I’m not a doctor, but I’m in the HIV/AIDS field. We’ve seen death rates from HIV disease all over the country drop drastically (40% and more) since the introduction of effective medical therapies in 1995/1996. Nobody knows how long this trend will continue and some drug-resistance is being seen - especially with those who have difficulty being compliant with their drug regimes - but the majority of people with HIV are doing extraordinarily well in this new era of effective therapies. We still don’t have a cure, but many infected individuals have viral load laboratory tests showing undetectable levels.
Until recently, many experts advised that people start on therapies as soon as possible after infection, the theory being that maybe aggressive treatment early on would knock the virus out of commission for good, or at least keep it from replicating. A new report is coming out soon in one of the medical journals with revised recommendations, though. I’ll see if I can find the email I got about this the other day to be sure what I’m about to say is accurate… If I recall correctly, new studies have shown that the side effects of these drugs can get worse over time and maybe even be life-threatening, and with the threat of developing eventual drug resistance, it’s better to wait awhile - until viral loads start to go up or symptoms appear - before introducing aggressive therapy. But let me get back to you to confirm that this is what it really said.
It’s true that some diseases become less virulent over time (syphilis for example), but I don’t think it’s because of the population developing antibodies like egkelly said. It seems more likely that the reason would be that the less virulent strains wouldn’t kill their hosts so fast, so would have more time to spread to others. The most virulent strains might burn out quickly. I don’t think anything like this is happening with HIV, though there is a less virulent type - HIV II - that’s found mostly in parts of Africa. It’s from a completely different lineage than HIV-I, not an evolutionary form of it. There are substrains of HIV-I which have variances in virulence, preferred modes of transmission, etc., but I’m in over my head if I start talking about that.
No one in our field, that I have seen, is predicting life spans for people with HIV nowadays… even for people who are or have been symptomatic. It’s a completely new era, even for some of those who were on their deathbeds a few years ago. I’ll tell you one thing - we practically never get reports of people with diseases like pneumocystis carinii pneumonia anymore, unless they are people who haven’t been on therapy.
There are specific “opportunistic diseases” that are rare or never occur in people with normal immune systems that, along with a confirmed HIV + test, give one an AIDS diagnosis. Another criterion for an “AIDS diagnosis” is a CD4 cell count under 200. Many of these “opportunistic diseases” that give one an AIDS diagnosis have become rare again - mostly I think because of the effective protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and antiretroviral therapies allowing the immune system to keep them in check and partly because of the specifically effective prophylaxis now available against these diseases.
Some good websites for accurate information about HIV and AIDS are: www.cdc.gov and http:\hivinsite.ucsf.edu.
