Interview of Dr. Magnus GISSLEN
"Most patients live very good lives. It is totally different to be an HIV doctor now" – ISHEID expert's perspective

"This is the first time I will be coming," Dr Gisslén told us. "I have heard from others that it is a very good conference so when Alain Lafeuillade sent me an invitation I thought it would be a good way to discover the event. I'm looking forward to an open discussion in a broad ranging conference with people in the front line of research."

 Download the preliminary program. 

 For Dr Gisslén, one of the main topics of interest on next year's program will be on reservoirs and curing infection. "There are different types of reservoirs where the HIV virus can hide from the immune system and also from antiviral drugs," he explained. "Much of my research focus is on the central nervous system, which is an important reservoir in HIV. There are lots of reports that show people on good treatment still develop some kind of cognitive impairment. This could be because some of the drugs that we use don't get into the brain."

It is critical to study new treatments and their effects on the central nervous system, according to Dr Gisslén. "The brain is an important organ in the body," he said. "We know the virus can hide in the brain and the central nervous system. It can also hide in resting T lymphocytes and memory cells. Some we know about and others we don't. This will definitely be a feature of next year's program."

 HIV patients have benefitted from significant improvements in treatment in the last decade, linked to both effectiveness and variety, Dr Gisslén said. "There are better antiretroviral drugs with fewer side effects," he observed. "We have many alternatives, making it possible to effectively treat almost every patient. There are very few patients that we can't treat due to resistance, provided they are taking the drugs. Almost nobody dies from AIDS in the western world anymore."

The developing world has seen improvements, too, though much is still to be done. "The need is not met but many more people are treated now than 10 years ago," Dr Gisslén said. "These are large steps and the problem is more minor now than 10-15 years ago. We now talk about side effects such as cardiovascular disease – 15 years ago this would not even have been discussed."

In the general society, too, there is room for improvement. "It is not easy for an HIV positive person to live in a social environment," he said. "It is still not a fully accepted disease yet, even though so many years have passed since the beginning of the epidemic. Some sufferers have problems in their social lives due to other people's thinking about the disease. The focus in the press has dropped in recent years, too, which may also contribute."

Dr Gisslén was optimistic about the goal of universal access to anti-HIV treatment across the world, though he felt it was unrealistic in the medium-term. "This question is evolving all the time," he said." It is closely related to development. I am optimistic when I project for the next five years, but I don't think it will be universal. So many things are involved. You need money for treatment and it is also necessary to have the structure to start treatment. You need a structural network, a social network, hospitals and political stability."

While some fear a decline of pharmaceutical research activity in HIV, Dr Gisslén understands a more pragmatic view. "It is not easy to make a profit on new drugs now," he said. "For example, very few new antibiotics have been developed in the last 15 years as the focus has shifted from bacterial to viral infection. It will be similar for HIV antivirals. Probably fewer new antiviral drugs will be developed in the next 15 years. Pharmaceutical companies are now involved in developing drugs for hepatitis C. Some companies have shifted their focus from HIV to hepatitis C."

The good news is that with the enormous advances made in antiviral treatments, Dr Gisslén notices more optimism in his patients today. "Most patients live very good lives," he said. "The drugs have to be taken regularly but there are very few side effects and those who do suffer from side effects are in a minority. It is totally different to be an HIV doctor now. In the past we had to struggle to get HIV patients to survive. In many ways it is much easier."

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