En español | Bruce Ward can pinpoint exactly when he became infected with HIV: the New Yorker was vacationing in Hawaii in early 1984 when he came down with the flu-like symptoms associated with exposure to the virus. This was still a couple months before medical experts would announce that they had discovered the cause of AIDS, a virus initially labeled as HTLV-III. Two years later, he took an HIV test and learned that he was positive for HIV.
Ward, now 63, considers himself one of the lucky ones: “I always managed to stay one step ahead of the virus,” he recalls. In 1988, he started taking AZT, the first antiviral drug approved to treat HIV. Other, similar drugs followed, which he would go on for a couple years before developing resistance to the medication. (Because the HIV virus mutates rapidly, it easily becomes resistant to medications.) In 1997, when a breakthrough three-drug cocktail of antiviral medications became available, he started on that.
“What people don’t realize is what a big deal that was — everything changed almost overnight,” he says. “I had lost over 90 friends to the virus, but after that, it was no longer a death sentence.”
His feelings are echoed by Alan Taege, M.D., an infectious disease specialist at the Cleveland Clinic. While a positive HIV diagnosis is not something to be taken lightly, medical advances over the last quarter century have made living with the virus manageable.
“If a 25-year-old walks into my office now with an HIV diagnosis, I tell them that if they take their medication every day, and take care of themselves, they can expect to live a full life,” he says. Recently, Taege saw a patient in his mid-70s who just returned from an around-the-world trip with his life partner. “He looked at me and said, ‘I was diagnosed with HIV in 1987, and I never thought I’d be alive to do this,’ ” Taege recalls.
Here are four important things to learn about HIV today, ranging from the latest in treatments and breakthroughs in vaccine research to how the virus impacts older adults.
1. Longer-acting, simpler therapies
The advent of triple-drug therapy for HIV in the mid-1990s was a game changer when it came to management and treatment of the disease. But it required taking multiple pills several times a day, often with severe side effects.
Today, there are 11 combination-pill options on the market that include an entire regimen in a single pill. But adherence to this can still be difficult for some patients, especially those who are homeless or struggle with substance abuse or mental health disorders, Taege says. This past January, the Food and Drug Administration approved a new treatment, Cabenuva, which contains two different types of HIV drugs: cabotegravir and rilpivirine. It’s given as an injectable once a month.
But while it’s a step in the right direction, the injection may still prove challenging for some patients, notes Taege, as it requires monthly visits to a medical provider’s office. “If a patient misses a visit, or is even a week late, they may run into trouble,” he says.
Another injectable drug, Lenacapavir, is currently in clinical trials and, if approved, will only require a shot every six months. “This would be truly incredible, because it not only will make patients’ lives easier, it will also allow us to reach a whole group of people who otherwise might have fallen through the cracks,” Taege says
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2. New promise with HIV vaccines
In 1984, U.S. Department of Health and Human Services Secretary Margaret Heckler declared that an AIDS vaccine would be ready for testing within two years. Fast-forward more than 25 years and researchers are still struggling to develop one.
“Unfortunately, HIV itself is a very clever virus that has a lot of tricks up its sleeve to figure out new ways to infect the immune system,” says Monica Gandhi, M.D., an infectious disease specialist at the University of California, San Francisco.
But there’s new hope on the horizon, in the form of messenger RNA (mRNA) technology — the same technology found in Moderna and Pfizer-BioNTech’s COVID-19 vaccines. In fact, Moderna announced in April that it will begin clinical trials on one such HIV vaccine later this year. A small initial study found that the vaccine was able to stimulate the production of rare immune cells needed to create antibodies against the HIV virus in 97 percent of patient participants.
3. Different impacts on older adults
Thanks to effective HIV treatment, the number of older adults living with the virus is increasing. But they are also more vulnerable to other health complications, such as cardiovascular disease, diabetes, kidney disease and cancer.
“I consider myself the poster boy of physical ailments,” says Ward, who lives with high blood pressure and type 2 diabetes and says that he’s survived two bouts with cancer and a heart attack since his diagnosis in 1984. This is most likely related to the chronic inflammation associated with HIV — even well-controlled HIV — Taege says.
In addition, some patients, like Ward, lived with untreated HIV for more than a decade, until the current three-drug therapy regimen became available. “The more advanced the virus was before patients started therapy, the more wear and tear on the immune system,” Taege explains.
While it’s important for all older adults to get regular medical care, it’s even more so for people with HIV, Taege stresses. They’re more likely to experience side effects from HIV therapy, for example, so their bone, kidney, liver and heart health need to be monitored carefully. If they take drugs to manage chronic conditions such as high blood pressure or cholesterol, they also need to be closely followed to assess interactions between drugs.
HIV and its treatment can also impact the brain: anywhere between a quarter and half of people living with HIV have HIV-associated neurocognitive disorder (HAND), which can lead to depression, anxiety and, ultimately, dementia. While researchers are still studying why this happens, it’s important to screen older adults frequently for these conditions.
4. Lessons shared in the fight against COVID-19
The World Health Organization declared a worldwide pandemic on March 11, 2020, and less than nine months later, COVID shots were entering Americans’ arms. “This was all thanks to the activists who spent decades fighting another deadly scourge: HIV,” Gandhi says. Because of the hard work of these activists, for example, the FDA created a “parallel track” program that gave patients access to as-yet unapproved drugs.
“The program is now part of an ‘expanded access’ program that allowed COVID patients rapid access to new treatments, such as remdesivir,” she explains. After that, the FDA created a new procedure to grant faster approvals for interventions during public health crises: emergency use authorization (EUA) — which is how the Moderna, Pfizer-BioNTech and Johnson & Johnson (Janssen) vaccines were all available to the public so quickly.
There is, however, one lesson from HIV activists that Gandhi wishes everyone would heed: not shaming those who become infected. Being less strident in health “messaging” — whether about unprotected sex or getting a COVID vaccine — could help get more people to comply, she says.