sexual transmission of an extensively drug-resistant HIV-1 strain” which described a patient whose infection was resistant to four different classes of drugs. “This subtype-B strain had resistance mutations to all available nucleoside reverse-transcriptase inhibitors, non-nucleoside reverse-transcriptase inhibitors, and protease inhibitors, and near-complete resistance to integrase inhibitors, except low-level resistance to dolutegravir and bictegravir …” There doesn’t appear to be firm data giving the rates of infection with drug resistant HIV, but reports of infections have come from France, China, Myanmar (Burma) and Canada. This is not totally new, since a case of highly drug resistant HIV was reported from Toronto in 2004. Transmission appears to be unchanged – contact with infect body fluids, either through sex or intravenous drug use.

The implications are frightening. In the 1980s and 1990s AIDS was an epidemic, but on a background of traditional diseases. Now it reappears with a pandemic still in progress and an international crisis in Ukraine.

The good news on AIDS is very limited. The web site WebMD reported “Feb. 16, 2022 — This week’s news that a third person has been “cured” of HIV through a unique transplant of stem cells has given hope for a larger-scale way to beat back the HIV epidemic … experts involved in the effort say we are still a long way from a universal cure.”

Stem cell transplantation is a high-risk, high-cost treatment for patients with cancers, and not suited for routine therapy. It has not been subject to wide-scale testing, and may not be available outside of developed nations. The WebMD report suggested that the stem cell treatment might be appropriate for HIV infected patients who also had cancers that were subject to stem cell therapy – about 50 patients a year.

And yes, this is a political problem, from President Ronald Reagan, who never said the word “AIDS,” to George W. Bush, who blocked stem cell research, to Donald Trump, who scoffed at global warming, important work has been held back along party lines. Oh yes, in the 1980s, New York and California were the centers of the AIDS epidemic. While they still have relatively high rates of the disease, they’re beaten out by Texas, Louisiana, and Florida. When will we ever learn?

Sam Uretsky is a writer and pharmacist living in Louisville, Ky, who was involved in AIDS research in the 1980s. Email sdu01@outlook.com.

From The Progressive Populist, April 1, 2022

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