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Since then, the epidemic has entered a new era, with many patients now experiencing AIDS as a manageable, chronic disease. The clinic itself has mirrored that shift, moving out of the acute-care environment and into a community setting. Its new home on Welch Road, where some 500 patients now come regularly for treatment, is more like a private doctor's office than a hospital ward.

In the early days of the Positive Care Clinic, caregivers there saw two or three patients die each month and two or three others hospitalized each week because of HIV-related complications, recalled clinic nurse Robin George. With the advent of new drug "cocktails," however, those figures have declined dramatically. Today, two clinic patients might be admitted to the hospital in a given month, and those hospitalizations might not even be related to HIV, she said. And there are fewer deaths, even though the clinic now cares for a significantly larger group of patients.

"It's clear that people with HIV are, on average, doing better," said Dr. Andrew Zolopa, director of the Stanford Positive Care Clinic and an assistant professor of medicine. "They have an improved quality of life. They have more vigorous health, are active, fit and stronger, and many are returning to work or thinking about it. It's a kind of Lazarus effect."

Looking to the future, some experts are even cautiously optimistic about squelching the epidemic. "AIDS care providers are now having serious discussions about eradicating the infection. That would have been unimaginable three years ago," Zolopa said.

Care More Complex

While the availability of new drug regimens has brought some extraordinary benefits for patients, it also has made AIDS care more complex. "It's much more complicated than it was three years ago, even for healthy patients," Zolopa said.

"There are many more drug choices and difficulties in balancing them. Therapy has become more aggressive. It takes good experience to apply it well."

In its three years of existence, the Stanford Positive Care Clinic has developed a strong reputation in the AIDS community and has grown well beyond the expectations of its founders. It is now one of the largest HIV care programs in the Bay Area outside of San Francisco, drawing patients from Salinas, Monterey, the Central Valley, the East Bay and the north coast region, as well as from the Peninsula and South Bay. The majority of its patients are gay men, many of them professionals in Silicon Valley, George said.

However, in another trend that mirrors the epidemic at large, caregivers at the clinic are seeing an increasing number of heterosexual women who are discovering they are HIV-positive. These women now make up about 10 to 15 percent of the clinic's patient population, George said.

The clinic has launched a range of community outreach activities, including offering free self-care workshops for patients, sponsoring a daylong seminar on the science and politics of AIDS (the next one is planned for this spring), providing treatment updates for community physicians and raising tens of thousands of dollars for local health and social agencies through the annual AIDS Walk.

As a result of the growth in patient demand, the clinic last year added a new physician, Dr. Jose Gilberto Montoya, an assistant professor of medicine (infectious diseases). The staff has also expanded to include a social worker, a pharmacist, an AIDS benefits counselor and a dietitian.

Research Link

The philosophy of the Stanford Positive Care Clinic is to combine personalized care, much like that received in a private physician's office, with the added benefits that come with linkage to an academic medical center. Zolopa works closely with Dr. Thomas Merigan, Becker Professor of Medicine and director of the pioneering Stanford Center for AIDS Research, in designing clinical trials to fit patients' needs.

"There aren't many private practitioners who sit down regularly and talk with leading researchers on what new (research) protocols are being developed," Zolopa said. "That is how ideas for new treatment approaches are sparked. That really does color what we do here at the clinic."

Patients say they appreciate the access to new knowledge and cutting-edge treatments, as well as the personal attention they receive at the clinic. In patient-satisfaction surveys, the Positive Care Clinic has received among the highest marks, said clinic manager Jocelyn Purins.

"The care is excellent. I can't say enough good things about it," commented one patient, a 58-year-old San Jose man who has been coming to the clinic since its inception.

Case in Point

The patient, whose first name is Don, said he has been HIV-positive for five years but is free of symptoms and feels great. Don is upbeat and tanned, a healthy-looking man who appears younger than his years. In April, he began taking a new drug regimen after tests revealed that his viral load, the number of HIV particles circulating in 1 cc of his blood, had reached 110,000. Since then, the new regimen, which requires taking five pills a day at specified intervals, has helped reduce his viral load by 90 percent.

During a recent visit, Zolopa told Don he is still not satisfied with those results and would like to see the virus eliminated altogether from his system. He asked Don if he had been taking his pills religiously, since a series of missed doses can lead to drug failure. Don told him he had twice forgotten to bring his pills to work.

"We'll still give you an A," Zolopa told him with a smile. "But don't do that anymore or we'll fail you."

The two discussed a possible adjustment in Don's therapy and agreed to talk more about it when Don returns next month for his regular visit.

Contact:

Stanford University Medical Center Jody Sumrall, 650/723-7897 or 723-6911 (media) Dr. Andrew Zolopa or Dr. Jose Montoya, 650/498-5013 (for comment or patient inquiries)

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