HIV: A chronic disease, not a death sentence

SAN FRANCISCO - When Michael Siever was diagnosed with HIV nearly 20 years ago, he assumed it was a death sentence.

He never thought he'd make it to 2000. He certainly never thought that in 2011 -- approaching the 30th anniversary of the AIDS epidemic -- that he'd be a relatively healthy 61-year-old man, sitting in an auditorium listening to people talk enthusiastically about how there would be a cure for AIDS someday.

"Living with HIV has been kind of a weird roller coaster," said Siever, director of behavioral health services for the San Francisco AIDS Foundation. "So many things, whether it's a vaccine or a cure, have turned out to be more disappointing than initially hoped. But obviously things are way better than they used to be."

Sunday marks the official anniversary of the AIDS epidemic, when the first federal report came out, in 1981, about a rare pneumonia that was striking gay men. It would be another several months before doctors identified a virus as the cause of the disease, and at least a year before the name AIDS, for acquired immune deficiency syndrome, stuck.

The tapestry of the HIV/AIDS epidemic has changed dramatically since that first report, and in the United States, at least, doctors and patients have begun to consider HIV infection a chronic disease instead of a death sentence. More than 30 drugs are available to treat HIV infection, and those drugs in most people can almost completely suppress the virus, to the point that it's virtually undetectable in the blood.

The development of antiretroviral drugs completely turned around the AIDS epidemic in the United States. The worst is now in Africa, which has about two-thirds of the world's HIV cases.

New focus on prevention

"In San Francisco, we could make the next 30 years the last 30 years," said Dr. Grant Colfax, director of HIV prevention at the San Francisco Department of Public Health. "Even five years ago, we were thinking more about how do we keep things from getting worse.

"Now we're talking about wow, this can really be done. It's not just a dream anymore."

More than a million Americans -- and more than 33 million people worldwide -- are living with HIV, or the human immunodeficiency virus that causes AIDS, according to the U.S. Centers for Disease Control and Prevention. As of 2008, nearly 600,000 people in the United States had died of AIDS since 1981.

Drug therapy has significantly reduced AIDS death rates -- in 1995, at the peak of the epidemic, 50,628 people died from AIDS. Today, there are just more than 17,000 AIDS-related deaths a year, according to the CDC.

Doctors now have ways to prevent new infections in every type of demographic group most affected by AIDS -- gay men, straight men, women, minorities and drug users. In the past year, studies have shown that HIV-negative men who take an antiviral drug can significantly reduce their chances of becoming infected, assuming they take the medication daily.

Some disappointments

There have been disappointments, too, especially in efforts to develop a vaccine. Study was halted into one experimental AIDS vaccine in 2008 after early results showed that it failed to provide any added protection.

Even some of the so-called breakthroughs hailed by many researchers -- such as the evidence that early treatment with antiviral drugs can prevent the spread of HIV -- merely confirmed what researchers already suspected, said Dr. David Katzenstein, a Stanford professor who has studied the global AIDS epidemic for more than two decades.

Since the development in 1996 of highly active antiretroviral therapy -- or HAART, the famous cocktail of drugs that stops HIV from ever developing into AIDS -- U.S. researchers haven't made any "truly remarkable" progress in treating or preventing HIV, Katzenstein said.