An ongoing dialogue on HIV/AIDS, infectious diseases,
November 23rd, 2021
Gratitude for 40 Years of Progress in HIV Care and Research
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:
The "History of HIV" talk I gave last week actually has this title, which I don't think is an overstatement. Posting it now with gratitude, just in time for Thanksgiving (my favorite holiday — the gratitude and family part).
(Part 1 thread)
— Paul Sax (@PaulSaxMD) November 20, 2021
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.
*”Hit it out of the park”: To do or perform something extraordinarily well.