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? - D.K., Atlanta
Answer: Potentially, yes. We've come a long way from 1983, when the HIV virus was first identified. In 1986, AZT (Zidovudine) became the first HIV 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 3 years.
In 1996, we began using the three drug regimen of AZT, Crixivan and 3TC, but this increased the average life expectancy of a 25-year-old man with AIDS by only 23 years. It's surprising just 13 years ago, this man had an average projected life expectancy of just 48 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.
As of 2012, we now have 26 antiviral drugs to combat the virus and the ability to reduce the HIV viral load to an undetectable blood level. There is now a treatment for virtually everyone, and failure comes from poor patient compliance rather than poor drugs.
While the average life expectancy of folks diagnosed with AIDS is reduced somewhat (range: 5 to 15 years), the belief by researchers is that with early diagnosis and aggressive treatment of HIV infection, life expectancies could approach that of non-HIV folks. The sad reality, however, is only 28 percent of folks with HIV infection are getting adequate treatment that suppresses their HIV blood level to an undetectable level.
Question: My granddaughter has quite a few warts on her skin. What is the cause and cure for them? - R.H., Franklin Square, N.Y.
Answer: They're caused by a human virus, so I can assure you they didn't come from holding or kissing a frog. The specific virus that causes warts is the human papilloma virus (HPV), of which there are at least 60 different types. As you know, warts can grow on all parts of the body, including the skin, genital area and the 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 folks get warts and others don't. We do know cracked non-intact skin allows the virus to penetrate much easier, 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 system plays a role in the likelihood of getting warts, just like some folks get more colds than others.
Treatment of warts on the skin depends upon 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 can also be applied to chemically destroy the wart. The downside of chemical destruction is it tends to destroy healthy surrounding skin. Controlled freezing is my preferred method of treatment of warts. Electrosurgery and laser treatments are great options for treatment-resistant warts. Warts on the feet are treated in much the same way, but they're 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, especially in children, may spontaneously disappear over time, it's difficult to say whether the cure was time or some folk remedy miracle.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," P.O. Box 767787, Atlanta, GA 30076.