Interviewer: It wasn't too long ago that HIV treatments were a nightmare and the diagnosis was a death sentence. What's treatment like today for HIV positive patients?
We're here with Dr. Adam Spivak. He's an assistant professor in the School of Medicine and he specializes in HIV. And today we're talking about some of the HIV treatments available these days. How is the treatment today different than say what we did 10 years ago, 20 years ago? How has treatment changed?
HIV Treatment and Care Has Changed in Recent Years
Dr. Spivak: I think one of the things we've come to recognize is that the real revolution in HIV care began roughly in the mid '90s, by 1995, '96, with the introduction of combination antiretroviral therapy and you go back to the medical journals and recognize from the scientific studies how miraculous that was. Taking a disease that for the previous 15 years, from its first descriptions of AIDS in 1981 through, again, the mid '90s, this was a death sentence for patients. This was a disease that we really could slow down but not stop and that was killing more and more people every year. And we got these amazing combinations of drugs and people started to do fabulously well.
However, that didn't seem to apply to everybody and even though the drugs were so great, it was really under the rubric of a controlled medical study that we were seeing the benefits. And so, when you bring those into the real world and you're asking people to take at least in those days, difficult combinations of medicines that had lots of side effects, had to be taken every day, some with food, some without, some refrigerated, some not, it was extremely difficult to do. Even the most compliant patients, any of us trying to take medicine three times a day, it's difficult. And to ask people to do that up to 20 pills, it was really, really hard.
So I think what happened in the late '90s, early 2000s, was the recognition that we needed to do more than just sort of have the medicines available. And a physician just writing a prescription is not enough, which is perhaps an obvious thing in retrospect. But a clinic like ours is trying to really maximize the benefits of these medicines by providing enough of the resources to actually make it happen.
Interviewer: So specifically with medicines, what has changed? Are we still dealing with those 20 pills a day, 3, 4 times a day or what are they dealing with now?
Dr. Spivak: Yeah, luckily that has also changed and so that's really perhaps what we would call version 1.0 and that's way actually, luckily in our distant past. What has happened in the last certainly 10 years or so, is that we've gotten some new medicines and what the drug companies have also provided, are combination pills. So we have some new classes but also a recognition that those early days, medicines are only good if you can take them, you can tolerate them. And we are now to the point where we have four or five first-line regimens that are one pill, once a day.
Within that pill are three different medicines. They're co-formulated, minimal side effects. Again, very easy to take. Take on an empty stomach, take them with food, really not a huge deal. And this has really freed people to live their lives and take these medicines on a regular basis, without missing them, and basically live long healthy lives.
What to Expect at an HIV/AIDS Clinic
Interviewer: Besides the medications, just the straight up treatment. Take me through. An individual has tested positive for HIV and they come into your clinic. What do they expect when they come to the clinic there?
Dr. Spivak: HIV, even though the picture I was just painting, had been a life-threatening, devastating illness, and is now essentially a chronic medical condition that can be well controlled with medications, it's a disease with a lot of stigma. And so it's a devastating diagnosis to have, it is an extremely difficult thing for patients who are newly diagnosed.
So my first visits, and I know this is the same with my colleagues in the clinic, when I sit down with a patient who is new to the clinic and new to the diagnosis of HIV, we essentially spend the first visit or sometimes first several visits, just talking it through. Just talking about what it means. A lot of reassurance. A lot of education trying to get the patient up to speed with modern treatments, with life expectancy, with how they acquired HIV.
There's often a lot of discussion, a lot of reflection about what happened, what risks were taken, what can be changed going forward. I think I'm an optimistic person at baseline, but there's a lot to be optimistic about in this illness. And I think one of the messages I try to get across is that, "You're going to be okay. You're going to be fine. This is a partnership. We have phenomenal treatment. You're going to live a long healthy life."
And again, perhaps on the on the bright side or the silver lining, any number of patients that will come back after six, nine months, a year, obviously we have been seeing each other in clinic in the interim but they'll come back and reflect upon those first visits and they'll tell me how much they've changed.
A lot of the changes that they identify in their life after a diagnosis of HIV are positive changes. Some of the behaviors that may have put them at risk in the first place leading to their diagnosis have changed. Their lifestyles have changed and so I think certainly if people could go back and reduce those risks and minimize their chances of HIV diagnosis, they would.
But I see this a lot where people come in and realize that this in some ways was a wake-up call and they're leading a healthier, happier life than they were, believe it or not. So it's not necessarily something we tried out right away, but there can be some positive benefits. So it's a lot of talking. We take it slow at first.
Interviewer: So if there was one thing with the new treatments, with the clinic care and everything, that you would tell to someone who had just found out that they were HIV positive, what would it be?
Dr. Spivak: I would say what I tell my new patients, which is, "You're going to be okay. We're going to take care of you. You're going to live a long, healthy, productive life and you're entering a new phase of that life with a new set of partners who's going to help you through."
updated: December 1, 2022
originally published: February 22, 2017
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