As recently as a few years ago, patients infected with HIV living in Africa were likely to be turned away from health clinics, with no help for treatment in sight. They were told to go home and plan their funerals. This was the story old on NPR news radio this week. But a few recent studies may presage a different ending to this sad story.
Two studies indicate that daily prophylactic use of antiretroviral therapies may be an important addition to an overall anti-infection strategy for uninfected individuals who engage in sexual activity with HIV-infected partners. In mid-July, the Centers for Disease Control and Prevention released results of a study (referred to as the TDF2 study) done in Botswana, along with a separate trial by the University of Washington conducted in Kenya and Uganda, that show “a daily oral dose of antiretroviral drugs used to treat HIV infection can reduce HIV acquisition among uninfected individuals exposed to the virus through heterosexual sex.” In this study, uninfected individuals taking pre-exposure prophylaxis (PrEP) reduced their risk of acquiring HIV infection by roughly 63 percent overall.
A previous study, says the CDC release, demonstrated that PrEP can reduce the transmission of HIV among men who have sex with men as well.
The CDC release cautioned that the prophylactic therapy “was only shown to be effective in clinical trials when provided in combination with regular HIV testing, condoms, and other proven prevention methods.” The release contained other important conditions and caveats.
When administered properly, this type of preventive, or pre-exposure prophylaxis, treatment has amazing promise, especially for populations in sub-Saharan Africa countries, where two-thirds of the world’s HIV infected individuals (a total of nearly 34 million people are HIV-infected) reside, according to World Health Organization and UNAIDS statistics.
Another report, published in this week’s Annals of Internal Medicine, shows that life expectancy of patients living in Uganda “increased substantially” with the use of combination antiretroviral therapy, again giving hope to already infected HIV patients that they may be able to live a long, normal life.
This time last year, President Obama initiated a National HIV/AIDS Strategy that aims to reduce the number of new HIV infections, increase access to care and improve health outcomes for people living with HIV, and reduce HIV-related health disparities. Since then, investments [e.g., funding for the AIDS Drug Assistance Program in FY 2011 was increased by $50 million and funding for HIV prevention programs at CDC were increased] and related policy changes have been made. But to continue making progress and to meet the strategy’s upcoming year of goals, which largely focus on increasing collaboration and partnerships, the government needs to maintain its commitment to HIV/AIDS prevention and treatment.
The debt ceiling debate that has plagued the news wires recently is not just about the US government’s ability to pay back its loans or about America’s reputation around the world (although those are highly important factors), but it also affects many programs, including healthcare and ultimately HIV/AIDS prevention and treatment. Potential cuts to the Medicaid program as part of a debt-relief deal could have a significant negative effect on the National HIV/AIDS Strategy and its related goals, reports David Ernesto Munar of the Huffington Post.
This week, the sixth annual International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention is taking place in Rome. On July 19, data released at the conference showed that global investments in HIV treatment-related research and development reached $2.46 billion in 2009, with the US National Institutes of Health providing the most public-sector investment at $1.6 billion [www.treatmentactiongroup.org.] In the same year, bio/pharmaceutical companies invested $591 million. According to a UNAIDS press release about the report, an estimated 6.6 million people currently have access to antiretroviral treatment but 9 million more are still in need.
UN member states committed to expanding access to treatment for 15 million people by 2015. And Goal 6 of the UN Millennium Development Goals, which the US and all UN member states have agreed to work to achieve by 2015, calls for universal access to treatment for HIV/AIDS and for the reversal of the spread of HIV/AIDS.
The scientific community is doing its part to make breakthroughs in HIV prevention and treatment that could not be conceived of even 5 years ago. It’s only fair that US leaders continue to do their part as well.