Ask Dr. H: Drugs lengthening lives in HIV cases

Question: I remember when Magic Johnson was diagnosed with HIV in the early 1990s. I thought it was his death sentence. Two decades later, he is healthy and the virus is completely under control with the medication he takes. Have we reached a point where people living with HIV can have normal life expectancies?

Answer: Potentially, yes. We've come a long way since 1983, when the HIV virus was first identified. In 1986, AZT (Zidovudine) became the first drug available to treat HIV. Unfortunately, it wasn't effective enough in combating the AIDS virus. In 1995, a 25-year-old man diagnosed with AIDS had a life expectancy of just three years.

In 1996, we began using the three-drug regimen of AZT, Crixivan, and 3TC; this increased the average life expectancy of a 25-year-old man with AIDS by 23 years.

The subsequent decade would see a huge increase in the number of antiviral drugs to combat HIV and an average increase of 47 years in the projected life expectancy of a 25-year-old man recently diagnosed with HIV. We now have 26 antiviral drugs to combat the virus and the ability to reduce the HIV viral load to an undetectable level.

There is now a treatment for virtually everyone, and failure comes from poor patient compliance. While average life expectancy of those diagnosed with AIDS is reduced somewhat (five to 15 years), researchers believe that with early diagnosis and aggressive treatment, life expectancies could approach those of the HIV-free population. The reality, however, is that only 28 percent of those with HIV infection are getting adequate treatment that suppresses HIV in their blood to an undetectable level.

Q: My granddaughter has quite a few warts on her skin. What is the cause and cure for them?

A: They are caused by the human papilloma virus (HPV), of which there are at least 60 types. Warts can grow on all parts of the body, including the skin, genital area, and rectal area. The latter two are transmitted through sexual contact.

Although we contract HPV through direct contact with a wart, we're not sure why some people get warts and others don't. We do know that cracked, non-intact skin allows the virus to penetrate much more easily, which may explain why children or adults who bite their fingernails or pick at hangnails and scabs seem to get more warts. Our own immune systems play a role in the likelihood of getting warts, just as some people get more colds than others.

Treatment of warts on the skin depends on their location and the age of the patient. For common warts on the skin, chemical acid, such as salicylic acid, can be applied many times over several weeks to gradually destroy the tissue. Cantharidin also can be applied to chemically destroy the wart.

The downside of chemical treatment is that it tends to destroy healthy surrounding skin. Controlled freezing is my preferred method of treating warts. Electrosurgery and laser treatments are options for treatment-resistant warts.

Warts on the feet are treated in much the same way, but they are a bit harder to treat since the bulk of the wart is below the skin's surface.

What about folk remedies? I've heard stories of cures using coal tar, onions, axle grease, and garlic. Since warts may spontaneously disappear over time, especially in children, it is difficult to say whether the cure was time or a folk remedy.


Mitchell Hecht is a physician specializing in internal medicine. Send questions to "Ask Dr. H," Box 767787, Atlanta, Ga. 30076.