[elgabogringo]

Hmm... I'm surprised by this. At least in the US AIDS is under much more control, is it not? My fiancee treats AIDS/HIV and has never mentioned "resistance" except when referring to antibiotics. This seems more like a funding issue, though I could be wrong.

All told, this is sad. Aids is the most easily preventable disease. Most of her patients know exactly when they got it.

[chimeracoder]

A few things are at play here.

First, there are a number of different forms of HIV. HIV-1 is what's most prevalent in the US; HIV-2 is mostly restricted to sub-Saharan Africa, but a lot of HIV cases in Africa are HIV-1. (These can be broken down further - for example, there are about seven groupings of HIV-1 - but HIV-1 vs. HIV-2 is the most important distinction). Treatment for HIV-1 and HIV-2 can vary, and a lot less research has been done into the types of HIV that are common in Africa and India.

Secondly, yes, AIDS (as opposed to HIV) is "mostly under control" in the US. There are still cases of AIDS in the US, but they tend to be in populations that are undertreated medically. For people who identify HIV early on, while their CD4s are still manageable, if they stick to a treatment regimen, they're far more likely to die from something else. In fact, people in the US who are HIV+ and under active treatment now live slightly longer lives than their HIV- counterparts.

> Aids is the most easily preventable disease.

AIDS is somewhat preventable (for people who already have HIV), but it requires an active and ongoing treatment regimen, as well as periodic medical care from a clinician. The funding for both of these is an issue, particularly in developing nations.

HIV itself is somewhat preventable, though, which is why pre-exposure prophylaxis (PrEP) has been met with such excitement from HIV prevention efforts[0]. Not only is it over 99.9% effective[1], but it piggybacks off of the exact same drugs that are already used for treatment of HIV. It's much more effective to utilize the same distribution network for both treatment and prevention than it is to try to have separate efforts that exist side-by-side, but do very different work.

[0] The AHF is the lone exception, but they've turned into the anti-vaxxers of HIV/AIDS prevention[2]. I don't consider them to be an HIV prevention group anymore; they've done far more work recently to worsen the HIV/AIDS epidemic than they have to stop it.

[1] There has only been one infection recorded from a patient who was actively taking PrEP, and he was on an off-label treatment (PrEP is not approved for prophylactic purposes in his country), so it's unclear how typical his medication schedule was.

[2] See in particular #2 and #3: http://www.hivplusmag.com/opinion/2015/06/24/op-ed-10-worst-...

[mortehu]

> people in the US who are HIV+ and under active treatment now live slightly longer lives than their HIV- counterparts

This sounded implausible, so I looked for a source. This page says "the average life expectancy of a 20-year-old person in the U.S. or Canada who began [anti-HIV therapy] shortly after he or she became HIV positive should be around 70", which is less than the life expectancy at birth of U.S. men:

http://www.catie.ca/en/treatmentupdate/treatmentupdate-200/a...

They do mention a plausible way for HIV-positive individuals to live longer, though: "compared to HIV-negative people, many HIV-positive people in Canada and similar countries are under a relatively high degree of medical scrutiny—they undergo visits to the clinic for interviews and laboratory tests several times each year. This degree of heightened medical surveillance is likely to detect any complications early on, before they can become serious"

[rm999]

I found this study that supports chimeracoder's claim: http://www.aidsmap.com/Life-expectancy-now-considerably-exce...

>A study from the US has found that some groups of people with HIV, especially those treated before their CD4 count falls below 350 cells/mm3, now have life expectancies equal to or even higher than the US general population ... the sole contributor to the increased mortality in people who started ART early was AIDS.

[Aelinsaar]

It's probably hard to underestimate just how significant that it though. How many medically founded causes of death can be traced to something that, if caught very early, would have been treatable? If every single little "blip" was a concern worth investigating, you'd undergo a lot of testing, but you'd rarely slip through the cracks.

Expensive and painful though.

[pkaye]

I think chronic kidney disease is one of them and I'm dealing with it. If they did urine test screening of the whole population every few years they could catch it in the early stages and try to keep it stable for much longer. Most of the medicines to do this are affordable generic medicines like ACE inhibitors and prednisone however once the kidney damage gets to a point where it is physically noticeable it is too late to treat or manage and costly dialysis and transplants are the only solution.

[Aelinsaar]

To be honest, that's more the norm for organ systems than not. The tests are mostly giant red flags, not subtle warning signs. Hopefully this is an area ripe for disruption with machine learning systems.

[derefr]

Wouldn't the HAART therapy used for HIV coincidentally treat at least a few other viral diseases than HIV, ones that would otherwise go untreated?

[bonzini]

> AIDS is somewhat preventable (for people who already have HIV),

I think he means, much more simply, that HIV is preventable by avoiding risky behaviors. Which may well be the case in countries where AIDS/HIV prevalence is small and restricted to specific demographics, but much harder in poor areas where 10% of adults have HIV. It's going to be hard to convince one in five couples in sub-Saharian Africa not to have children.

[elgabogringo]

Well, by preventable, I think I meant something different than you. I meant you could not share needles or you could always use a condom. Sex/needles are what, 99% of transmissions?

And yeah condoms break, but if HIV transfer was limited to the condom breaking that would be a step in the right direction.

[mootothemax]

I can tell you exactly when I broke my arm and the steps I could have taken to prevent it.

Hindsight alone does not make something as easy to prevent as you might like to believe.