What will it take to “end AIDS”?
Over the last two decades, scientific advances in the fight against AIDS have been remarkable. Antiretroviral therapy has progressed to the point that treatment regimens that once called for the ingestion of dozens of pills, some of which had debilitating side effects, now consist of a well-tolerated pill taken once daily. Recent studies have also taught us that when individuals initiate treatment as soon as they are diagnosed with HIV, they are much less likely to transmit the virus to their partners, and they will also have better health outcomes. And a daily pill, used for preexposure prophylaxis (PrEP), can be taken by people at high risk for HIV infection, such as gay and bisexual men. When it is taken as prescribed, it makes HIV acquisition very unlikely.
It would seem that we have the tools we need to end the epidemic. Yet more than 1.5 million people around the globe become infected with HIV each year and another one million die of AIDS.
The logistics of getting everyone who is HIV positive into care, and ensuring that they not only have access to medicine, but also adhere to their treatment plans, are complicated, especially in regions of the world where health care resources are limited.
It’s clear that, despite our great progress, we require better tools to fight AIDS. The need for new preventive technologies, in particular, is acute. That is why there is so much excitement around this year’s annual Conference on Retroviruses and Opportunistic Infections, which will convene in Boston Feb. 22-25. We are going to learn more about two emerging tools to control the HIV/AIDS epidemic: prevention medicines that are easy to use and protect those who are HIV negative from infection, and advances in vaccine research.
Researchers will present the results of two large trials conducted in several countries in Southern Africa evaluating the use of a vaginal ring containing antiretroviral medication. During the trials, the ring was inserted monthly. It holds the advantage of making it easy for a woman to protect herself from HIV transmission without the need for cooperation (in the form of condom use) by her partner. If these studies are shown to have been effective, making such rings readily available could have an enormous impact in reducing HIV transmission. Meanwhile, second generation rings that would only need to be inserted every three months, instead of every month, are already being developed for future trials.
Interesting findings that will inform HIV vaccine development will also be presented. The more we learn, the more optimistic researchers are about the feasibility of developing a safe and effective HIV vaccine. Recent studies of people who have been infected with HIV for decades, yet whose immune systems remain resilient, combined with advances in immunology, have led to the development of new bioengineered antibodies that have shown great promise in animal studies. We will learn more about these studies next week, and what we learn will certainly inform the future development of HIV vaccines. We already know that one of the new bioengineered antibodies, called VRC01, will be studied in two trials due to start next month that will enroll more than 4,000 at-risk men and women in Latin America, sub-Saharan Africa, and the United States, including two sites in Boston, Fenway Health and Brigham and Women’s Hospital.
Thirty-five years into the AIDS epidemic, it is clear that we need much better ways to prevent transmission of HIV. As HIV vaccine research progresses, the use of preventive antiretroviral medications delivered via daily pills, bimonthly injections, and vaginal rings hold the potential to dramatically reduce HIV transmission. The end of AIDS is possible, we just need to keep up the fight and continue to support innovative research.Dr. Kenneth H. Mayer is cochairman and medical research director of the Fenway Institute at Fenway Health.