Anthony Faucii says today he can look a 25-year-old, HIV-positive patient in the eye and tell him, “If you start on one pill a day, you will live 50-plus years. There are few successes that can match that,”
The end of the AIDS epidemic — one of worst pandemics the world has known — is now in sight, given the myriad scientific tools available today, from drug prevention to circumcision and methods to stop transmission from mother to child, Anthony Fauci, MD, the country’s top AIDS scientist, said today at the Stanford University School of Medicine.
Fauci, director of the National Institute of Allergy and Infectious Diseases, said the 30 years of the epidemic, which first came to light in 1981 in a seemingly innocuous report about a rare pneumonia among gay men, represents one of the “unprecedented success stories of investments in biomedical research.”
Where he once expected his newly diagnosed patients not to live beyond six to eight months, today he can look a 25-year-old, HIV-positive patient in the eye and tell him, “If you start on one pill a day, you will live 50-plus years. There are few successes that can match that,” Fauci told an overflow crowd of 400 at the school’s Li Ka Shing Center for Learning and Knowledge.
And that has all turned on the stunning progress in both the basic and applied sciences, which in the past two decades has produced more than two dozen approved antiretroviral drugs as well as a wide array of prevention tools that Fauci predicted ultimately will lead to an AIDS-free generation.
“It’s a convergence of scientific accomplishments that have become breathtaking, together with implementation that is unprecedented in U.S. history,” said Fauci, who oversaw vast investments in AIDS research and treatment both through the National Institutes of Health and the President’s Emergency Plan for AIDS Relief, the five-year, $15 billion initiative begun under the Bush administration in 2003.
Today, some 34 million people are infected with HIV worldwide, with 2.7 million becoming newly infected in 2010 alone. In the United States, the federal Centers for Disease Control and Prevention estimates some 1.2 million people are living with HIV, with 50,000 new cases diagnosed every year — an “embarrassing number,” Fauci said. Some 20 percent of infected individuals in the United States don’t even realize they are carrying the virus, he said.
Identifying those individuals and getting them into treatment, as well as keeping up with the pace of new infections, are among the major challenges of the campaign to stop the spread of AIDS, he said. For every person who received life-saving, antiretroviral treatment in 2010, two more became infected with the virus. “So you’re losing that game,” he said.
However, a landmark clinical trial, sponsored by the NIH and published in May 2011, could dramatically change that equation. The study, which involved 1,763 couples in nine countries, showed antiretroviral treatment could reduce the risk of heterosexual transmission by 96 percent. Fauci called the results, which Science magazine singled out as the scientific breakthrough of the year, a “real showstopper.”
“Treatment as prevention has a one-two knockout punch,” he said. “It saves the life of the person already affected and has a 96 percent chance of preventing transmission to another person…. We believe this is going to be a major tool for getting the whole level of the virus in the population down.”
Preventing transmission from HIV-positive pregnant women to their newborns is another area in which there has been major progress, Fauci said. With the use of drug intervention, the rate of mother-to-child transmission in the United States has fallen from 10.9 percent in 1997 to near zero today, he said.
The U.S. government and nongovernmental organizations now are aggressively rolling out treatment among pregnant women in sub-Saharan Africa, where hundreds of thousands of infants are born HIV-positive every year. Now, Fauci said, “It looks like we can turn off mother-to-child transmission if implemented properly.”
Circumcision, now recommended by the World Health Organization, also is beginning to have an impact on transmission rates, Fauci said. More men have been stepping up to have the procedure following studies in South Africa, Kenya and Uganda, which found it could reduce a man’s risk of HIV infection by up to 60 percent. Since then, male circumcision has been shown to have a 73 percent effectiveness rate in preventing viral acquisition over a five-year period, Fauci said.
“If we had this (result) with a vaccine, I would be in the Rose Garden announcing it,” he said.
Women, too, could benefit from emerging technologies that can block the virus during sexual activity. At the International AIDS Conference in Vienna in 2010, South African researchers announced a stunning result with a vaginal gel, containing an antiretroviral drug, which could be used before sex to reduce a woman’s risk of infection by 39 percent. Since then, researchers have announced the development and large-scale testing of a vaginal ring that could be used just once a month, making it even more appealing to women, Fauci said.
He said effective implementation of new technologies in the real world is always a challenge. People first have to know they are HIV-infected; then they have to be linked to care and stay in treatment. At each step, the numbers drop, so that fewer than one-third of infected people consistently remain in treatment — a phenomenon he called “the implementation gap.”
However, he said experience in some countries, such as Rwanda, have shown that it can be done, as the government’s aggressive program to identify patients and provide free treatment has led to a patient retention rate of 92 percent.
Combining these approaches, he said, will change the path of the epidemic, with a steady decline over the next few decades in the population of those who are infected. And while acknowledging that the virus still at times appears to defy the hopes for a cure and may not be fully eradicated in our lifetimes, Fauci said such measures will bring us closer to his vision of an AIDS-free generation.