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from Medical Issues
Physician Observes 25th Anniversary Of AIDS
By Analyzing Two Epidemics At Work
June 8, 2006 -
The June 8, 2006 issue of The New England Journal Of Medicine features a
commentary on AIDS by Kent A. Sepkowitz, M.D. Dr. Sepkowitz is an
infectious-disease specialist at Memorial Sloan-Kettering Cancer Center in New
York.
According to Dr. Sepkowitz, there is a growing gap between the haves and
have-nots so that HIV is responsible for two "distinct public health
calamities."
Sepkowitz notes that drug resistance among circulating HIV strains is
increasing. In samples gathered before 1996, drug resistance was evident in 5%
of the samples. In samples taken between 1999 and 2003, resistance had jumped to
15% of those samples.
He points out that approximately one million people are living with HIV or AIDS
infection in the U.S and between 164,000 to 312,000 do not know their status.
"Experts hypothetize that most of the 40,000 new infections that occur annually
in this country arise from contact with these undiagnosed persons." He suggests
routine testing become part of normal health care among physicians.
The second epidemic involves low and middle-income nations that are being
overwhelmed by HIV infections. Only one fifth of people in developing countries
who need treatment are receiving antiretroviral therapy.
Concern is rising among physicians and health care workers over the interaction
between HIV and Mycobacterium tuberculosis. He observes that TB kills as many as
one of every seven people with AIDS, and one-third of the increase in TB cases
over the past five years can be attributed to the HIV epidemic. Control of TB in
HIV-infected communities is hampered by fear of infection from this deadly
disease.
According to Dr. Sepkowitz: "We can only hope that the years ahead will be
characterized not just by better drugs, new vaccines, and improved prevention
methods, but also by adoption of the humility necessary to control a disease
that is transmitted through sexual activity and drug use - two of society's
least favorite topics." He believes that the primer mover of the epidemic is not
inadequate medications, poverty or bad luck but by our "inability to accept the
gothic dimensions of a disease that is transmitted sexually."
Additional Reading: Medical Issues.
Updated: 8 February 2008
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