Leaders in the 30-year war against HIV -- the virus that causes AIDS -- are expressing confidence that victory may soon be at hand. This week, as people across the globe marked World AIDS Day, 400 AIDS experts gathered for a two-day symposium at Harvard University in Massachusetts to discuss the steps needed to bring the worldwide pandemic to an end. While the recent declines in the number of new HIV infections have bolstered their confidence, these public health officials say much work still needs to be done.
Nearly 30 million people have died of AIDS complications since the HIV pandemic began three decades ago. But today, new antiretroviral drug treatments are turning the tide on the pandemic, according to experts. They say those drugs are reducing the total number of AIDS-related deaths to fewer than 1.8 million people each year, and enabling nearly half of the 34 million people currently infected with HIV/AIDS to live longer and relatively productive lives.
One of the biggest breakthroughs in the management and control of HIV was the discovery this past May that an infected individual taking antiretroviral drugs is 96 percent less likely to transmit the virus to an uninfected partner.
Similarly, HIV-positive pregnant women and mothers taking antiviral drugs are 95 percent less likely than untreated women to transmit the illness to their babies.
Richard Marlink is executive director of the AIDS Initiative at Harvard's School of Public Health, which is hosting the symposium.
He says that with the global economy in deep trouble, it's an especially important time to come up with ways to increase funding for HIV/AIDS eradication.
“All the mathematical models now show that we actually save money in the long run and depending upon how much money we spend now, we’ll be able to end AIDS faster going into this next decade. And so we’re noting AIDS at 30 years on World AIDS Day and here at Harvard with this symposium. But we don’t want to be, and we know we don’t have to be, here at AIDS at 40 years. And in the next decade we can turn this around and virtually eliminate AIDS -- if we spend enough money,” Marlink said.
Among the most important unmet goals is the development of an effective AIDS vaccine, which would protect vulnerable populations against HIV infection. Experts say it will probably take another five to ten years to develop such a vaccine.
Microbicides are another promising weapon against the virus. These are vaginal gels that contain antiretroviral compounds that women can use discreetly to prevent the sexual transmission of HIV from an infected partner.
A research consortium called VOICE, which stands for Vaginal and Oral Interventions to Control the Epidemic, has been conducting trials in Uganda, South Africa and Zimbabwe, comparing daily use of a microbicidal gel containing the drug tenofovir to the everyday use of oral tenofovir, to see if one approach is more effective than the other.
Jeanne Marrazzo is a professor of medicine at the University of Washington in Seattle, and co-chair of the VOICE protocols.
She says a microbicide could potentially resolve some of the social issues that contribute to the HIV pandemic.
“While we know condoms work very well for HIV, they clearly don’t work for every woman, every time, mostly because men often don’t want to use them. So, the idea behind the gel was and is that it’s something women can control,” Marrazzo said.
But VOICE halted its trial of the tenofovir gel last week, after an interim review of data showed the preparation was no more effective than a placebo, or a fake gel, at preventing HIV transmission.
Trials of other microbicides are underway, and Marrazzo is optimistic that eventually there will be a vaginal or oral medication that protects women against HIV. In the meantime, as research on anti-HIV vaccines and antibodies promises to bear fruit, health experts say the public must remain on guard against the virus, and remain committed to the battle until the war on HIV/AIDS is over.
