• DR. MICHAEL SENSION, MEDICAL
DIRECTOR OF HIV CLINICAL RESEARCH
AT BROWARD HEALTH HOSPITAL SYSTEM:
1HIV medication can stop working if a patient misses a dose and later repeats the regimen. If you had to take four pills every six hours or three pills every eight hours and you couldn't miss a dose, it would be difficult to maintain the regimen. Now, some medications can be taken once a day and still work if you miss the dose by a few hours.
2Medications have become better tolerated. Patients are taking fewer pills less frequently than they did 10 years ago. Some people can take medication that contains three medicines in a single pill. Many individuals had developed resistance to some drugs, but new medications block critical steps for the virus to reproduce itself.
3Some of the newer drugs don't have the same degree of toxicity as older drugs. There are newer protease inhibitors, which block the protease enzyme, thus preventing the virus from replicating and infecting new cells. The first protease inhibitor was approved in 1995, but since then there have been other targets developed to inhibit as well. One is the integrase inhibitor, approved last October, which inhibit the insertion of the HIV viral DNA into human DNA. Inhibiting integrase from performing this essential function blocks the ability of the virus to replicate and infect cells.
4There used to be a time when we were talking about prolonging life by a short period of time. Now we look at treatment goals even in very advanced patients. The main goal is to lower HIV to the point where a test would say it's undetectable. That doesn't mean there's a cure, but the person should do very well. We couldn't imagine that 20 years ago.
5A vaccine hasn't moved forward as quickly as our ability to treat HIV infection. That has to do with the nature of HIV. It mutates very easily, such that vaccine therapy has not proven to be effective. The ability for HIV to shift itself is much greater than the ability of the influenza virus to change itself from year to year.
• DR. ROBERT REID, PEDIATRIC
INFECTIOUS SPECIALIST IN
PRIVATE PRACTICE AND AT
JOE DIMAGGIO CHILDREN'S HOSPITAL
IN HOLLYWOOD:
6Perinatal HIV transmission is the common route of HIV infection in children and is the source of almost all AIDS cases in children in the United States, the Centers for Disease Control and Prevention reports. Up to 200 infants are infected with HIV annually, and many of the cases involve women who were not tested. Pregnant women are encouraged to be screened for HIV, and 95 percent of them get tested in Florida. The 5 percent who decline testing are usually at high risk.
7One out of three infected women pass the virus along to their baby. Most transmissions occur at the time of delivery. The risk of transmission is lessened if a woman delivers a child through a Caesarean section. The mother will be given Highly Active Anti-Retroviral therapy to bring her virus load to an undetectable level at the time of delivery. A baby born to a mother with HIV will be treated with AZT for six weeks, whether infected or not. The newborn will be tested at the time of delivery and at various other ages. There is no restriction of contact between the mother and her newborn, but breast-feeding is not allowed because HIV can be transmitted via breast milk.
• DR. MICHAEL KOLBER, DIRECTOR OF
THE UNIVERSITY OF MIAMI'S
COMPREHENSIVE AIDS PROGRAM:
8In January 2008, 55 new AIDS cases and 150 new HIV cases were reported in Miami-Dade County; in Broward, there were 48 new AIDS cases and 74 new HIV cases. In January 2007, there were 69 new AIDS cases and 102 new HIV cases in Miami-Dade; in Broward, there were 57 new AIDS cases and 54 new HIV cases reported. South Florida has among the highest rates in the nation of HIV/AIDS.
9There is a growing number of new cases in the elderly in South Florida. Of the number of HIV/AIDS cases in Florida among people 50 and older reported through 2006, 58 percent were diagnosed from Miami-Dade, Broward and Palm Beach counties. Of those cases, 30 percent were from Miami-Dade, 17 percent from Broward and 10 percent from Palm Beach.
10High modes of contracting the virus include intravenous drug use, heterosexual sex and male-to-male sex. In 2006, 50 percent of new U.S. HIV/AIDS cases among adults and adolescents were transmitted through male-to-male sexual contact; 33 percent by heterosexual sex; and intravenous drug use accounted for 13 percent.
11A standard test and a rapid test have a 99 percent accuracy rate. The standard test looks for antibodies in blood, and results will take up to two weeks. A rapid test, which gives results in 30 minutes or less, might involve a finger prick or an oral swab. Positive results should be followed by another test to confirm the results. Many at-home test kits, which also boast a 99 percent accuracy rate, are available. If you purchase one, follow directions carefully and make sure the kit has been approved by the Food and Drug Administration.
12University of Miami AIDS Clinical Research Unit seeks HIV patients for a study to assess a two-drug antiretroviral regimen. Contact Dr. Margaret A. Fischl, 305-243-3838 or mfischl@med.miami.edu.
