South Florida Hospital News
Tuesday May 18, 2021
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November 2004 - Volume 1 - Issue 4
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HAART: One of Decade's Greatest Advances

As 2004 winds to a close, it is important to look back a few years to see just how far the medical world has come in such a short amount of time. Huge strides have been made in the diagnosis and treatment of diseases like cancer and HIV; technology has resulted in the creation of state-of-the-art medical equipment to aid doctors in their work; new medications and procedures perfected through research have enabled patients to live longer, more productive lives.

We have asked the presidents of South Florida medical societies to tell us what they think have been the greatest medical advancements of the last decade. This month, Dr. Linda Cox, president of the Broward County Medical Society, shares her thoughts.

Sometimes we do not realize how much progress has been made in medicine because some advances have been made gradually over time. Reflecting back over the past 10 years to respond to "What are the greatest medical advances in the past decade?" HAART (Highly Active Antiretroviral Therapy) readily came to mind.

I have vivid recollections of the frustration and sense of futility when treating HIV patients during my internal medicine training at Jackson Memorial Hospital in the mid-1980s. This was the beginning of the HIV epidemic, when the disease seemed to be escalating out of control. This escalation was apparent in the short period of time between my senior year of medical school at Northwestern University, when a single HIV patient provoked the curiosity and attention of the entire immunology consultation service, to being the most common admitting diagnosis during my internship at Jackson Memorial Hospital. No effective treatment was available and the diagnosis was essentially a death sentence.

The HIV epidemic brought to light the difficulties encountered in taming new diseases. Prior to this, there had not been many serious new health threats, and in a sense we were caught off-guard. Identification of the cause of the syndrome, the human immunodeficiency virus, seemed to take forever. A cure seemed out of the question.

The first glimmer of hope came at a 'groundbreaking' conference I attending as an intern. Margaret Fischl presented the results of the AZT study, the first drug shown to have some efficacy against the virus. Unfortunately, at the high doses utilized, it had considerable toxicity as did some of the other drugs that were later developed. Was the cure worse than the disease? In the wards at Jackson Memorial Hospital, I am sure many of us felt overwhelmed by the seemingly endless cases of young men and women in advanced stages of HIV infection with virtually no weapons to halt or cure the disease.

After completing my internal medicine training, I went to Denver to study allergy and immunology, welcoming the change in disease management, seeing simple interventions such as inhaled corticosteroids lead to major improvements in an asthmatic’s quality of life. It felt good to be able to 'make someone better,’ a goal of most if not all physicians. Despite the immunology in allergy and immunology fellowship training, there was almost no exposure to HIV patients after leaving Jackson Memorial Hospital.

In my early years in private practice, there were very few patients with active HIV infections referred to an allergist. Treatment of allergies seemed of secondary importance when faced with this ultimately fatal disease. Consequently, I did not stay current with the advances made in this field for several years, focusing on my specialty instead. Then, in the late 1990s, I began to see an increase in HIV positive patients referred for evaluation and management of their chronic allergic disease.

HAART had been introduced in late 1996, profoundly affecting the landscape of the epidemic. HIV had been tamed by HAART. Now HIV infection had been transformed from a death sentence into a chronic disease, and patients could begin to get on with their lives and focus on other things.

In the past decade, we have seen an epidemic ‘tamed,’ and watched as the medical community hastily worked to identify the organism, understand the disease pathophysiology and develop effective treatments to control the disease. But we still await a cure or effective prevention through vaccination--something to look forward to in the next decade.

Dr. Linda Cox is an allergy and immunology board-certified physician who has been in private practice in Ft. Lauderdale for 12 years. She is an assistant clinical professor of medicine at the University of Miami School of Medicine and Nova Southeastern University School of Osteopathic Medicine, as well as past-president of the Florida Allergy Asthma and Immunology Society.
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