Aids Conference HighLights
Description
This article is from the Health Articles series.
Aids Conference HighLights
HAART Can Influence Opportunistic Lung Infections
So many of the opportunistic infections that affect people with HIV/AIDS involve the lungs. Pneumocystis cariini pneumonia, tuberculosis, and cytomegalovirus (CMV) are just a few. How has highly active antiviral therapy (HAART) affected the incidence and treatment of these disorders?
Dr. Mark Rosen, Chief of Pulmonary Critical Care at Beth Israel Hospital in New York, addressed the influence HAART has had on lung infections in people with HIV, and more specifically AIDS, on Tuesday at the American College of Chest Physician's annual scientific meeting in Chicago.
The most common pulmonary infection seen in people who are HIV-positive is Pneumocystis cariini pneumonia or PCP. Recent studies have shown that HAART has a direct influence in decreasing the incidence of PCP. It isn't because the HAART drugs directly kill the microorganisms that cause PCP, but because it strengthens the immune system by increasing the number of CD4 T cells. PCP is one of the "opportunistic infections" that take advantage of a weakened or nonfunctioning immune system.
Another lung disease that commonly occurs in patients with an impaired immune system is tuberculosis, a disease that had been rare in the United States before the HIV/AIDS epidemic. Here too HAART has had an impact. Since 1995, when HAART was first used to treat HIV, the incidence of TB has leveled off. In terms of treatment of TB, if you are on HAART, the recommended TB treatment has been changed. Previously, or in people who are not HIV-positive or on HAART, standard therapy includes a drug called rifampin. In HAART patients, this drug weakens the effect of the anti-AIDS medications, so they need to take another drug called rifabutin.
Another change in treatment guidelines for TB is a reduction in the length-of-treatment from one year to six to nine months, depending on the individual's response and the medications taken. It is imperative that TB medications be taken correctly for the full length-of-treatment prescribed, regardless of HIV status.
HIV and AIDS in 1998, Cost to our Country
The statistics are in, as is the doctor. Dr. Mark Rosen, Chief of Pulmonary Critical Care at Beth Israel Hospital in New York, came to the annual meeting of the American College of Chest Physicians to discuss the impact that highly active antiretroviral therapy (HAART) has had on the incidence of lung infections. What he delivered was a clear message that while HAART has improved both the length and the quality-of-life for someone with HIV/AIDS, there are still large groups of people for whom this therapy may as well not exist.
In 1998, there were 650,000 to 900,000 people infected with HIV in the United States alone. There are approximately 40,000 new cases each year, half of which occur in people under age 25 who were infected sexually. Internationally, there are 33 million people with HIV and new infections are occurring at the rate of 16,000 per day, 95 percent of which are in developing countries.
In the United States, the good news is that the total death rate from AIDS is decreasing as is the number of new cases, but certain subpopulations are bucking this trend. For example, 70 percent of new AIDS diagnoses made are in the African American and Hispanic populations. People of either minority are also more likely to die from AIDS.
Many physicians were surprised to learn that the South leads the nation as the region with the highest number of deaths due to AIDS. Localities with the highest number of diagnosed AIDS cases are Washington, DC; New York; the Northeast area; Nevada, Florida; and Texas.
Dr. Rosen also confirmed that gay men have seen the most precipitous drop in the rate of death due to AIDS. He added that this might be explained by this group's high rate of seeking out and adhering to the HAART regimen.
What HAART has also given us is 300,000 people that are living with AIDS. These people are not simply HIV-positive; they meet the Center for Communicable Disease's definition of AIDS. The overwhelming majority (86 percent) of those who have lost their lives to this disease died due to severe damage to their immune system. While HAART has provided hope for millions, it is clearly not enough.
Continue to:
My Books
