Wonderful Complexities

As HIV Plus marks its 10-year anniversary with this issue, I can't help but look back over the tremendous progress we've seen in HIV treatment during the past decade, especially during the four years that I've been a contributor to the magazine. In one of my earliest columns I expressed concern about what seemed to be a drug-development pipeline that was drying up. But what appeared at first as only a trickle in the pipeline proved to be a full-on flood of potent new medications. Since the approval of injectable entry inhibitor Fuzeon in 2003, we've seen the arrival of powerful new nonnucleosides (Intelence) and protease inhibitors (Aptivus and Prezista), the availability of the first oral entry inhibitor (Selzentry), and the introduction of a medication in the entirely new integrase inhibitor class (Isentress). Most of these medications are aimed specifically at HIVers whose infections are resistant to older anti-HIV medications, giving them new hope and renewed control over their infections through powerful salvage regimens. For many, however, the most significant day-to-day advances have been the simplification of medication regimens through the development of combination pills (Epzicom and Truvada) and the creation of Atripla'a single pill taken just once daily that contains an entire three-drug regimen. These treatment advances'coupled with our ability to better prescribe the best individualized combination of medications due to highly sensitive phenotype and genotype resistance tests'have enabled us to truly turn HIV into a manageable chronic disease for most. And now our focus as health care providers has turned from simply keeping our patients alive to helping them live long, healthy lives. Today, I talk regularly with my HIV-positive patients about diet and exercise, smoking and substance use, cardiac and cancer risks, and many other issues entirely unrelated to their serostatus. I've addressed with my patients'and readers of this magazine'topics like testosterone replacement therapy, the importance of flu shots and other immunizations, staying healthy while on holiday, and many others that affect their everyday lives. And of course, we keep a closer watch for conditions like high cholesterol, kidney and liver problems, depression, and other disorders linked to long-term HIV infection, antiretroviral treatment, or both. Sure, caring for HIV-positive patients is more complex today than it was a decade ago, when we all were just beginning to grasp what it meant for HIVers to be able to look forward to long, healthy, and productive lives. But what a wonderful complexity for us to deal with! Bowers is an HIV specialist and board-certified physician in family practice, and he is a senior partner with Pacific Oaks Medical Group, one of the largest U.S. practices devoted to HIV care, in Beverly Hills, Calif.