AIDS: A Personal Perspective That Engenders Hope.
I was deeply moved by David Sanford's Wall Street Journal article, which follows. As David's story recounts, he came to me in deep despair. He believed that there was little hope to escape what is commonly termed a "death sentence" from AIDS. With state-of-the-art treatment, he has regained considerable health, as his HIV viral load has fallen to undetectable levels and his helper T-cell number has increased. How long these changes will be sustained and what the future holds are still unclear. But it is clear that David is pursuing life with great vigor and his sense of optimism and commitment to survive have been restored. I believe the hematologist/oncologist is in a particularly unique position in the clinical care of people with AIDS. Our history of conquering diseases which were, like AIDS, regularly associated with decline and death, gives us a perspective that engenders hope. I recall a friend and classmate in the fifth grade in Public School 187 in Queens, New York, who died of childhood leukemia. In those days, mentioning the word "leukemia" was forbidden, so our teacher informed us that Eric had died of "blood poisoning." We children all sat confused, wondering how to protect ourselves from such insidious "poisons." Childhood leukemia is now curable in the majority of afflicted children; I suspect that Eric would have been saved had the current treatment regimens existed in the early 1950s. Similar triumphs against lymphoma and testicular cancer are held up as real examples of progress in the field of oncology. I point to such victories in counseling patients with AIDS facing currently incurable diseases. AIDS is a moving target. Important breakthroughs in rational drug design provided us with the protease inhibitors, and laid the foundation for combination therapy which might potentially control the replication of the virus for decades and thereby restore longevity. Prospects for a true cure (full eradication of the virus from the system) are still hotly debated, but no one can deny that the clinical gains made in the last two years have been significant. We have witnessed the first clinical remission of AIDS. David Sanford's individual story is a mirror to the larger world of people with HIV. His restoration of health is not unique, not an isolated antidote, but a prototype of what is being seen in controlled clinical trials. Moreover, the importance of access to medical care, particularly new drugs, is evident from his tale. The impact of these new therapies on a humanitarian plane is the greatest, but its economic impact, with reduction of hospitalization, and increase in individual productivity, is also apparent. I find myself, as a physician, being importantly instructed by people like David Sanford. Our greatest gratification comes from science changing clinical reality, and restoring productive lives that become filled with realistic hopes.
Groopman
JE
Division of Experimental Medicine, Beth Israel Deaconess Medical Center and Recanati Professor of Immunology, Harvard Medical School, Boston, Massachusetts, USA.