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UofU Doctor Talks of History and Future of HIV Treatment

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For the first time in the 22-year history of World AIDS Day, the University of Utah held a speaker series with researchers from its medical school to not only inform the community about groundbreaking HIV-prevention devices being created on campus, but to educate a younger generation about HIV’s history.

In the hour-long panel “HIV: Where we’ve been and where we are,” Dr. Larry Reimer, a professor of medicine and pathology at the school, described the discovery of the virus in 1981, and the public health care workers’ response to what they initially considered a “gay disease.”

“They were already part of an outlying community,” said Reimer, who founded HIV clinical programs at the school’s Health Sciences Center and George E. Wahlen Veterans Affairs Medical Center, where he remains the only HIV service provider today. In the early part of the 1980s, he noted, health care workers were not only critical of these ‘outsider’ patients, but worried that they would also become infected before they learned exactly how HIV was transmitted.

In just two years, HIV went from appearing in five gay men to what Reimer called “a huge escalation to hundreds of cases” including several outside the gay male community. This increase, he said, also resulted in increasing attention from the media and the scientific community.

“This was a huge concern for public health,” he said.

As public health moved — often slowly and inefficiently — to combat the growing crisis, what Reimer called “AIDS hysteria” also spread through the general public.

“There are stories of individuals whose houses were burned down, of people who had to move out of their communities,” he said.

One of these people was Ryan White, a teenager who contracted the virus through a blood transfusion and who had to fight to remain in public school. White, who died in 1990, would later inspire the federal HIV/AIDS program named for him, which provides low-income people with money for HIV/AIDS medication.

“Hysteria,” said Reimer, largely came from two camps: people who thought that AIDS was a punishment from God and went to such lengths as demonstrating against people with HIV, and HIV-positive people who demanded a drug to save their lives, and who wanted the medication AZT as soon as they heard of it.

“But the scientific community wanted to go through the whole development process to investigate [if it was safe],” said Reimer. “But if you were in the AIDS or gay community, you wanted the drug now. If you were threatened with this illness that was going to get you in six to nine months, you didn’t care about clinical trials.”

Wedged between these two polar opposite camps, Reimer said that scientists and public health officials witnessed an environment “very different from anything we’d seen before” unfold, particularly as they had to pass demonstrators on either side of the AIDS debate while attending world AIDS conferences. The end result, he said, was the creation of a truly unique model for treating HIV.

“If you look at health care delivery in general [for HIV/AIDS], it’s an integrated system that includes patients, social workers, scientists and physicians more than any other disease structure,” he said. “If I have a patient who has heart disease or diabetes and I want to send them to the comprehensive care center for heart disease or diabetes it doesn’t exist because they never had to deal with their illness from these societal perspectives that we had to [with HIV/AIDS].”

Meanwhile, AIDS hysteria began to calm down a little, said Reimer, when celebrities like actor Rock Hudson and basketball star Magic Johnson, who is straight, announced that they were HIV positive. Campaigns that discussed children with the disease and projects like the AIDS Memorial Quilt also helped to put human faces on the disease.

As the decade wore on, the Food and Drug Administration approved AZT and more drugs made their way to the market, including powerful anti-retroviral medications that are commonly used today. Unlike early drugs, Reimer said these new medications often have fewer side effects and lower levels of toxicity.

But for all the good they do, said Reimer, anti-retrovirals still have one major drawback: resistance. If people miss even a few doses, he said, their viral loads can go up and the medication, when resumed, may not fight the virus as effectively or at all. He also rejected the term “highly active anti-retroviral therapy” that is often applied to these drugs as misleading.

“If we had highly active treatment, we could cure somebody, like penicillin cures a sore throat,” he said.

Regardless, the introduction of anti-retroviral drugs in the United States leveled off the spiraling death rate for HIV-positive people. While Reimer said that the United States is the world leader in HIV treatment and prevention, in the past five years, infection rates across the country (and in Utah) have spiked. Meanwhile, numbers in other countries continue to grow as well, particularly in sub-Saharan African nations, which account for the largest percentage of the 34 million people in the world living with the disease. The challenge for public health, he said, is now preventing HIV/AIDS from reaching epidemic proportions in countries where rates are low so far.

Given that roughly 25 percent of U.S. Americans who have HIV are unaware of their positive status, Reimer said that the Centers for Disease Control & Prevention have advocated since 2006 that all adults get tested for HIV at least once. But access to testing, he added, has to improve, particularly for low-income people. Noting that a home HIV test that resembles a pregnancy test in appearance is “very close to being approved by the FDA,” Reimer said that this may be a solution — although he was quick to add that people who test positive at home may not know what to do next, or even want to do anything about it, thanks to the stigma that still surrounds the disease.

“I would like to see a day when this goes away but I don’t think it will be happening soon,” he said.

Reimer also touched on contemporary youth attitudes toward HIV/AIDS, which several members of Utah’s public health sector have called uniformed or even careless.

When asked by Sai Samineni, Safe Zone coordinator at the school’s LGBT Resource Center, if he thought that “fear-based sex education,” including telling students that sexually-transmitted diseases will “ruin your life,” worked to lower infection rates, Reimer said no. What worked in the 1980s, he said, was the lesbian, gay, bisexual and transgender community understanding that sexual behavior transmitted the disease and knowing that people they knew were being killed by it. Given how the disease and its treatment have changed in the last two decades, that is a conversation, he said, “that we can’t have anymore.”

“I think sex ed is important but it’s only one piece of sexual health and sexual negotiation,” he said.

Other speakers during the symposium included Dr. Wes Sundquist, who talked about how HIV replicates, and his lab’s research into how the body’s cells react to the virus. Dr. Vicente Planelles discussed the difficulties of destroying reservoirs of HIV, and his lab’s research into these virus stores that are often resistant to treatment. Dr. Michael Kay spoke about his laboratory’s research into devices, called microbicides, that can prevent HIV from infecting cells.

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