HIV - An End in Sight?

One of the amazing things proposed by HIV scientists, organizations, and advocates is the possibility of quelling the spread of disease. The widespread availability of antiretrovirals and recent research about ways to reduce transmission of disease with peripartum medications, circumcisions, and other interventions hold promise that within the next decade and a half, we may reach a tipping point in the AIDS epidemic. I've read a few articles that by 2030, we might reach a point where each patient with HIV infects fewer than one patient with HIV. This means that with each generation, fewer and fewer people will have the disease. Although cure remains remote (there is a widely publicized study of cure with a bone marrow transplant for concurrent leukemia), prevention may be the key to controlling this disease. If this is the case, then we will have witnessed an amazing era for infectious disease. What a time to be in medicine! I remember reading books about the first cases in the 80s, seeing acute HIV infection as a medical student, memorizing the early antiretrovirals as an intern, and now perusing the HIV issue of JAMA. Although this is not my area of expertise, I am awed by the changes in our approach to AIDS. I remember the debate about starting antiretrovirals early versus later, the opportunistic infections I'd admit every call day, the complex regimens of medications. Now we start ARVs early (we don't even necessarily call it HAART anymore!), I haven't seen an opportunistic infection in a long time (probably related to being in anesthesia and seeing patients in Palo Alto), and we have combination pills. It's fun seeing medical history unfolding even in my short period of training.