Thirty years on: Why we need a cure for HIV now more than ever before
Opinion piece by Elly Katabira.
June 03, 2011 - Thirty years ago this month, health agencies in the US began monitoring unusual clusters of diseases that would later be identified as the first cases of AIDS. A year later, a young medical officer working at a Health Center documented and reported to the Ministry of Health the first cases of AIDS in Uganda found on the shores of Lake Victoria in the Rakai district.
Over the past three decades, I have worked extensively in the field of care and support for people living with HIV, watching the story of AIDS unfold in my own country and around the world. I have witnessed some of the devastating consequences of silence and stigma, as well as the incredible results that translating scientific evidence into action can produce.
Today, HIV experts are in agreement that “prevention”, “treatment” and “care” are the three pillars to successfully responding to the HIV epidemic. Lessons learnt, and in particular the compelling new evidence that HIV treatment is also HIV prevention and that expanding antiretroviral therapy (ART) coverage has preventative benefits for the entire community, also show us that these three pillars must not be approached separately, but as three interconnected efforts.
Here at the International AIDS Society (IAS) however, we are convinced that the three pillar approach to ending the HIV epidemic is incomplete and, to mark this historic month, the IAS is calling for the addition of a fourth pillar -- “cure” -- to the international response to the HIV epidemic.
Under no circumstances should the inclusion of “cure” into the global response direct funding away from treatment, prevention and care programmes. The IAS will continue to advocate for increased funding across each of these pillars. The IAS does believe however, that it is imperative that donors, governments and the AIDS community make a viable economic investment in HIV cure research, and right now.
Globally, there are currently 33.3 million people living with HIV. Although significant progress has been made towards scaling up access to antiretroviral treatment, the increase in new infections in certain regions, a decrease in funding, and the fact that under new WHO guidelines HIV patients should be starting their treatment regimens much earlier, means that universal access targets are way off track. As new infections continue to outstrip numbers on treatment by 2 to 1 in resource-limited settings, the scale of unmet need can only increase.
Furthermore, while ART has greatly improved the quality of life of people living with HIV and reduced AIDS-related mortality rates, the virus remains persistent in certain cells even in patients being successfully treated. In turn, patients have no option but to undertake life-long treatment to keep the virus under control. Life-long adherence to these drugs remains both costly and tiring for the patient, while side-effects associated with ART usage can be severe. Lastly, resistance to treatment can occur for a number of reasons.
Funding research to develop a functional1 or sterilizing2 cure for HIV which could offer people living with the virus an alternative to the burden of a difficult life-long ARV regimen is therefore not only important for the health and human rights of people living with HIV, it is in our collective economic interest.
Professor Françoise Barré-Sinoussi, co-discoverer of HIV, Nobel Laureate and IAS President-elect, is currently guiding the development of a global scientific strategy, Towards an HIV Cure. This strategy aims at building a global consensus on the state of the art research in the field of HIV reservoirs and defining scientific priorities that must be addressed to tackle HIV persistence in patients undergoing treatment, the key hurdle impeding any alternative to long-term therapy.
Thirty years after the first cases of AIDS, if we are ever to envisage the remission of the disease in infected individuals, or even the eradication of the virus, then we must invest in and aggressively pursue an HIV cure.
Dr Elly Katabira is President of the International AIDS Society, the world's leading independent association of HIV professionals.
1 Functional cure some HIV genetic material remains in the body, but the patient’s immune defense fully controls any viral rebound, allowing patients to be free of antiretroviral treatment
2 Sterilizing cure no HIV genetic material can be found in the body, HIV infection is eradicated