AIDS at 30: Interview With Chief of HIV/AIDS at SF General - Treatment Past, Present and Future

As part of KQED's coverage of the 30th anniversary of the first official report of what later came to be known as HIV, The California Report's Scott Shafer interviewed San Francisco activists and caregivers who experienced the epidemic during its early dark days.

Here is the first in a series of three interviews. Dr. Diane Havlir, Chief of UCSF's HIV/AIDS Division at San Francisco General, discusses the current state of HIV/AIDS treatment and the incredible medical advances in that area over the past 15 years.

The content of each audio clip is summarized directly below it.

Dr. Diane Havlir on advances in treatment since the 1980s

Back in the 80s, AIDS was characterized by death, by despair, by fear, and by futility, with massive collateral damages. Familes and businesses were being destroyed; it had a profound effect on the arts community. We saw people coming in extremely ill, with exotic cancers, with purple skin lesions; people came in blind, with seizures, and demented. That's what clinical care was like.

Fast forward to now, things are very different. We have a test for HIV, and probably one of the biggest success stories in modern medicine is anti-retroviral therapy, the HIV cocktail. It transforms HIV from a uniformly fatal disease to a chronic disease.

Another great success is simplification of the treatment. You can be treated with one pill once a day. When we started out, you had to take 15-25 medications per day.

On the negative side, one of the things recently we've started to see is premature aging. HIV damages the heart, liver, and kidneys at an accelerated rate. We think therapy can slow that down, but we don't know if it can slow it down completely. We don't if we can ever reverse all the immune damage caused.

Dr. Havlir on the debate over when to begin treatment

At San Francisco General we offer treatment to everyone as soon as we find out their HIV status. The minute a person is infected with HIV, the damage starts immediately. We would argue that the data shows that the virus is worse than the drugs that we give, and that they represent the best chance of preserving health.

A secondary benefit is reduced transmission. When we made this policy, we did a modeling experiment and saw that over a period of five years, you reduce the number of new cases by 50-75%. Those are theoretical predictions, but we're tracking that and we do expect to see a reduction.

One study found that men who have sex with men have a reduced chance of getting HIV if they take the HIV drugs even before they're infected. It's a prophylactic to prevent transmission altogether.

Dr. Havlir on the hope of current research

Ten years from now we're going to have fewer infections. People living with HIV are going to have much longer life expectancies. We're going to have gained information about aging which is going to be very helpful. I think we've got tools in our hands right now to turn the corner on the global HIV epidemic.

I'm very optimistic we're going to make progress toward a cure. Meaning that one lives with HIV without any drugs and without getting sick.

Dr. Havlir on how a younger generation looks at HIV

Despite all the advances in research, stigma is still attached to this disease.

From the AIDS perspective, complacency in the American public is one of our biggest challenges. We have 60,000 new infections a year, and people will say "is that still a problem?" We need to increase public awareness, because community support is how we changed AIDS from uniformly fatal to a treatable disease. Over the next 30 years, in order to turn the corner, we're going to need equal if not greater support.

Dr. Havlir on the contribution of San Francisco patients to HIV research, and the San Francisco model

Our patients have been incredibly generous with their time and their lives. Everybody wants the answer to the research study but they don't want to take the risk, and we're on the cutting edge of developing new therapies and having access to them because of the participation of our patients, and we're eternally grateful.

The status of the "San Francisco model" is that it's still a holistic approach. Our patients deal with addiction, housing problems, mental illness -- the model now incorporates services to address those issues, because without addressing them, the drugs won't help.