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Researcher: We Can Eliminate HIV/AIDS in 40 Years

5 years ago
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The Holy Grail of AIDS research has long been the development of a vaccine to halt the spread of the virus. But what if, using only the medicines we already have right now, we could eliminate AIDS within the next 40 years? According to Dr. Brian Williams, an AIDS researcher for the South African Center for Epidemiological Modeling and Analysis, it is possible -- we just need to think bigger.

On the surface, the strategy is disarmingly simple: New antiretroviral HIV/AIDS drugs aim to slow the spread of the disease by keeping the concentration levels of the virus in the body low, which also decreases the likelihood of HIV/AIDS transmission. So, the theory goes, have voluntary HIV/AIDS tests for every person at least once a year, and start anyone who tests positive on antiretroviral drugs before viral loads increase.

Then, repeat. And repeat again, and again, and again.

If all goes according to plan, Williams estimates that in five to 10 years, transmission of the virus will have essentially stopped and, by 40 years, HIV/AIDS would be eliminated.

Williams presented the plan at the Conference on Retroviruses and Opportunistic Infections (CROI) last week in San Francisco and then again -- to considerably more public fanfare this time -- at the annual meeting of the American Association for the Advancement of Science in San Diego over the weekend. He was also one of the World Health Organization scientists, along with Dr. Reuben Granich, who published a paper outlining the ideas in the medical journal "The Lancet" more than a year ago, in January 2009.

Of course, universal testing and then providing treatment for the millions who have the virus is anything but simple. Or, inexpensive. But, Williams notes that the spread of HIV/AIDS is already costing billions of dollars.

"The cost actually stays quite flat," Williams told doctors at the CROI conference. "The reason it stays flat is initially we have a big capital outlay -- we spend a lot to get everybody onto antiretroviral therapy. But, once we do that, if we really reduce transmission and the number of people that are infected, then we save money."

Williams estimates that over the last 25 years, the cost of AIDS has already rung up a staggering total of more than $150 billion. "We have a choice," he said, "and the choice is we can do nothing and spend $60 billion over the next 40 years, or we can save 3 million lives, and spend $60 billion over the next 40 years."

But cost is not the only issue. There's also the issue of how -- and, indeed, if -- a program of this size would be feasible. There are currently more than 33 million cases of AIDS worldwide. The United Nations estimates that AIDS is responsible for more than 2 million deaths a year and that an additional 7,500 people are infected each day with HIV/AIDS.

Dr. Anthony Fauci is the director of the National Institute of Allergy and Infectious Disease and is working on a pilot test program to look at the feasibility of the "test and treat" method in two communities with some of the highest HIV/AIDS infection rates in the United States: Washington and the Bronx in New York.

Fauci cautions that, though he thinks it's too soon to begin to evaluate the pilot program, a plan to eliminate HIV/AIDS with "test and treat" would run into a number of difficulties.

"The first thing you have to do is see if you can test a large enough group of people for this to work," he told Politics Daily. "Then, do you have the infrastructure for it? Third, will they accept the treatment?" And those aren't the only roadblocks; it's also possible that a resistance to the drugs could start to build up, necessitating new medical developments.

But, he notes that even if the project doesn't eliminate HIV/AIDS, it will nevertheless do some good. "We don't want the perfect to be the enemy of the good," said Fauci. "You may not be able to test everyone or even treat everyone, but, using treatment as prevention will still have a major positive impact on diminishing the virus."

Still, even with the possibility of making measured dents in the virus with existing treatments, the search for the Holy Grail goes on. "Obviously, the major goal is still a vaccine," said Fauci.

But that, too, is likely to be difficult. In September, researchers in Thailand announced a seemingly major breakthrough for the possibility of an HIV/AIDS vaccine. But, since then, researchers have been disappointed with both the potential effectiveness and longevity of that vaccine. And -- until a vaccine does emerge -- it's hard to quarrel with expanded testing and treatment. Especially if it ends up working.

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