Science / Medicine : Doctors Say Detecting, Treating HIV Can Delay Onset of AIDS, Related Illnesses
Doctors and public health officials, who have long urged early detection and treatment for cancer, are increasingly offering the same advice for another life-threatening condition: infection with the AIDS-causing human immunodeficiency virus (HIV).
Their call for early diagnosis and treatment offers some hope to the estimated 1.5 million people in the United States who are infected with HIV but are not yet ill. Epidemiologists estimate that, without treatment, the average incubation period between infection with HIV and full-blown AIDS is 11 years.
But now, many doctors say they are gaining confidence in their ability to slow the deterioration of their patients’ immune systems. While they offer no cures, they say that at the least they have the tools to delay onset of some of the biggest killers among the infections that ravage people with AIDS.
“There are enormous changes taking place in how we approach cases of early infection with HIV,” says Dr. Paul Volberding, co-director of the AIDS Clinic at San Francisco General Hospital and editor-in-chief of the Journal of Acquired Immune Deficiency Syndromes.
But early treatment would require voluntary testing for HIV infection--a proposal that remains highly controversial. “People have argued that a positive test result is too frightening, that it removes hope, that it pulls the rug out from under people,” Volberding says. In addition, people fear that positive test results can cost them jobs, health insurance and housing.
However, notes Dr. Marcus Conant, chairman of the state Department of Health Task Force on AIDS and a San Francisco clinician, “we can only help those who know they have been infected.”
Despite the potential pitfalls, more and more gay men, who account for more than 90% of AIDS cases in California, are stepping forward to take the test. When Project Inform, a San Francisco-based clearinghouse for HIV- and AIDS-treatment information, last December publicly urged gay men to get tested, the group braced for criticism. But “instead of getting beat up, we got accolades,” says Martin Delaney, one of Project Inform’s co-founders.
HIV infection, Delaney argues, is a “chronic manageable illness” if detected and treated early enough, rather than a death sentence. While many doctors say Delaney is overstating the case, they agree that early treatment of HIV is an obvious strategy.
Rather than waiting for life-threatening pneumonia or cancer, Volberding says, “It is important from a medical standpoint to diagnose the infection, to establish where the patient stands on the spectrum of HIV disease, and to start talking about treatment.”
Dr. Robert E. Anderson, president of ViRx Medical Group, said that AZT, an anti-viral drug currently used to treat AIDS patients, is “certainly helpful” in patients whose immune systems show substantial laboratory evidence of deterioration. But as for “early, early intervention,” the question remains: “When do you intervene, and with what?”
Of course, definitive answers await the completion of time-consuming and carefully controlled scientific trials. But Project Inform’s constituents don’t feel they have the time to wait. The group’s literature offers advice on the efficacy and availability of three classes of drugs: anti-virals, immune stimulants and antibiotics to ward off opportunistic infections such as the pneumonia that kills most AIDS patients.
One pitfall, acknowledged William J. Woods, Project Inform’s project manager, is that “for many, expanded treatment options result in more conflict and confusion than comfort.” In addition, some doctors also argue that early treatment with the wrong agents could tip a delicately balanced immune system into sickness.
Still, doctors say the trend toward early treatment will continue.
Project Inform’s message that HIV infection is a manageable condition “lies somewhere between hope and denial,” said Dr. Mervyn Silverman, head of the American Foundation for AIDS Research. But he added: “If I were infected, I am sure I’d be trying anything that had potential.”
