Opinion: The AIDS challenge after 30 years
A demonstration at the UN on June 8 for more efforts to end AIDS Credit: AP
Dr. Anthony S. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and Gregory K. Folkers is Fauci’s chief of staff. This is from Kaiser Health News.
Thirty years ago, the first five cases of what is now known as the acquired immune deficiency syndrome were reported in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. The amount of knowledge gained since then has been extraordinary, and the pace at which research findings have been translated into lifesaving treatments and tools of prevention is unprecedented. But much remains to be done to deliver the fruits of this research to the people who need them most.
The discovery of the human immunodeficiency virus as the cause of AIDS in 1983-84 was followed by an understanding of how HIV leads to AIDS; the creation of a diagnostic blood test; and the development over the years of more than 30 antiretroviral drugs. The approval of the first protease inhibitors in 1995-96 paved the way for powerful, multi-drug antiretroviral therapy.
The many combination regimens now available have dramatically improved the quality of life and extended the life expectancy of people with HIV. An HIV-infected person properly treated with this combination therapy, and provided other needed care and services, now can expect to live for decades after being diagnosed. Antiretroviral regimens also can prevent HIV infection, energizing the medical, public health and activist communities.
Entering the fourth decade of HIV and AIDS, our task is to build on these advances and deliver scientifically validated interventions to everyone who needs them, in the United States and abroad. Six in 10 HIV-infected people in developing countries who need combination antiretroviral therapy are not receiving it, which puts their health and that of their sexual partners at risk.
Domestically, access to treatment and care isn't optimal, either. A recent analysis estimated that of the 1.1 million people living with HIV in the United States, about 20 percent are unaware of their infection. And within the entire group of infected people, only about 19 percent have a viral load that has been driven to undetectable levels by combination therapy.
Both at home and globally, greater numbers of HIV-infected individuals need to be identified early in the course of their disease, through expanded voluntary testing programs and linkage to appropriate care and antiretroviral treatment.
In addition, prevention programs using proven tools must be refined, improved and made more cost-effective. At the same time, we must continue to develop additional effective prevention strategies.
We also must find innovative approaches to curing HIV/AIDS by eradicating or permanently suppressing the virus in infected people, thereby eliminating the need for lifelong antiretroviral therapy. In addition, a robust research effort is critical to address the malignancies, cardiovascular and metabolic complications, and premature aging associated with long-term HIV disease and/or antiretroviral therapy.
Despite these challenges and the huge burden of this modern-day plague, we now look at the fight against HIV/AIDS -- and our chances of prevailing -- with considerably more optimism than before. With the medical and public health tools now or soon to be available, controlling and ending the global HIV pandemic are feasible goals.
Unfortunately, there are considerable global constraints on resources to support this goal. Every effort must be made to efficiently apply existing resources, so that proven interventions are delivered in the most cost-effective way. Public-sector, commercial and philanthropic commitments to AIDS research and implementation of proven findings must be sustained and strengthened with additional resources, to ensure that HIV treatment and prevention services are universally available to the people who need them, wherever they live.
With a global commitment, we can control and ultimately end the HIV/AIDS pandemic. On this commemoration of the 30-year anniversary, let's recommit ourselves to that goal.
