Читать книгу Knowing One's Medical Fate in Advance - Группа авторов - Страница 9

Manuel Battegay

Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

To know one’s medical fate in advance is difficult if not impossible even if, as with the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/ AIDS), a very serious prognosis seemed clear just some years ago. Specific parameters and factors of a specific disease may be stable enabling a quite precise prognosis, however, there is still a high degree of uncertainty, also with all the knowledge we have. In this presentation I will show how things can evolve very, very quickly and that prognosis 15 years ago was not the same as it is now, especially with HIV/AIDS.

The change of perspective can be observed with Time Magazine covers. In the early years a disease with unknown origin was first described: what is AIDS, what is HIV? In 1983, the important discovery of the virus for which the Nobel prize was given to Barré Sinoussi and Luc Montaigner in 2008 was made. Time magazine well representing the general atmosphere gave bad news: ‘The Growing Threat’, ‘The Big Chill’, ‘Losing the Battle’. This was just 15 years ago. In 1996, research on the viral replication gave a perspective on modern treatments which were introduced with much hope at that time.

After infection the virus disseminates and causes already after few days an important immune damage. Nevertheless, the immune defense eventually combats the virus leading usually to a significant decrease of viremia, i.e. the concentration of the virus in the blood. Afterwards the immune function decreases as measured by an excellent surrogate marker, i.e. the CD4-T cell lymphocytes [1]. The risk of opportunistic infections or tumors increases then due to impaired cellular immunity.