Six months before World AIDS Day was observed for the first time, University of Iowa Hospitals and Clinics launched its HIV/AIDS clinic.
It was the summer of 1988, and the new clinic was expected to draw an initial cohort of about 20 patients. Instead, nearly 80 people sought care in the first few months, and by the end of the clinic’s first two years, it was treating some 200 patients.
The AIDS epidemic was in full swing in the U.S., with the number of reported cases of the disease doubling to 100,000 between 1987 and 1989. The UI clinic was the state’s first clinic to treat HIV infection and AIDS, and it remains the state’s largest such clinic, says director Jack Stapleton. He says a lot has changed since 1986, when he was recruited to campus in part to establish the clinic.
“A patient today with a new diagnosis of HIV has as good a life expectancy as someone newly diagnosed with diabetes or hypertension,” says Stapleton, professor of microbiology and internal medicine in the UI Carver College of Medicine.
Considering that AIDS had become the leading cause of death for Americans ages 25 to 44 in 1994, that’s significant progress. Though the disease has no cure, advances in antiviral drug treatment have helped slow the progression of HIV to full-blown AIDS, when the immune system can no longer fight off infections. Now, people who are HIV-positive and who receive prompt, consistent medical treatment can live long, healthy, and productive lives.
“We recognized early on that we needed a multidisciplinary approach to care in our clinic, and the hospital administration came through with the resources we asked for,” Stapleton explains. “We were able to hire a nurse and set up a patient database to help us track the disease.”
Did you know?
• Human immunodeficiency virus (HIV) attacks cells in the body’s immune system. If left untreated, HIV can lead to acquired immunodeficiency syndrome (AIDS). Most people who are HIV-positive today do not progress to AIDS.
• HIV is mainly spread through sexual behaviors and/or needle or syringe use. It is not spread through casual contact.
• There is no cure for HIV, though the infection can be controlled with proper treatment and medical care.
• More than 1.2 million in the U.S. live with HIV infection, and 1 in 8 don’t know it. There are 36.9 million living with the virus worldwide.
• New HIV diagnoses have declined 19 percent over the past decade.• According to 2015 statistics from the Iowa Department of Public Health, there were 153 people living with HIV in Johnson County and 2,496 statewide.
The UI team has grown to include as many as 20 experts in infectious diseases, social work, psychiatry, pharmacy, and nursing. They also make referrals to health care professionals who have experience treating patients with HIV—from dentists to obstetricians to ophthalmologists—and operate a satellite clinic in Waterloo twice a month. More than 2,100 patients have been treated at the UI clinic, with more than 600 patients seen in 2016.
“Our staff provides an amazing amount of care. We will arrange rides or provide gas cards, if patients need transportation—and our pharmacists call two weeks after appointments just to check in,” he says. “The part I enjoy most is meeting patients and taking care of them. Some of them I have taken care of for nearly 30 years. I’m like their family practitioner.”
Stapleton, who earned an undergraduate degree in zoology from Iowa in 1977 and an MD from the University of Kansas in 1980, was first inspired to go into science by a high school chemistry teacher (“Everyone thought he was a nerd, but I thought he was really cool,” he says). He thought he might want to be a general surgeon, but changed his mind after experiencing the thrill of problem solving during an internal medicine rotation.
“I remember going home and telling my wife that the field of infectious disease was really interesting and rewarding,” he says. “A patient can be really sick and if you do the right thing, you can cure them. There were patients of all ages and lots of unusual symptoms. I knew I’d never run out of things to learn.”
Stapleton stuck with it and has been at the forefront of HIV treatment and research ever since. In fact, he remembers when he encountered his first patient with AIDS. It was the fall of 1980 during a medical residency at the University of North Carolina at Chapel Hill—and before the disease had been formally identified. The patient was a 19-year-old woman who presented with symptoms of “a weird pneumonia,” he recalls. “She died the following spring, after she was hospitalized with a bloodstream infection. She had had chemotherapy for Hodgkin’s disease when she was 14 and had contracted HIV during a transfusion.”
Throughout his nearly three decades of running the clinic at Iowa, Stapleton has seen firsthand the progress made in the fight against AIDS. The clinic has participated in numerous clinical trials that have led to advances in AIDS treatments.
World AIDS Day Reading of Names 2016
In celebration of World AIDS Day and as part of IC Red Week, a student-led HIV-AIDS awareness initiative, a dawn-to-dusk Reading of Names from the AIDS Memorial Quilt will be held on the east side of the Old Capitol Museum in recognition of those lost to AIDS. Learn more…
“In the past three to five years, we’ve seen multiple drug treatment regimens that are less toxic and better tolerated,” he says. “Patients are living longer and enjoying a higher quality of life.”
That noted, Stapleton says he does not anticipate a cure to be found in the near future. The ability of HIV to duplicate quickly makes it a formidable foe—and underscores the importance of research.
“Finding the molecules that the virus needs to have in order to multiply led to the discovery of drugs that can interfere with that process. The key is to inhibit replication,” says Stapleton, who studies antiviral therapy and the effect of co-infection of HIV, HCV, and GB virus type C.
Since HIV has a latent stage where its genetic material is inserted into an infected patient’s chromosome, today’s treatments can’t eradicate it, Stapleton says. Because of this, he thinks the cure will take an entirely new approach.
“A lot of things are being tried to cure HIV, and we’re learning important information about the virus and its treatment,” he says. “However, I believe that the current approaches are unlikely to lead to a cure and that it will instead take a totally unexpected angle to get to a cure. Most great advances in science are not planned—they’re serendipitous.”