Dr. Judith A. Aberg, Director of HIV Services at Bellevue, received the State's prestigious 2008 Laubenstein Award for HIV Clinical Excellence. She is co-chair of the HHC HIV Clinical Advisory Group, principal investigator of the NYU/Bellevue AIDS Clinical Trials Unit, and member of several clinical journal editorial boards. Reflecting on the 21st anniversary of World AIDS Day, Dr. Aberg shared some of the wisdom accumulated from her 18 years of treating HIV patients.
How have the major advances in HIV and AIDS treatment affected your work?
Since there was little treatment in the early days, the care we provided was basically palliative in nature. Today, the vast majority of patients with HIV live longer and we are their primary care doctors for illnesses that are the natural consequence of aging, such as cardiovascular disease, hypertension and prostate cancer. However, some of the powerful drugs that suppress the HIV virus can also cause or exacerbate heart disease and cancer. So, we must be very vigilant of the overall health of our HIV patients.
What are specific challenges for women patients, regarding clinical trials and HIV treatment?
Women are more fearful than men of taking investigational drugs, regardless of the disease. However, I think the main problem for women is they see themselves as caretakers, and often put their health second to their families.
What's on the horizon?
Besides trying to determine the best combination of HIV medications to maximize effectiveness and minimize side effects, we are also looking at drug combinations for people who have failed previous combinations. Many new drugs have been approved and are under investigation. We are also evaluating strategies for a therapeutic vaccine to boost the immune system to control HIV replication.
What about advances in prevention?
We still have a long way to go in this area. New York still has the highest number of persons living with HIV/AIDS in the country. Among people under 65, HIV is the third leading cause of death in NYC, yet one in four people living with HIV -- approximately 25,000 New Yorkers -- don't know they're infected and can unknowingly infect others. People still think it can't happen to them - that "nice" people don't get AIDS. That why testing programs like HHC's are such critical components of HIV prevention. By offering HIV testing in the community and making it a routine part of healthcare, HHC has doubled the number of individuals diagnosed with HIV. Earlier entry in care will result in longer and improved quality of lives.
As a long-time educator, do you see a difference in today's medical students who have known HIV/AIDS their whole lives?
In a sense, that makes it easier to work with them. However, we still have to keep addressing some of the myths that are common in the population at large. We have to remind medical students and staff that everyone needs to be tested, not just people who are gay or substance abusers.
What are some of those myths about HIV/AIDS?
There are so many. One is that it is curable. There is no cure, just better treatment. But, we also have the myth that a diagnosis of HIV is a death sentence, which is not only wrong, but a barrier to testing. Another myth is that middle class people or middle aged people don't get HIV/AIDS. It is a disease that can and does affect everyone, regardless of their income or age.
December 2008
