By now, those of us in the AIDS business long term have cared for thousands of patients. No one with that kind of personal experience can doubt for a moment the malignant potential of H.I.V. or the lifesaving capabilities of the drugs developed against it. But there are also now hundreds of footnotes and exceptions and modifications to those two facts that make the big picture ever murkier.
Dr. Zuger highlights some of the incongruities of our current situation, where someone who looks quite healthy may be failing his/her treatment, while someone who looks quite ill may be doing quite well on treatment (but not so well with the side effects). She also points to the frustrating level of complacency that new treatments have brought to both prevention and HIV diagnosis.
Twenty-five years ago, . . . [w]ith no possibility of saving our patients, life was sadder but far simpler. The big war was already lost, so we could concentrate on small victories instead.
Now, a complete rundown of all the news from the front would take hours. Risk of death from AIDS: way down. Risk of death from other things: going up. Risk of drug reaction: depends. Risk of fatal drug reaction: low but not zero. Risk of drug resistance: gets higher every year. The statistics change almost hourly as new treatments appear. It is all too cold, too mathematical, too scary to dump on the head of a sick, frightened person. So we simplify. "We have good treatments now," we say. "You should do fine."
Her article highlights 25 years of research and progress in treatment that still leaves us in the same place we were 25 years ago: we still only have one vaccine (prevention); we still only have one cure (prevention).
[Bloogered again. Eliminating duplicate post.]