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On June 5, 1981, the first acquired immune deficiency syndrome (AIDS) case was reported in the United States, generating widespread public awareness of the virus. AIDS-related deaths continued to increase dramatically until the late 1990s. Since then, advances in treatment and public awareness have drastically reduced human immunodeficiency virus (HIV) cases and death rates.

Today, approximately 40,000 people a year become infected with HIV in the United States. Nearly one million people are presently infected with HIV and 250,000 of them are unaware of the infection.

Physicians and staff members at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School want more people to be tested and support a government campaign to increase early HIV diagnosis through routine testing. The campaign calls for HIV testing as a part of standard medical care provided to all those treated at the hospital. They expect to reduce the number of people who don’t know they’re infected.

Routine HIV testing for pregnant women was implemented in 1999. According to Vito Iacoviello, M.D., Division of Infectious Diseases at Mount Auburn Hospital, if an infected mother is not treated for HIV, her baby carries a 25 percent chance of becoming infected. In contrast, if the mother is treated, the baby’s chance for infection can be reduced to less than two percent. Routine therapy for all HIV infected mothers has dramatically reduced perinatal transmission of HIV from mother to child.

Doctors at Mount Auburn Hospital expect similar positive outcomes when routine testing is implemented for all patients. Even though patients may decline the HIV testing, The Centers for Disease Control and Prevention and physicians at Mount Auburn Hospital urge people to accept the test.

Dr. Iacoviello says, “It’s imperative to find out if people are HIV positive so we can get them into treatment, both to preserve their health and to prevent the transmission of the infection to others.” Routine testing can also reduce the controversy and judgment often associated with the HIV test. “If you make it routine, you’re not stigmatizing anyone. You’re just saying, ‘this is routine, this is part of your normal healthcare maintenance,’” he says.

Routine testing and access to care saves lives. “I do not expect my patients to die from HIV infection; I expect them to get the disease under control,” says Dr. Iacoviello. Advancements in technology and treatment are allowing patients living with HIV to live longer and more normal lives than was possible 20 years ago.

In the early years of HIV therapy, patients had to take zidovudine (AZT) every fours hours, including through the night. Later, dosing improved to two or three times a day but the necessity for a fist-full of pills was not unusual. Last July, the FDA approved a new all-in-one pill called ATRIPLA. Now, instead of taking more than 20 pills a day, HIV patients may only need one pill before bed.

The all-in-one pill is very convenient and may make “directly observed therapy,” which means patients are more likely to take the medications exactly as directed by their physicians, more feasible, especially for patients who suffer from substance abuse and psychiatric illnesses. “The most important message to send to people is that taking the medication every day is critical,” says Dr. Iacoviello. Missing doses reduces the level of the drug in the body and allows the virus to become resistant to the medicine, which could lead to resistance to several other medications for HIV as well. “It’s important for patients to have open communication with their doctors if they are having problems with their medication. If they can’t tolerate one, we can try something else,” says Dr. Iacoviello.

According to Dr. Iacoviello, most people with HIV can stay healthy and lead productive lives as long as they take their medication properly once treatment is deemed necessary.

As patients with HIV live longer, new challenges emerge. Patients may develop other chronic illnesses such as hypertension, diabetes and heart disease. Combating HIV, coupled with the danger of chronic illness, takes a team effort. Mount Auburn Hospital’s HIV specialists work together with the patients’ primary care physicians. Dr. Iacoviello is proud to be a 14-year member of the Mount Auburn Hospital team and says, “Having the primary care doctor involved in managing the coexisting illnesses and preventive measures is critical. As it was in the past, and as it will be in the future, the two work together.” It’s a life saving combination.

For a free Mount Auburn Hospital physician directory, please call us at 617-499-5094.