Years ago I worked part time at SF General. At that time HIV infections were rampant among gay males and iv drug abusers. For many the disease meant  destruction of the immune system, followed by death. I remember scores of very sick HIV patients and having few drugs or medical research to help me treat this virus.

Things have changed quite a bit since then. Last month marked the thirty year anniversary since the first few cases were discovered in San Francisco. Early treatment of single antiviral medications has been replaced with multiple drug regimes; patients are treated often as soon as the disease is diagnosed; and all efforts are made to preserve the immune system. In addition, huge progress has been made in  preventing this disease. Safe sex including frequent use of condoms as well as treating pregnant HIV females with antiviral agents before delivery have resulted in a major decline of new cases in America.

In fact the treatments have become so effective that HIV patients are now contracting the same diseases that the rest of middle age and older Americans have: heart disease, arthritis and cancers. HIV patients however have a higher risk of having cancer and heart disease due to the effects of chronic infection and inflammation on the body. Nevertheless, doctors have had not only to worry about knocking that virus out, but also about expanding waistlines, elevated cholesterol and lack of exercise.

Yet much work still needs to be done. The disease is still rampant in third world countries especially in Africa. Many there cannot afford antiviral drugs which are hugely expensive. Males do not use condoms often, perhaps due to lack of education. Several prominent politicians believe wrongly that HIV is not caused by viruses and have not encouraged Western countries to help those afflicted with the disease.

And even in America there is much  to be done. An effective vaccine which could prevent most cases has not yet appeared. Inner city youths are once again abandoning safe sex. IV drug abuse still plagues this country. Many of the drugs have major side effects and the search is on for safe, well tolerated anti HIV medications.

So, there is cause to celebrate but at the same time there is a need for progress.