HIV no longer means certain death

July 15, 2012


Survivor … David Polson was diagnosed with HIV in 1984 – among the first to be diagnosed in Australia. Photo: Tamara Dean

After David Polson was diagnosed with the human immunodeficiency virus in 1984, he was advised to get his affairs in order.

He was among the first people in Australia to be diagnosed with HIV, and, at that time, people diagnosed with the little-understood virus could expect to die within a decade.

But, at 57, Mr Polson is still here, living comfortably in his Potts Point flat and filling his time with public speaking engagements to educate the broader community about HIV.

”I was determined I wasn’t going to die,” he recalls. ”At that time, of course, it was a death sentence.

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”But I just stayed very positive and surrounded myself with laughter and humour. It was probably a little naive but that was all I had. There was nothing, really, in terms of treatment.”

This October marks three decades since the first case of HIV was recorded in Sydney. The first death from AIDS occurred a few months later in July 1983 in Melbourne.

Andrew Carr, the director of the HIV, immunology and infectious diseases unit at St Vincent’s Hospital, has spent the past 23 years at the hospital and observed a striking change in that time.

”I started work here in 1989 and it’s a very different place now,” he says. ”Up to 1996, we had 24 beds that were always full of sick and dying patients. Then, with the introduction of effective treatment, the wards emptied out and they are still relatively empty now.”

Just as new treatments have improved lifespans for people with HIV, community attitudes have also changed. While stigma towards people living with the virus still exists, it is certainly nothing like the mid-’80s when the Grim Reaper loomed large on our television screens and a three-year-old HIV positive Eve van Grafhorst was chased out of her central coast pre-school amid unfounded fears she would infect other children.

She was the first child in Australia to contract AIDS via a blood transfusion and died in New Zealand surrounded by family and friends.

Perhaps the biggest misunderstanding about HIV infection today is the belief that it automatically means a painful decline to an early death.

New treatments have transformed HIV into a manageable, albeit chronic, condition which has a smaller impact on a person’s lifespan than many other conditions.

”There are certainly other diseases that carry a far worse prognosis these days,” Professor Carr says.

”Once upon a time the average person who got HIV had a life expectancy of about 10 years.

”Now, if you get HIV and go on treatment your life is still probably shorter than if you had never had the virus, but maybe only five to 10 years less.

”When you take away groups who are prone to HIV – for example people who inject drugs who unfortunately have a shorter life expectancy anyway – then the difference becomes even smaller.”

Mark Bloch, the director of Darlinghurst’s Holdsworth House Medical Practice, which treats about 1600 people living with HIV, agrees the medical advances of the past few years have been gratifying for both patients and health specialists. ”People with HIV who go on treatment are now living close to a normal lifespan,” he says. ”While we don’t have a cure as yet, it gives people an opportunity to participate in society and stay in the workforce and lead a normal life.”

Another recent development is the evidence HIV treatment dramatically reduces the risk of transmission.

”The other thing that has happened in the last 18 months is the idea that we can use HIV drugs to stop other people in the community getting infected,” Professor Carr says.

”We’ve known for almost 20 years that if you treat an infected mum, then her baby is almost certainly not going to be infected because the growing HIV that is infectious disappears from the bloodstream, so there’s been a precedent there for a long time.

”But more recent studies have shown that transmission can be reduced between sexual partners where the infected partner is on HIV therapy.”

Treatment for HIV in many cases no longer means a cocktail of drugs with severe side effects, with two new single-tablet treatments being introduced in Australia in the last few years.

However, between 20 per cent and 30 per cent of people living with HIV in Australia are not being treated, something which concerns specialists such as Dr Bloch and Professor Carr. The National Health and Medical Research Council is conducting a study into why people with HIV decline treatment.

”In my experience there is a mix of reasons,” Professor Carr says.

”There are people who don’t know they have HIV so they don’t get tested. There are people who do know they have HIV but for them there is that real mental barrier: ‘If I am taking tablets, I must be sick so if I don’t take the tablets, I’m well’. Which is a very human logic that happens with every disease, particularly chronic diseases.

”Then there are patients who have heard bad things: that treatment has lots of side effects or is terribly complicated. That was the case 15 years ago but since then we have developed much better treatments.”

The 2011 annual surveillance report into HIV, viral hepatitis and sexually transmissible infections in Australia, compiled by The Kirby Institute at the University of NSW, reveals that new infection rates peaked at 2400 in 1987 before declining to a low of 719 cases in 1999. Infection rates have remained stable in NSW for the past five years; however, there has been a slight increase in Queensland and Western Australia.

While the report found HIV transmission primarily occurred through sexual contact between men, about 25 per cent occurred through heterosexual contact.

The 2011 report found that of the 1297 new cases of HIV infection between 2006 and 2010, in which exposure was attributed to heterosexual contact, about 60 per cent were in people who were either from high prevalence countries or had partners from those countries. Countries in sub-Saharan Africa continue to be the most affected by HIV/AIDS with about 23 million infections, according to figures compiled by the World Health Organisation, UNAIDS and UNICEF. There are 4 million people living with HIV/AIDS in south and south-east Asia, 1.5 million in Latin America and 1.5 million in eastern Europe and central Asia.

While the numbers are staggering, Bloch believes the global response to treating HIV infection in developing countries is improving.

”There have been some huge advances in trying to roll out treatment in a global sense,” he says. ”It’s still not quite adequate but there are several million people receiving treatment in Third World countries now.

”A lot of the pharmaceutical companies have graded the prices of their products so they can offer the medication at cost to very poor countries and middle-income countries. Wealthy countries like Australia pay a lot more for treatment.”

David Polson was working as the manager of the Don Burrows Supper Club at Sydney’s Regent Hotel when he was diagnosed, and vowed to stay healthy, despite the lack of effective treatments available at the time.

”I formulated my own plan,” he says. ”I adopted a very healthy lifestyle and I started exercising, had a great diet, took hundreds of vitamin supplements, used positive visualisation and meditation.”

Eventually, he started treatment and estimates he has been on 29 drug trials, some of which left him with permanent side effects.

Now the retiree is on a treatment regimen that he describes as fantastic, though complex.

”Because I have been on so many drugs in the past, I’ve developed resistance,” he said. ”I’m on six HIV drugs and a heap of other pills to counter the side effects. I take about 48 tablets a day in total but I keep swallowing those tablets and I don’t mind because it’s better than the alternative.”

Talk of a cure or vaccine for HIV has been around almost as long as the virus itself, but Professor Carr believes they are still many years off.

Bloch agrees work on a cure is still ”pretty theoretical” but notes that treatments have come a long way in three decades.

”When I started in this field 25 years ago it was basically a death sentence,” he says. ”It was heartbreaking, really.

”But, thankfully, today that’s simply no longer the case.”

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