Who Still Dies Of AIDS And Why?

New York Magazine has posted an excellent dissection of "who still dies of AIDS, and why."

By the time [Mel] Cheren learned he had AIDS [in 2007], he was already suffering from a rare, drug-resistant pneumonia, what infectious-disease specialists refer to as an opportunistic infection, and he had lymphoma, an AIDS-related cancer that had spread to his bones.

Within a month of his diagnosis, Cheren was dead. The official cause was pneumonia, although, as his cousin Mark Cheren points out, cause of death in these cases is a moot point. “Infection from pneumonia was probably the culprit,” he says, “but only because that acts quickest when you don’t stop it.”

Dying from AIDS, or dying with an HIV infection, which may not be the same thing, is a significantly less common event than it was a decade ago, but it’s not nearly as uncommon as anyone would like. Bob Hattoy, for instance, died last year as well. Hattoy, 56, was “the first gay man with AIDS many Americans had knowingly laid eyes on,” as the New York Times described him after Hattoy announced his condition to the world in a speech at the 1992 Democratic National Convention. Hattoy went on to work in the Clinton White House as an advocate for gay and lesbian issues. In the summer of 1993, he told the New York Times, “I don’t make real long-term plans.” But the advent of an anti-retroviral drug known as a protease inhibitor, in 1995, and then, a year later, the multidrug cocktails called HAART—for highly active anti-retroviral therapy—gave Hattoy and a few hundred thousand HIV-infected Americans like him the opportunity to do just that.

If the pharmaceutical industry ever needed an icon for evidence of its good works, HAART would be it. Between 1995 and 1997, annual AIDS deaths in New York City dropped from 8,309 to 3,426, and that number has continued to decline ever since. The success of HAART has been so remarkable that it now tends to take us by surprise when anybody does succumb, although 2,076 New Yorkers died in 2006 (2007 figures are not yet available). Though many of the most prominent deaths, like Cheren’s and Hattoy’s, tend to be of gay men, the percentage of the dead who contracted the disease through gay sex is now reportedly as low as 15 percent (with a large proportion still reported as unknown). Intravenous-drug users make up the biggest group, 38.5 percent, and women account for almost one in three of total AIDS deaths.

Mel Cheren, the founder of famous dance music label West End Records, was a well-known and highly-regarded HIV/AIDS activist who provided the Gay Men's Health Crisis with their first office back in 1982. Yet somehow he had stopped testing himself for HIV in recent years. The virus was full-blown before he realized he'd been infected.

The article also makes several references to "sins of the past" patients, people who have been living with HIV since before the advent of HAART, but are now suffering the ill effects of the pre-HAART monotherapies like AZT. The treatment kept them alive, but allowed their virus to mutate to be resistant to today's front-line drug arsenal. Says one doctor: "I still expect most of my patients to live a normal life expectancy, but they may do so with a bit more nips and scrapes.” Nips and scrapes like heart, liver, and kidney disease.

Test, test, test. There is no excuse not to do so. Not everybody goes on treatment right away and some don't begin for many years. But constant vigilance as to how your body is handling the infection right now will pay off in ten, twenty, or thirty years.