By Peter Richards CMC –The director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr. Anthony Fauci said Monday that the robust arsenal of antiretroviral drugs and scientifically proven interventions now available to treat and prevent HIV infection offers unprecedented opportunities to make major gains in the fight against the HIV-AIDS disease.
Addressing the 19th International AIDS Conference here on “Ending the HIV/AIDS Pandemic-From Scientific Advances to Public Health Implementation”, Dr. Fauci said the treatment now offers a hope for an end to the pandemic that has infected more than 34 million people globally.
NAID conducts and supports research throughout the United states to study the causes of infectious and immune-mediated diseases and to develop better means of preventing, diagnosing and treating these illnesses.
“We are on scientifically solid ground when we say we can end the HIV/AIDS pandemic. The end of AIDS will not be accomplished, however, without a major global commitment to make it happen. We have a historic opportunity, with science on our side to make the achievement of an AIDS-free generation a reality,” he told the conference being attended by more than 20,000 delegates from more than 150 countries.
Dr. Fauci said that extraordinary advances in basic and clinical research in HIV/AIDS have been made over the last three decades.
He said that this understanding has paved the way for evidence-based interventions, including the development of nearly 30 approved antiretroviral drugs to treat people with HIV infection.
Used in combination, these medications can dramatically improve an individual’s health and longevity, he said.
But Dr. Fauci said that despite international programmes that have markedly increased global access to antiretroviral therapy, challenges remain and that nearly half of HIV infected people living in low and middle income countries and eligible for therapy are still not receiving needed antiretrovirals.
He said only a fraction of the people infected with HIV worldwide, including those living in wealthy countries, can effectively navigate the HIV care process from testing to successful treatment.
”We know that retaining patients in a community-based HIV treatment setting is possible,” Dr. Fauci said, noting that an HIV treatement programme in rural Rwanda, for example retained 92 per cent of its patients for two years.
“We need to figure out how to make this work on a much broader scale and in different settings,” he said, adding that in addition to their lifesaving role as treatment, antiretroviral have also played an important role in HIV prevention, augmenting the non-treatment related prevention tools that already exists, thus providing a comprehensive, combination prevention strategy.
“In the United States, we have virtually eliminated mother to child HIV transmission through antiretroviral access, but it remains a significant problem globally,” Dr. Fauci said, noting that several clinical trials have shown that people at high risk for HIV infection can reduce their risk of acquiring the virus by taking an antiretroviral pill daily, a practice known as preexposure prophylaxis (PrEP).
Dr. Fauci said that antiretrovirals formulated as microbicides for use at the genital mucosa also have shown promise as PrEP, adding that people who have most closely adhered to their oral or tropical PrEP regimen have experienced the best results.
The conference was told that the US Food and Drug Administration (FDA) recently approved a a pill combining two antiretrovirals for once daily use as oral PrEP when used as part of a comprehensive HIV prevention strategy.
Dr. Fauci said to improve treatment adherence, researchers are working to develop longer-acting antiretrovirals that could be given monthly or even less frequently, such as by injection or tropically in virginal rings.
The preventive effect of antiretroviral therapy has also been demonstrated among serodiscordant heterosexual couples, where one partner is HIV-infected and the other is not, in a strategy known as “treatment as prevention.
“Antiretroviral treatment helps an infected person stay healthy by controlling his or her levels of virus. At the same time, by reducing the level of virus in the infected individual, treatment makes that person less likely to infect his or her sexual partners, thereby preventing HIV infection,” said Dr. Fauci.
Other proven HIV prevention methods include voluntary medical male circumcision, which was shown in linical trials in Kenya and Uganda to reduce a heterosexual man’s risk of acquiring HIV by 50 to 60 per cent.
Dr. Fauci said that HIV prevention interventions found efficacious in clinical trials have shown impressive effectiveness when scaled up and properly implemented in well defined real world setting.
He said that although significant scientific challenges remain in HIV research, notably, developing a vaccine and a cure, results from these real-world settings strongly indicate that global scale up of existing and scientific evidence –based interventions could dramatically changed the trajectory of the HIV/AIDS pandemic and ultimately lead to the end of AIDS.
“Ending the HIV/AIDS pandemic is an enormous and multifaceted challenge, but we now know that it can be done.
“It will require continued basic and clinical research, and the development and testing of additional treatment and HIV prevention interventions and, importantly, implementing these interventions on a much wider scale,” Dr. Fauci said.
He said, this will require a global commitment of countries, governments and communities to strengthen their health care systems and build the capacity to provide HIV treatment and prevention.
“This will require the continued investment of current donors and partners and the addition of new donor organisations and countries.
“Lastly we must enhance what works and eliminate what does not, overcome legal and political barriers and to remove the stigma associated with HIV,” Dr. Fauci told the conference.