This past week, I had the honor of celebrating a remarkable thirty-year anniversary, and I am proud to share it with you. Thirty years ago, a couple walked into my office deeply worried about their future after the husband had just learned he was HIV positive. During their recent visit, we were able to celebrate not only that milestone, but many others as well—and even laugh about the bad backs, prostate issues, and other aches and pains that tend to come with growing older. It was a moment of gratitude, perspective, and hope.
Three decades ago, however, HIV was far more difficult to manage than it is today. In 1996, I had just moved to the Metro Atlanta area from New York City, where I had been an attending physician at St. Clare’s Hospital, then the largest designated AIDS center in the city. One of my colleagues, pulmonologist Tony Gagliardi, jokingly nicknamed me Bottom Gun, a play on Top Gun, because I often cared for the sickest and most medically complex patients on the service. These were not difficult people—they were patients facing overwhelming, life-threatening illnesses, and we were doing everything we could to keep them alive. Many were battling multiple serious conditions at once. One patient I cared for before leaving New York had CMV retinitis, toxoplasmosis of the brain, Kaposi’s sarcoma, and active tuberculosis, and was admitted with a high fever, dehydration, diarrhea, and a dangerously low white blood cell count. Cases like that captured the reality of HIV care at the time.
The Toxicity of AZT, Zerit, and First-Generation Protease Inhibitors
In 1996, HIV was still widely seen as a death sentence. Around the time my young family and I moved to Georgia, triple-drug therapy had begun to show real promise. For the first time, we could see a path toward long-term survival. But those early regimens, often built around medications such as AZT and Zerit, came with significant toxicity. While they could be effective, they could also cause serious side effects, including bone marrow suppression, lactic acidosis, liver damage, and muscle injury. Some protease inhibitors, such as Viracept, created additional complications. In some cases, patients developed severe damage to the hip joint and needed referral to orthopedic surgeons for hip replacement.
Another major challenge was the complexity of treatment itself. Patients often had to take multiple pills at different times throughout the day, sometimes setting alarms just to keep up with the schedule. Not surprisingly, that made adherence difficult. And with HIV, adherence is especially critical. Unlike many other chronic conditions, where missing doses may have a gradual effect, HIV can develop resistance quickly when treatment is not taken consistently. That is why early HIV care demanded not only effective medications, but also extraordinary discipline from patients who were already carrying an enormous burden.
Modern HIV Care From Multi-Pill Regimens to Once-Daily Therapy
Thankfully, today HIV treatment is often as simple as one pill once a day, with far fewer toxicities and far better outcomes. What once felt like an impossible fight has become a story of progress, perseverance, and hope.
Celebrating this anniversary with my patient and his wife was more than a personal milestone—it was a reminder of just how far medicine has come. Thirty years ago, we could only hope for more time; today, we can celebrate lives lived fully and futures once thought impossible. Moments like this are a powerful reminder of why we continue the work: to keep pushing forward, to keep improving care, and to keep giving patients not just more years, but better ones.
