132011Oct

HIV Treatment Crossroads: Where Are We Now?

By Stanley T. Lewis, MD MPH
Chief Medical Officer

The story of HIV is an extraordinary adventure in the history of medicine and the history of mankind. At this moment, we are faced with the unenviable challenge of confronting this global threat to our existence. What we do now will not only set the course for the future, but it will define us as either the generation that rose to the challenge or the generation that squandered or deferred the opportunity to triumph.

Until there is a cure, the story is unfinished. We have made some strides along the way. We have also had a few noteworthy victories in battle. But winning battles is not winning the war. We still have work to do. Medicine and medical science have produced many soldiers brilliant, brave and courageous. But even after we identified the viral enemy, we have come to understand that the pathogen was only one adversary in this battle. We now understand that to be successful, we must overcome far more than just a virus. We must overcome hatred (of Gays and minorities) and the irresponsibility of youth. We must overcome competing priorities of non-communicable diseases that plague humans as well as this infectious menace. We must overcome politics and prejudice. We must overcome our habits and our nature. We must overcome ignorance and stupidity. We must overcome poverty, depression, and denial. Beyond pedestrian problems like resistance, adherence and medication toxicity, we must overcome a far greater foe. We must overcome ourselves.

I believe we stand on a battlefield but at the same time at a crossroads as we prepare to pen the next chapter in this story. Like previous moments in time, we must find the balance between a qualified workforce and the growing epidemic. We must have trained soldiers to fight a vicious enemy. Unlike previous moments in this story, the courageous and compassionate that rushed in to save the day initially grow weary and frustrated. The guff of brave souls committed to conquering the scourge that is HIV is dwindling. And we stand in the heat of battle struggling to secure the upper hand while the enemy is poised and planning the next wave of attacks.

We must continue to respect our foe. Have we forgotten the eighties and the early nineties? HIV has proven itself to be formidable for even the brightest among us. Can we afford to now send a force less trained and less prepared to man the frontlines? Will history recount a generation that rose, made progress and then with victory potentially in sight, left the fight unfinished? Will we leave this fight for our children by retreating and relenting? Is this who we are?

HIV is complex and requires the mindful attention of well-trained and dedicated professionals in prevention and treatment of the disease. Beyond medical complexity, the patients that live with HIV require an extra measure of compassion. They arise from the societal margins unresourced with muted political voice. And society continues to indulge in an insulting and irrelevant questioning: are patients victims (thus deserving of sympathy & compassion) or culprits (deserving whatever they get)? Wherefore art thou humanity? We need you now.

As HIV treatment regimens become more simple, they remain juxtaposed to the inescapable truth that this is still a complex undertaking. Patients, Prescriptions, and Pathogen are all moving at the same time. Sometimes the move is in concert and sometimes in conflict, but it is never stagnant. And the provider that dares attempt to orchestrate the delicate dance must be fortified with knowledge, experience, patience, and a fearlessness to step outside of the sanctuary that is medicine and take up the fight in all the societal crevices that provide quarter for HIV to thrive.

Here we stand at the crossroads. At the same time we discover more medications we discover more interactions, more resistance and more implications of not finding a cure. And if nothing else history has taught us, this virus is unforgiving of our mistakes. If we leave it here smoldering it will rise again to plague generations to come. And history is sure to be unforgiving of us also. Would we have them write of our opportunity to end this that we shrunk and shunned the dust of the arena? Will they tell a tale of how we kicked the can down the road? Or will they say we rose and met the challenge? Will they say we were unrelenting, unwavering and undaunted? Will they say, Venimus, vidimus, vicimus?