W. David Hardy, M.D., is director of infectious diseases at Cedars-Sinai Medical Center in Los Angeles and an associate professor of medicine-in-residence at the David Geffen School of Medicine, University of California, Los Angeles (UCLA). For nearly 40 years, Dr. Hardy has been one of the leading figures in HIV clinical research and practice. The following are excerpts from a wide-ranging discussion we had about how living with HIV has changed since the beginning of the epidemic.
Michael Broder: What would you say is new or different about being newly diagnosed with HIV now compared to the past? How would you say the medications themselves have changed since the beginnings of ART over 30 years ago?
David Hardy: I would say there’s a huge difference being diagnosed now versus being diagnosed even 10 years ago. The antiretrovirals today are much, much better. They are better in terms of potency and the ability to keep the virus suppressed. They have much less toxicity. And they’re much easier to take. You know, right now, the state of the art is single-tablet regimens, one pill once a day. But we’ve already seen licensure of the first monthly injectable back in January. And before the end of this year, I will wager that we’re going to see an extension of that to injection every two months, because the data actually support it from another study that ViiV [the manufacturer] did. There’s basically four pharmaceutical companies now that work in HIV: Gilead, ViiV, Merck, and Janssen. Those are kind of the last four standing of the 12 that were there before. So, you know, coming down the pike, all of those companies now are taking the same line of developing long-acting injectable or implantable treatments.
The antiretrovirals today are much, much better. They are better in terms of potency and the ability to keep the virus suppressed. They have much less toxicity. And they’re much easier to take.
What has changed about the basic approach to starting HIV treatment?
What is great about today is that a person who is diagnosed can look forward to initiating therapy almost immediately. The back and forth we used to do about should we start now, should we start later, how much the T cells have to fall, blah, blah, blah, blah, blah, is over. It’s been over since 2012, almost 10 years. But you know, it’s—you get diagnosed, you get treated like any other STI. It’s different, but it’s still kind of the same principle.
What does the future hold for medications?
There are much, much better medications on the horizon, so that the interference that taking medications for HIV has caused in many people’s lives, is going to get less and less and less. In terms of treatment, that’s a big difference.
What has changed about community and public attitudes towards HIV and PLWH?
In terms of stigma, and sort of living and coping with HIV, there is a difference now compared to the 1980s and 1990s, when there was a great amount of compassion. Red Ribbon compassion for persons who are positive, a lot of that has sort of passed. And that sort of, I’m special because I’m HIV-positive sort of feeling, or I deserve this because I’m HIV-positive, or feel sorry for me because I’m HIV-positive I think has also changed. It has now become, this is part of my life. I accept it. I deal with it. I try not to hide it. I disclose it when necessary, and I no longer live in the state of fear, or shame, that someone’s gonna find out, because it is just a fact of life. Like if I had diabetes, hypertension or anything else, it just is what it is. And I get treated for it and take care of myself.
So, I think there’s been a huge evolution in terms of what people who are HIV-positive are being exposed to now, compared to what went before. In years past it was always, I can’t tell this person, I can’t tell that person, and I’m holding this big, nasty secret. I’m hiding my pills as best I can, and making sure no one ever sees them—those days hopefully are over. I think there’s a whole brand-new sense of openness, and acceptance. What they used to call “AIDS exceptionalism,” the idea that persons with HIV should be granted extra sort of privileges, because they’re HIV-positive, I think is also passed, and become more about yes, you’re HIV-positive, here are the medications, take advantage of them, and move on through your life because data are showing that your chances of living a long time are very good.