Can We Eradicate AIDS?
|April 23rd is the 30-year anniversary of the day my colleagues and I
reported that a new retrovirus, now known as HIV, was the agent causing
AIDS. We also announced the development of an effective HIV blood test
and the capacity to continuously produce the virus so that drugs could
be tested. Since then, basic science has driven a better understanding
of how HIV infects humans, resulting in the development of effective
antiretroviral therapy (ART). Last summer, the National AIDS Treatment Advocacy Project
reported that "a 20-year-old HIV-positive individual on ART in the U.S.
or Canada is expected to live into their early 70s, a life expectancy
approaching that in the general population."
There are still areas where much progress needs to be made, however,
particularly in our nation's inner cities, where a large share of the
HIV/AIDS burden falls heavily on people of color. According to a 2010 Centers for Disease Control and Prevention (CDC) report,
African Americans comprised 86 percent of newly diagnosed infections in
Baltimore City and 78 percent in Washington D.C. Nationally 20 percent
of people living with HIV infection are undiagnosed, and 75 percent are
either not receiving treatment, are wrongly treated or are not taking
their medications, according to the CDC.
Over these last three decades I've frequently been asked if I believe
we can eradicate HIV and stop the epidemic. I believe the answer is yes
- if the public and private sectors begin to invest more
resources in research, treatment and in reaching people at risk.
We are ethically obliged to diagnose and treat HIV/AIDS, but there is
also an economic advantage to doing so. Currently the cost of treating
a person with HIV over a lifetime is approximately $370,000. One cannot
begin to fathom the cost of not treating patients - including numerous
visits to the emergency room and long hospital stays.
I believe a "functional" cure for HIV/AIDS is doable. What is a
"functional" cure? It is an HIV positive individual who can suppress
the virus through drug therapy so completely that HIV becomes nearly
unidentifiable for a sustained period of time - hopefully a full
lifetime. An HIV-infected person with a "functional" cure will not
transmit the virus, nor develop disease and ultimately may not need
treatment after a period. With sufficient resources a "functional" cure
may be doable within the next five to 10 years.
Our colleague and the U.S. leader in HIV/AIDS, Dr. Anthony Fauci, MD, director of the National Institutes of
Allergies and Infectious Diseases (NIAID), has been a big supporter
in funding these research efforts.
Currently, less than a quarter of those with HIV infection nationwide
achieve viral suppression. Congressman Elijah Cummings, a Maryland
Democrat, has become a significant advocate for a program that achieves
virus suppression close to a "functional" cure as 1 out of every 29
African Americans in his district over the age of 13 has AIDS.
Effectively and aggressively treating those infected can drastically
reduce transmission to others.
I also believe our field can crack the vaccine challenge. We previously
overcame what was once thought impossible when we developed effective
viral drug therapy for the first time as a result of the AIDS crisis.
However, the challenge of the HIV/AIDS preventive vaccine is more
complex, but we think solvable. At our Institute
of Human Virology (IHV) in Baltimore, we have a vaccine candidate
funded largely by the Bill and Melinda Gates Foundation and, in part,
by the National Institutes of Allergies and Infectious Diseases.
Similar to the success of the U.S. Army Thai trials in 2009, we are
able to produce antibodies for protection in monkeys. But in too brief
a time period the requisite antibodies are no longer produced. We need
to make these antibodies last longer for protection because we know
vaccine boosting every three months or so is not feasible or practical.
Thus, we need more science advances as we progress with additional
Past medical history suggests that eradication of HIV/AIDS is possible.
After all, we have achieved enormous successes against such viral
scourges as polio through public-private partnerships both at the
national and international levels. In the middle of the last century,
the March of Dimes, for example, forged an effective public-private
partnership that led to the Salk vaccine in 1955. And a worldwide
campaign led to the complete eradication of smallpox from the planet in
1980. These successes, at the national and international level, provide
hopeful precedents for our ongoing work against HIV/AIDS. Admittedly,
HIV is a different "beast" and presents far greater challenges in
achieving an effective vaccine.
So, as we work toward a "functional" HIV cure and effective vaccine,
what should be done in the meantime? Test, test, test and treat, treat,
treat. The CDC estimates that more than 1.1 million people in the U.S.
are living with HIV infection, and almost 1 in 6 is unaware of their
infection. A 2012 Johns Hopkins study reported that the number of new
cases of HIV infection among black women in Baltimore, D.C. and other
urban "hot spots" is five times higher than previously thought. Over
the years I have advocated for the establishment of a domestic program
similar to the highly successful President's
Emergency Plan for AIDS Relief (PEPFAR) overseas program.
I urge the president and the Congress to fund a PEPFAR-like pilot
program in Baltimore and Washington, D.C. - perhaps also including
other "hot spots" such as San Francisco and Miami with the goal of
ending the epidemic in those cities - and, if successful, to use the
lessons for a nationwide effort.
Robert Gallo, MD, a professor
at the University of Maryland
School of Medicine, directs the Institute of Human Virology in
Baltimore. He is also the scientific director of the Global Virus Network. He led the discovery of
HIV, a retrovirus as the cause of AIDS and the development of the HIV
blood test as well as the discovery of the first and second known human
retroviruses (HTLV-1 and HTLV-2). He can be reached at firstname.lastname@example.org.
|Posting Date: 04/21/2014
|Contact Name: Robert Gallo, MD
|Contact Phone: 410-706-1952
|Contact Email: email@example.com