March 30, 2007
Volume 35
Issue 13
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World has Gay activists to thank for AIDS treatment
World has Gay activists to thank for AIDS treatment
by Lisa Sterman, M.D., M.P.H. - Special to the SGN

Twenty years ago this month, the Food and Drug Administration approved the anti-HIV medicine, AZT, the first ray of hope for people living with HIV/AIDS. AIDS community advocates in the Bay Area, who campaigned tirelessly for effective treatments, played a key role in making AZT and other early AIDS medications available for people living with HIV. And, thanks to their tireless early leadership, the Bay Area continues to spearhead dramatic advances in AIDS treatment.

I remember the day AZT arrived in March 1987. Working as a volunteer in Ward 5A at San Francisco General - known then as "the AIDS ward" - I saw dozens of young men and women, from all walks of life, cut down in their prime. In the early 1980s, an HIV diagnosis signaled, in almost every case, a death sentence.

Somebody had to assume the role of advocate for people dying of this dreadful disease and, in the vacuum created by the national silence on the issue, it was the Bay Area's Gay community, which quickly established pioneering organizations such as the San Francisco AIDS Foundation, Project Inform, and branches of the national organization "Act Up", among others.

Thanks to these brave leaders, several truly monumental things happened. First, government researchers and pharmaceutical companies began to consider prioritizing the development of medications to treat HIV. Among the first patients in the world to receive AZT were those in Ward 5A. I recall the real feeling of hope it gave them. All too quickly, we discovered that treatment with AZT alone had significant limitations, as did the other first-generation HIV medications that soon followed. Our only comfort was that we had succeeded in getting medications out of the pipeline and into patients in desperate need.

These same early advocates were instrumental in reshaping how the Food and Drug Administration deals with experimental medications for people with a wide range of life-threatening illnesses, not only HIV. Options such as early access to investigational therapies and expedited drug approvals simply didn't exist in any meaningful way before the AIDS community made its voice heard.

Perhaps most importantly, grassroots advocates made clear how HIV treatment had to evolve in order to work for patients over the long term. When AZT was approved on March 20, 1987, there were concerns over the side-effects associated with high-dose therapy with the drug, which proved well-founded. Advocates demanded more action and more resources, including prioritizing improved and diverse treatment strategies, as well as more palatable treatment options that were easier to take and tolerate.

Eventually, with tireless effort and persistence, they got them. Researchers and drug companies began to deliver more powerful and patient-friendly treatment regimens, which today can be as simple as one or two pills a day. These advances mean that patients can stick to treatment more easily, which is key to keeping the virus in check. The result: A 25-year-old who is diagnosed with HIV today and receives appropriate care can expect to live an additional 35 years or more. As an example of this push for new treatments, two entirely new classes of HIV drugs should be introduced later this year.

Even with all the promise of today, we cannot forget the past. I was recently reminded of just how many people didn't make it in those days when I returned, yet again, to see the AIDS Memorial Quilt. The quilt began in the Bay Area in those early days of devastation, and is currently on display at the San Francisco Columbarium. Fortunately, as our medical advances accumulate, we are getting closer to defeating this disease. When that day finally comes, we will again have the Bay Area's pioneering HIV community to thank.

Dr. Sterman is in private practice at Davies Medical Center and is associate clinical professor of medicine at the University of California, San Francisco. This piece first appeared in the San Jose Mercury News on March 23, 2007

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