Not likely, says Gayle. The heterosexual epidemic in Africa results largely from conditions that do not exist in industrialized countries. These include large-scale population shifts, little information about AIDS prevention, many migrant workers, widespread prostitution, deep reluctance to use condoms and frequent, untreated sexually transmitted diseases. Still, heterosexual transmission is slowly increasing in the United States, largely in low-income black and Hispanic women. Fears that the highly effective AIDS drugs would quickly lose their punch have not come true.
Most patients continue to do well, although long-term side effects are the biggest worry.
I would like to believe people will be able to go for 35 or 40 years on antiviral drugs, but that s a lot to ask because of the dropout we see due to drug toxicity, says Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. Side effects that make some people quit treatment include an abnormal redistribution of body fat that leaves them with buffalo humps and skinny faces and extremities, along with a variety of metabolic complications, such as high blood sugar and cholesterol. Thinning bones are the latest anxiety. People are really questioning whether it s possible to have people on therapy decade after decade, says Dr. Joel Gallant of Johns Hopkins University. Eventually some run out of options.