Reducing HIV Mortality: A New Paradox for Practitioners Working in Countries with Socialized Health-care Systems

The milestones marking substantial changes in the lives or in the survival of humans deserve to be remembered. It has been only 11 years since we experienced an event that not even the most optimistic amongst us would have predicted before 1997. Let us place the facts in time. At the beginning of the 80s, we faced the distressing reality that more than three quarters of all children, men and women found to have antibodies directed against a new infectious agent named human immune deficient virus (HIV) were bound to die. The mere reactivity of the serum of a human being against a virus characterized in 1983 (antibodies) handed an almost inevitable sentence of death. At that time the evolution of this viral infection was assessed by the quantification of a sub type of white cells, the auxiliary lymphocytes or CD4. This count was the principal evidence for most of the predictions on how a person might survive without degradation, and the value of such cells was the abacus used to forecast the time when an individual would develop irreversible blindness, to anticipate respiratory failure, and to predict the time before weakness would appear after devastating diarrhea, etc. We should recall that the CD4 cell count was even used as a predictor of the initiation of cognitive shrinkage, forecasting dementia as well as the signs that would take hold of personality as a consequence of infections or neoplastic transformations in the encephalitic mass.