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No longer a death sentence: The evolution & development of HIV in the U.S.

by Marley Vogel, Cornell University ’24 and participant in the 2021 Institute for Public Health Summer Research Program- Public & Global Health Track


Photo: Unitaid (Accelerating innovation in global health)

On July 20, trainees in the Institute of Public Health Summer Research Program – Public and Global Health Track attended a captivating seminar by William G Powderly, MD.  Among his many roles as director of the Institute for Public Health and co-director of the Division of Infectious Diseases at the Washington University School of Medicine, Dr. Powderly has immense knowledge in the fields of infectious disease, specifically HIV. Ever pertinent in today’s landscape, the field of infectious diseases is broad and crucial to maintaining public health in the U.S. and beyond.

Dr. Powderly’s career has come full circle ever since a New England Journal of Medicine editorial came out six months before his medical school graduation. This editorial questioned the need for infectious disease physicians. In an interesting turn of events a mere two years later, the CDC announced the first report of a new immunodeficiency, eventually established as HIV/AIDS. At the height of the HIV epidemic, Dr. Powderly embarked on a Fellowship in Infectious Diseases at the Washington University School of Medicine. For Dr. Powderly’s career, this path was serendipitous. During his lecture, Dr. Powderly stressed the importance of recognizing opportunities as one encounters them, despite these opportunities not being what one fully expected. “The road not taken” can often be beneficial to bright-eyed young professionals who are seeking a career that is fulfilling and contributes to the greater good. As a hopeful physician interested in infectious disease, this advice is useful and aligns with my passionate attitude towards medicine and health.

During the first ten years of Dr. Powderly’s career, most HIV patients died. The prognoses began to improve in the early 1990’s when it was found that if replication of the virus inside a patient could stop, the progression of HIV to AIDS could cease and the body would regenerate. In 1996, the first trials for drug combinations came out. These pharmaceutical interventions were available by 2000 and showed incredible success. Replication of the virus stopped within a patient and with this, mortality rates dropped dramatically.

A virus that was once a death sentence became managed with medication and appropriate care. Researchers began to investigate a HIV vaccine that could make people immune to infection. Despite vast efforts, these goals have yet to be reached. However, the toll of HIV has steadily lessened as research reveals new truths and care becomes more widespread.

A crucial message from Dr. Powderly was the need for a continuum of care for HIV patients. With medication and lifestyle changes, patients can become virally suppressed and undetectable. But this can only happen if there is a commitment to medical intervention on everyone’s end: the patient, the provider, the government and more. A plethora of social and financial challenges continue to stand in the way, so understanding the need for care and reducing stigma is a major aim.

By 2030, the CDC aims to bring yearly new HIV infections in the U.S to under 3000 people. With the efforts of esteemed Infectious Disease specialists, such as Dr. Powderly, we can reach this goal on a national scale. Ultimately, as Dr. Powderly said, “We can do this. We just have to have the willingness to.”