Ask the Doctors

Dear Doctor: Is it true that HIV can now be considered a chronic disease? Does that mean people are no longer looking for a true cure?

Dear Reader: To answer this, we first have to agree on the meaning of "chronic disease," which, believe it or not, has more than a few definitions. Rather than take a deep dive into those important but perhaps snooze-inducing distinctions, let's go with the most common understanding of the term. That is, a chronic disease is one that cannot be cured, but with ongoing medication and treatment can be managed. And thanks to the stunning success of antiretroviral therapies, infection with HIV now fits that definition of chronic disease.

As most of our readers probably know, HIV is shorthand for the human immunodeficiency virus. The virus undermines the immune system by attacking certain white blood cells that are vital to the ability to fight infection. The loss of these white blood cells leaves HIV-positive individuals vulnerable to disease, infection and complications of illness. AIDS is the stage of HIV infection at which damage to the immune system is profound, and patients are unable to fight off a host of opportunistic infections. For people with AIDS, infections that a healthy immune system would brush off become potentially deadly.

According to one school of thought, the antiretroviral drugs that are now the main treatment regimen for people living with HIV amount to a functional cure. But just because infection with HIV is no longer a near-certain path to developing AIDS, that doesn't mean living with the virus is problem-free. The drugs, which must be taken daily and for the rest of an infected person's life, are extremely powerful. Cumulative toxicity becomes a real concern. And while the antiretrovirals do prevent an HIV infection from progressing to full-blown AIDS, the individual's immune system remains affected by the presence of the virus and, consequently, is less robust. Add in the ability of HIV, like all viruses, to rapidly mutate and become resistant to existing drugs, and infection remains a serious condition.

Compared to the early days of the HIV crisis, when each new development in decoding and understanding the virus was heralded, things may now seem quiet on the news front. But as researchers focus on both prevention and a cure, the science continues to move forward.

For many, the idea of a vaccine is the gold standard. In that regard, there has been encouraging news from researchers at the University of Massachusetts, who recently reported that they are about to enter into a phase 1 trial to assess the safety of a potential HIV vaccine. Other scientists are looking into topical medications that can stop the virus at the site of infection.

And thanks to ongoing advances in the field of immunotherapy, there is renewed hope of finding a cure. Earlier this year, researchers at the University of Maryland reported success in engineering immunotherapeutics that target and neutralize the virus on multiple fronts and across multiple strains. (And yes, that's a greatly simplified explanation.)

An estimated 36 million people worldwide now live with HIV, and while scientific advances don't always make headlines, they do make a difference.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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