In the 17 years he's been treating people with AIDS, never has Gerald H. Friedland, M.D., been more optimistic. New therapies such as protease and reverse transcriptase inhibitors are thwarting the onset of full-blown AIDS in HIV-infected people, slowing the progress of the disease and offering patients more hope than ever before.
Those therapies, however, have changed the way doctors care for people with AIDS and shifted treatment strategies to outpatient and community settings. “Because there are fewer deaths and because people are living longer, in some ways the clinical burden of care, the resources needed to produce care, have increased,” says Dr. Friedland, director of the Yale AIDS Program since 1991. “The benefit of these therapies is very dependent upon all the clinical systems that have been put in place to care for people with HIV disease. It's not just writing a prescription and that's it. You need a whole system of care to help people benefit.”
Dr. Friedland first encountered AIDS at Montefiore Hospital in the Bronx in 1981, when he saw injecting drug users manifesting the symptoms of an illness then believed to afflict only gay men. At Montefiore he brought not just physicians and nurses into the care of AIDS patients, but social workers, mental health workers, clergy and others. That same multidisciplinary approach is at work at the Yale program, which opened in 1983 and was the first clinic dedicated to AIDS in the state. In addition to clinical care for HIV-positive patients the program offers counseling, testing and outreach programs and does prevention work in city schools. There's also a community health care van carrying counselors and outreach workers into New Haven's neighborhoods. Physicians and other research staff are performing clinical trials of new anti-retroviral therapies and studying the interactions of anti-retroviral agents and methadone in substance abuse programs.
“This is a wonderful time in the history of the AIDS epidemic in the United States,” says Dr. Friedland, professor of medicine and epidemiology. “There are potent and effective therapies. They are very complicated and difficult but their benefit is unquestioned at this point in preserving and prolonging life. However, difficulties in providing therapies to all who can benefit from them remain, as does their still unknown durability. This is a time for intensified therapeutic effort, not relaxation.”