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Massachusetts Medical Society's Physician Focus

March 2014



  • More than one million people in the U.S. are living with HIV, and about 16 percent of those do not know they are infected.

  • Some 50,000 new HIV infections occur each year, and 15,000 people die each year from AIDS in the U.S.

  • Worldwide, 34 million people are living with HIV, with about 2.5 million new cases a year.

  • Today, because of advances in treatments and medications, the life expectancy of a newly-diagnosed patient with HIV is nearly normal.

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The disease was first reported in the Centers for Disease Control’s Morbidity and Mortality Weekly Report of July 3, 1981: “Kaposi’s sarcoma, an uncommonly reported malignancy in the United States, has been diagnosed in 26 homosexual men.”

“It may be the most famous report in the history of the CDC,” says Thomas Treadwell, M.D. “It was a stunning report that no one understood. It reported an outbreak of deaths in previously healthy gay men who were developing strange tumors and a very unusual lung infection.”

That CDC report was the first official account of what was later to be identified as HIV, or human immunodeficiency virus, the virus that leads to AIDS, disease that has claimed the lives of 30 million people across the globe.

Dr. Treadwell, who treated his first AIDS patient just days after the CDC report was released, is now the director of the infectious disease clinic at MetroWest Medical Center in Framingham, Massachusetts. As the guest on the March edition of Physician Focus with the Massachusetts Medical Society, he discusses the early days of the AIDS epidemic, the medical community’s response to the emerging epidemic, and how far we’ve come in treating this once mysterious condition. Hosting this edition is primary care physician Bruce Karlin, M.D.

“It was really a truly horrible time,” Dr. Treadwell recalls of the early days of the disease, “certainly for the patients, but also because there was so much uncertainty. We didn’t know what was causing it, and there was no treatment. Whatever was causing this epidemic had resulted in a severe derangement of the immune system.”

The disease killed people quickly, with most patients in the early days of the epidemic dying within weeks or months of the diagnosis.

Progress in fighting the disease began in 1985, when a blood test was developed that could test people for HIV. The test also served another critical purpose: it protected the blood supply, as HIV cases from transfusions were a big problem in the early 1980s.

In 1986, the development of the drug AZT was another step forward, but deaths still increased. Then in 1990, scientists were able to figure out the dynamics of the infection. That led to the development of an AIDS “cocktail” in the mid-1990s - a triple therapy with more than one drug that for the first time led to a decline in deaths. Tremendous medical advances continued through the next decade, and today, more than 20 drugs exist to treat HIV. Most HIV patients now take just one pill once a day for treatment.

In just a little more than three decades, medical science has taken HIV from a death sentence to a manageable, treatable disease. Bad news, however, exists with the good, along with caution.

“The bad news is that HIV is not curable,” says Dr. Treadwell. “With today’s medications, however, the life expectancy of a newly-diagnosed patient is nearly normal. But people need to understand that if they stop their medication, the virus returns and that HIV increases the risk of heart disease, kidney disease, and stroke.”

As research into cures and vaccines continues, HIV and AIDS remain prime targets of public health officials, and the calls for screening remain loud and clear. Today’s guidelines recommend that everyone between 13-65 years of age get tested with a single HIV test, with those in high-risk groups (gay and bisexual men, substance abusers) getting tested more often. Pregnant women have been tested for some time, and that’s had a huge effect on reducing neo-natal transmission, as the fetus can be protected even if the mother is infected.

With one million people in the U.S. living with HIV, with many of those unaware they are infected, and with 50,000 new infections every year, Dr. Treadwell is quick to point out why testing is so crucial.

“You can’t treat a patient,” he says, “if you don’t know they’re infected.”

Watch the video for more discussion, including more conversation on those most at risk of infection, the prevalence of HIV and AIDS in the U.S. and around the world, the negative effects of improved treatment of HIV, the public health benefits of treating patients, and the prospects of a cure or vaccine for the disease.

MMS/Richard Gulla

U.S. Department of Health and Human Services

U.S. Centers for Disease Control

AIDS Action Committee of Mass.

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From left, Bruce Karlin, M.D., Thomas Treadwell, M.D.
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