When AIDS first reared its ugly head in the United States in the early 1980s, those diagnosed with human immunodeficiency virus, or HIV, typically had only months to live. Today it can be a much different story.
"Thirty years ago, it was a death sentence," says Terry Cunningham, chief of the HIV, STD and Hepatitis branch of Public Health Services in San Diego. "Now it is almost to the point where it's a chronic controllable disease, in that you can take medications on a daily basis to pretty much live a normal life."
Cunningham says that with the introduction of HAART, which stands for highly active antiretroviral therapy, in 1996 and all the different generations of drugs that have since followed, HIV has changed entirely.
"People are now living longer because the drugs are so effective in targeting the HIV and bringing the viral load down to undetectable levels," he says. "It keeps them from succumbing to opportunistic infections, which are the diseases that cause mortality in people with HIV. It keeps the HIV from going to the AIDS diagnosis."
That's for the majority of people, Cunningham stresses, adding that there are still people who are diagnosed and have incredibly harsh side effects from the drugs. including diarrhea, nausea, vomiting, sore mouths, skin problems, colds, coughs, fevers and general malaise.
"(The drugs are) highly toxic to the system," Cunningham says. "It's not a cure; there is no cure. People still have to be very diligent about taking their medications. You can't just skip taking them. You have to take them on a daily basis, or you can build up resistance."
Cunningham says it's important for a sexually active person to be tested every three to six months for HIV, a relatively easy task because the tests are free, painless and confidential. Knowing your status is so vital, he says, because you could conceivably have the virus for 10 years and not know anything is wrong and then all of a sudden have your immune system fail.
The sooner an HIV-positive person begins treatment the better his/her chances are of not progressing to a diagnosis of acquired immune deficiency syndrome, or AIDS, Cunningham says. That diagnosis occurs when a person's T cell count is less than 250 and he/she has contracted an opportunistic infection, such as Kaposi's sarcoma or pneumocystis carinii pneumonia.
Cunningham says it's also vital to know the status of your partner and to be able to talk about it together. "So many people just assume that if the other person doesn't bring anything up about HIV, then that person's negative," he says. "There's no way of just looking at someone and telling whether or not he or she has HIV. People have to be responsible."
Part of that responsibility includes engaging in safer sexual practices, for example, using condoms, Cunningham says.
The Centers for Disease Control and Prevention says there are about 55,000 new cases of HIV a year, a figure that has remained roughly stable since the mid-1990s. Cunningham says the fact that the numbers aren't decreasing is concerning.
"People are living longer with the disease, and every year, we add people onto the list of people we have to provide drugs for. It gets more and more expensive," he says. "Soon there may well come a time that we have to put people on waiting lists, and that would be incredibly unfortunate. But there's only a finite amount of money to fight this disease."
Cunningham adds that there are parts of the country that already have waiting lists for ADAP, the AIDS Drug Assistance Program.
Cunningham, who's been working in the field for 28 years, says that though people's odds of living long and healthy lives with HIV today are much better than they were in the '80s, it's not a given that it's going to be an easy road. There's still a long way to go in the fight against AIDS.
"It's still there; it's still a threat, and it's a major health concern," Cunningham says. "You don't hear about it that often on the news anymore, but it is still something that everyone needs to be concerned about. We need to stop the spread of this disease."