Thirty-five years ago we were beginning to hear about a disease that made sex deadly: AIDS.
Dr. Donald Brode, a family physician at Austin Regional Clinic, began working in an HIV clinic in Austin in 2000 and before that was focusing on HIV care in his residency. We talked to him about what’s new in treatment for AIDS and HIV, which no longer has to carry a death sentence.
One of the first questions someone who has just been diagnosed will still ask Brode is: “How long do I have?” he says.
He reassures them that “it’s not a death sentence. It’s just a chronic disease. Like diabetes, it’s manageable,” he says.
He counsels them on how to manage it, but he also talks about their other health issues that might lead to things like heart disease or diabetes that might actually be their undoing.
“The vast majority don’t know what it’s like to be ill from HIV,” Brode says.
What happened? The first drug cocktail for HIV/AIDS was approved by the FDA in 1997. More drugs were developed and became more readily available through insurance. Generics were developed. Then co-pay assistance made the medications more affordable. People started staving off infection and their T-cell counts went up. (T cells are lymphocyte cells that the virus invades causing the immune system to crash.)
Then people who weren’t infected began taking the drug cocktails and the new medications that have since been developed. Now people who think they might be at risk are encouraged to take these medications — a practice known as pre-exposure prophylactic use or PrEP. One drug, Truvada, is specifically marketed for this use. Brode likens PrEP drugs to taking birth control to prevent pregnancy.
Brode has patients fill out a question-and-answer tool to determine whether PrEP is for them.
The challenge has been to let people know that there is this option; they don’t have to wait until they are infected for treatment. Brode says doctors made progress with men who have sex with other men, but people they aren’t reaching as well include younger gay men, women, especially African American women, and people of color. Those are groups most at risk for HIV infection.
PrEP drugs can’t officially be considered a cure and aren’t endorsed that way by the Centers for Disease Control because a study done about 10 years ago found some detectable virus in about 10 percent samples tested. In another study of about 1,500 people, two anecdotally might have been infected while on PrEP.
Again, Brode likens it to birth control: if you’re not taking your medicine regularly, you might get pregnant.
These drugs aren’t quite like a vaccine, though, and researchers still are working on 16 potential vaccines, Brode says, but vaccines have proven to be hard to develop. In fact, he says, Austin had one of those vaccine trials early on for a failed vaccine.
Researchers are also working on medications that will be what Brode calls “functional cure,” therapies that will allow the body to keep the virus in check without daily medication and make the virus virtually undetectable. These are therapies that make the body inhospitable to HIV, that lock it out of T cells and that work at altering genetic codes.
“It feels like there’s so much,” Brode says of the research going on. He says 10 years ago he would go to a conference and talk of these kinds of therapies and it “felt like you’re talking ‘Star Trek.’ It was interesting coffee talk. Now you go and there are details.”
The first step might be taking a shot once a month or every other month rather than taking a daily pill. He says that will be the next breakthrough.