Bold Efforts to Find a Cure for HIV AIDS and New Prevention Tools Are Urgently Needed, Says NIAID Director

		SUMMARY: There is an urgent imperative both to scale up use of proven tools of HIV treatment and prevention, and to develop bold new interventions -- from curative therapies to vaccines and other new prevention methods --according to Drs. Anthony Fauci and Greg Folkers of the National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health (NIH).

In a recent article in Health Affairs, NIAID director Anthony Fauci, MD, and Gregory Folkers, MS, MPH, health scientist and chief of staff in the Immediate Office of the Director of NIAID, discussed the necessity of formulating new interventions that could lead to a innovative prevention programs, a safe and effective HIV vaccine, and ultimately a cure for HIV/AIDS.

Approximately 2.7 million people were infected with HIV worldwide in 2007 -- an average of more than 7000 individuals each day, according to the authors. In the U.S., nearly 600,000 people have died of HIV/AIDS since the beginning of the epidemic, and an estimated 1.1 million people are currently living with HIV. For about the past 15 years, approximately 56,000 people in the U.S. have become infected annually.

HIV Treatment and Prevention of Transmission

The authors noted that only a fraction of people worldwide who need HIV treatment, prevention, and related services are receiving them. Even if access to scientifically proven HIV care and services were greatly improved thanks to increased funding or improved efficiency, they added, slowing and ultimately ending the HIV/AIDS pandemic also will likely require major advances in 2 areas.

Working toward a Cure for HIV Infection

Halting the pandemic would first entail curing a sizable proportion of people already infected with the virus, so they do not require lifelong antiretroviral therapy. Second, it is necessary to develop more effective prevention tools to slow the rate of new infections. The authors asserted that the scientific challenges related to these 2 goals are the most important issues in HIV/AIDS research today.

Fauci and Folkers explained that a cure for the disease theoretically could involve complete eradication of HIV from the body, known as a "sterilizing cure." Alternatively, a cure could reduce the amount of HIV in an individual's body to the point where the immune system could control the infection without ART, dubbed a "functional cure."

Other compelling challenges in HIV/AIDS research relate to developing, assessing, and validating new approaches for blocking HIV transmission, the authors wrote. These approaches include:

	Reducing HIV transmission by reducing viral load -- Increase the number of HIV positive people on ART to reduce the amount of virus in their bodies, which both has benefits for their own health and makes them less likely to transmit the virus to others.
	Pre-exposure prophylaxis with antiretroviral drugs (PrEP) -- Antiretroviral therapy administered to high-risk, uninfected individuals to protect them from becoming infected.
	Topical microbicides -- Creams, gels, or other products applied to the vagina or rectal mucosa to prevent HIV infection.
	Preventing or treating coinfections -- Preventing or treating diseases such as malaria, tuberculosis, parasitic diseases, and other sexually transmitted infections like herpes may decrease susceptibility to HIV or the likelihood of transmission to others.
	HIV vaccines -- Vaccines that prevent HIV infection or slow the course of disease in people who become infected would again both benefit the recipient and potentially reduce infectiousness to others.

Fauci and Folkers concluded that it is essential to sustain a robust HIV/AIDS research agenda to develop these interventions, which have the potential to be truly transforming. Without such tools, they wrote, "the scope and burden of the HIV pandemic will continue to grow."

11/06/09

Reference
AS Fauci and GK Folkers. Investing to meet the scientific challenges of HIV/AIDS. Health Affairs 28(6): 1629-1641. November/December 2009.