HIV and ID Observations

An ongoing dialogue on HIV/AIDS, infectious diseases,
all matters medical, and some not so medical.

November 23rd, 2021

Gratitude for 40 Years of Progress in HIV Care and Research

The Chap Book — Thanksgiving, Will H Bradley, 1895.

I was working with one of our outstanding senior ID fellows in clinic last week, and she presented the case she’d just seen, a 54-year-old man with HIV (certain details changed for confidentiality):

Will is doing great on [fill in one-pill daily regimen], missing no doses. He’s having some difficulty with sleep (his wife says he snores all night if he doesn’t use CPAP), not really sticking to his low-salt diet, and back pain. He agreed to get the flu shot. He’s due for labs.

In other words, this was your very typical HIV follow-up visit. Someone quite brilliantly likened them to well-baby visits for us ID doctors, because they often have zero active ID issues. It’s all about health maintenance.

(The flu shot doesn’t count as an active ID issue.)

Why even bring this up? Because this ID fellow had the wisdom to add, in an aside:

It’s hard to believe that just two years ago his CD4 cell count was 6, his viral load was over a million, and he was hospitalized with PCP.

Yes, it’s hard to believe. And it is amazing.

Remember, the median survival for a person like this with a serious HIV-related opportunistic infection in the 1980s was roughly 1 year. And today, this man not only has an excellent prognosis, but his active medical issues are the bread-and-butter of any primary care practice — sleep apnea, hypertension, low back pain, immunizations.

Thanksgiving is this week, and the best part of this holiday is that we express thanks for the good things that have come our way over the past year. In this spirit, I’ve typically written an ID-themed “gratitude” post in honor of this annual Thursday day off from work. It’s a fun column to write, and it’s interesting to look back and see the progress we’ve made and what we cheered about — especially in the pre-pandemic times. Sigh.

But this year, in honor of the 40th year since the publication of the first cases of AIDS, and because someone invited me to give a “History of HIV” talk, and because World AIDS Day just happens to be December 1, I’m going with just this biggie — the medical miracle of HIV care and research over the past 4 decades.

Here’s the talk I gave, Part 1, which covers the first twenty years:

Part 2 is here, bringing us up to date, and finishing with a link to the full slide set — go ahead and download to your heart’s content. Both Parts 1 and 2 include content quite miraculous by any standards.

Grateful for this progress!

And grateful also for Saturday Night Live — a show which, despite its age, can still hit it out of the park* every so often.

Happy Thanksgiving!

*”Hit it out of the park”:  To do or perform something extraordinarily well.

Categories: Health Care, HIV, Patient Care, Research
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9 Responses to “Gratitude for 40 Years of Progress in HIV Care and Research”

  1. Jeanne Breen says:
    November 24, 2021 at 7:13 am

    Amazing indeed. Well-baby visits certainly *never* came to mind when caring for HIV/AIDS patients as a resident and fellow back in the late 80s/early 90s.

    Since your title includes the word gratitude, I’d like to express mine Dr. Scott Hammer, who made so many important contributions to HIV research and care over the course of his career; he died last week. I consider myself extraordinarily fortunate to have been one of the many residents and fellows for whom he served as the highest benchmark of clinical acumen, teaching skill, humility and integrity.

  2. Loretta S says:
    November 24, 2021 at 10:05 am

    Thanks for that slide set, Paul. I think you could give me some lessons in succinctness. 🙂 Or at least my students would think so! And thanks for the 2 photos of Louie. What would this world be without all the Louies in it?

    I am grateful for the number of patients I see these days who are either already on PrEP, or who want to start it. Amazing and so gratifying. I also had a patient like the one you mentioned was in hospice and today is fine. The patient was hospitalized and was not expected to live. She was given the then-new ART. She describes getting out of her hospital bed and feeling like Lazarus! When I saw her, roughly 20 years later, she was seeing me for hypertension and prediabetes — the Primary Care Hit Parade. Again, so gratifying.

    I do feel sadness when thinking about the turnaround in HIV treatment, because of the people I knew who died before we had effective treatment. Some died so close to the introduction of effective treatment.

  3. Willian Tovar says:
    November 24, 2021 at 11:32 am

    Gracias por la atención y por brindarnos la oportunidad

  4. ROCMDMPH says:
    November 24, 2021 at 2:53 pm

    I’m in hospice care now for cancer and have cognitive impairment issues which presumably explain why I missed the amazing advances in transferring all these advances and the people and resources to prevent and treat HIV (Tb et al) in less wealthy areas/countries. Perhaps it will be highlighted in the followup 20 year presentation.

  5. satpathy p k says:
    November 25, 2021 at 12:38 am

    Evolution of a disease like HIV and the effective ART don’t travel on a parallel track of time. Discovery of HIV and effective ART at the same time could have saved millions. Blanket initiation of ART irrespective of CD+4 count and PrEP have revolutionized the HIV management strategy.
    Excellent job, Dr Paul Sax.

  6. JEFFREY T KIRCHNER says:
    November 25, 2021 at 8:30 am

    Well-said on this Thanksgiving Paul – and having started Medical School in 1981 also am
    privileged to have the long-term perspective that many others do. That being said while on the IAS
    PrEP webinar this past Friday with Mike Sagg and Henry Masur (both who provided guidance to me while I was figuring things out just out of Residency) it remains discouraging that
    2019 still gave us more than 35,000 New HIV infections – still much work to do if want to get close to 0.

  7. Aurora Orzechowski says:
    November 30, 2021 at 2:45 am

    I always try to read about Dr Saxs Iam an internist
    I worked with HIV patients since 1985 then Dr Carlos del Río returned to México and worked with him
    We forgot so much about other diseases with the CoVid19 it’s time to go on with prevention of HIV and other illnesses

  8. Aurora Orzechowski says:
    November 30, 2021 at 2:58 am

    At home my mother loved Thanksgiving as my son was born in San Antonio an all the family sat happy and excited to be reunited
    Then I met Dr del Río and we worked together in CONASIDA it was a very important moment in my life also met Dr Robert Murphy and Montagnier.
    And recently 10 years ago Dr Sax
    Beginning with prayers until medication came to us at México

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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