TARO YAMASAKI / GETTY IMAGES
18-year-old AIDS patient Ryan White, accompanied by his mother Jeanne, is examined by his doctor in early 1990
This is a rich country. We’re a long way off seeing such success in parts of Africa, where they still take cheap medication with serious side effects; where they don’t even have the facility to measure viral load
therapy, “so the virus would need multiple mutations to survive”. “We figured out using two or even three drugs at a time was far more effective, and caused fewer side effects than applying single medications,” Dr Englund continues. For one thing, the virus mutated so quickly, patients were constantly being shifted from one medication to the next “until we were out of drugs to treat them with”. For another, the levels of monotherapy needed to have any material impact were almost toxic, says Dr Huda. “The side effects and complications were huge.” Developments in HIV medication continued along these lines over the decades until the present day, which sees HIV carriers prescribed with three different medications contained in a single pill, with few or no side effects. What was six tablets a day—three in the morning, three in the evening—is now just one, which can even be tailored to individual patients according to age, lifestyle, gender and underlying conditions. In the near future, there’s potential for “injectable medications— so instead of taking a pill once a day they can take a shot per month,” says Dr Englund, a “far more convenient” form of medication and “a great
deal easier for those who struggle to remember to take their pills”. One of the upshots of the new medication was that it enabled, for the first time, couples who carried HIV to conceive naturally, and to breastfeed their children. “Previously, if a couple wanted a biological child, the father would have to have gone through the complex and expensive process of removing HIV from his sperm— a process not available on the NHS— or else gone down the route of sperm donation or adoption,” says Dr Huda. If the biological mother was carrying the virus, the possibility of breast feeding was non-existent. To have medication that can “reduce the viral load to the point whereby it’s undetectable and untransmissible” makes it possible for those with HIV not only to survive but to build a fulfilling family life that would previously have been inconceivable. So far, so much progress. But when Dr Huda was asked to take part in a debate in which the motion was ‘Is this the end of HIV?’ she successfully argued against it. “We won the argument that this is not the end. Yes, in the UK we’ve hit the UN’s target of 90% of people with w Prognosis—37
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