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Tuesday, December 1, was the
annual observance of World AIDS Day. The epidemic continues to take an enormous
toll, even as scientists have developed a range of medicines that have turned
an AIDS diagnosis from a likely death sentence to a manageable condition ... at
least for those who can get the right treatment.
The editor of the health policy journal Health Affairs, Susan Denzler,
says HIV/AIDS remains a huge, global concern. She said:
"More than four million people, as we know, worldwide are now alive and
more-or-less well because they are on anti-retroviral drug therapy. An
estimated seven million more worldwide probably should be. And then, of course,
as we know, another 2.7 million people become infected with the virus every
Health Affairs examines the battle against AIDS in its current issue. In an article on financing the fight against
AIDS, Robert Hecht says current funding mechanisms aren't working very well.
Hecht is managing director of the Results for Development Institute, a
Washington non-profit that studies economics and health policy, among other
issues. HECHT said: "We need to move out of the emergency mode, the
hand-to-mouth approach to AIDS, which has characterized the last decade, and
take a long-run view of AIDS financing and of the epidemic in general if we're
going to do the right things now - today, tomorrow, over the next few years -
to change the course of AIDS."
Without a more strategic approach, Hecht says, there may be some progress
against AIDS, but not a decisive victory.
Even without that decisive victory, AIDS researcher Dr. Anthony Fauci says
researchers have posted some very significant gains. He said:
"The advances in
HIV/AIDS research from the very beginning, from 1981 to 2009, is something that
is really unprecedented. It's unprecedented likely because it was a new
situation with enormous opportunities and a phenomenal amount of resources from
the research standpoint were poured into that."
Dr. Fauci, who heads the U.S. National Institute of Allergy and Infectious
Diseases, says those advances have changed the outlook for many young patients.
In what he calls the "darkest years of his medical career," during
the '80s and early '90s, Fauci says an AIDS patient with pneumocystis pneumonia
survived on average only six months after the diagnosis. Today, it couldn't be
more different. He added:
"If someone walks into
my clinic now at the NIH and is 20 years old and is newly infected, they will
likely live to older than 69 years old. I don't think there is a medical
intervention that we've had, at least in the last several decades, that has had
that profound impact."
Better treatments notwithstanding, a vaccine is the real goal, but success on
that front has been elusive. HIV is a particularly challenging opponent that
can hide out in the body and avoid the body's own defenses.
When scientists develop a vaccine for a disease, they try, in a sense, to
replicate what the body's own immune system does ...He said:
"... which means that the body has already proven the concept that (a) it
can eradicate the virus, it can create an immune response that will be protective
for the rest of your life. Not the case with HIV. So we have to do better than
what the natural infection does."
A recent vaccine trial conducted in Thailand showed some limited results for
some of the people in the study, but even if that approach pans out, it will
still be years before the vaccine gets to market.
Dr. Fauci outlined several
other strategies for fighting HIV/AIDS that are in the works, but he said all
have their drawbacks.
Topical microbicides are medicines applied to the genitals, typically by women
before sexual intercourse. There are significant traditional obstacles in many
places, and women who use them often have to use them covertly. But Fauci says
such medicines are an important way to prevent the spread of HIV. He observed:
"Topical microbicides [are] an absolute must that we must do for so many
reasons, not the least important of which is that we do need something,
particularly in the developing world, where women can take into their own hands
their prevention of something that, up to now, has essentially been beyond
their control in certain cultures."
Fauci said tests are underway to see if a prevention method called pre-exposure
prophylaxis is effective. In theory, giving anti-AIDS drugs to people who
haven't been exposed to HIV should be an effective strategy, but he said it's
difficult enough in many places for health workers to reach and treat people
who are sick; it's likely to be even more difficult to get people who are healthy
to accept anti-AIDS medicines as a preventive measure.
Another approach is called "voluntary test and treat," which involves
mass testing and treatment of everyone who tests positive for HIV, regardless
of whether they are sick or their blood count suggests they are likely to get
Anthony Fauci and Robert Hecht spoke about the fight against AIDS at a
symposium sponsored by the journal Health Affairs
on December 1.