Dr. Anthony S. Fauci heads research to prevent, diagnose, and treat infectious diseases such as HIV/AIDS, influenza, tuberculosis, malaria, and illness from potential agents of bioterrorism. He serves as one of the key advisors to the White House and U.S. Department of Health and Human Services on global AIDS issues, and on initiatives to bolster medical and public health preparedness against emerging infectious disease threats. At the 19th International AIDS Conference in Washington, DC, last July, he spoke of a new breakthrough in treatment as prevention and a possible end to the AIDS pandemic.
What is the current state of the HIV/AIDS epidemic?
Globally, more than 34 million people are infected with HIV. That includes more than 1.1 million people in the United States. Since the early 1980s, when the first cases of what came to be known as AIDS appeared, roughly 30 million people worldwide have died, including more than 600,000 people in the U.S. More than 50,000 people become infected with HIV in this country every year.
Why are you optimistic about ending AIDS?
NIAID convincingly showed that treating individuals infected with HIV—sooner rather than later—can have a major impact on reducing HIV transmission. The infected participants—both men and women—reduced the risk of transmitting the virus to their uninfected sexual partners by taking oral antiretroviral medicines when their immune systems were still relatively healthy.
How does early "treatment-as-prevention" work against AIDS?
Early antiretroviral treatment helps an HIV-infected person stay healthy by suppressing his or her level of virus. With lower levels of virus, the HIV-infected person is less likely to infect his or her sexual partners. Antiretroviral treatment dramatically decreases morbidity and mortality of HIV-infected individuals. Earlier treatment also saves money because it prevents expensive-to-treat opportunistic infections and halts transmission of the virus to uninfected individuals.
Are there enough drugs to do the job?
There are nearly 30 approved antiretroviral drugs. Used in combination, these medications can dramatically improve a person's health and longevity. Studies have also shown that people at high risk of HIV infection can reduce their risk by taking an antiretroviral pill daily. This method is known as PrEP (for pre-exposure prophylaxis). The Food and Drug Administration recently approved a pill combining two antiretrovirals to use as PrEP. It is intended for certain high-risk groups to use together with condoms and other prevention tools.
A two-in-one pill for HIV sounds easy. Is it?
The effectiveness of PrEP is directly related to how well people adhere to the prescribed regimen. This underscores that behavioral factors must be addressed when rolling out new prevention methods. Biologically and behaviorally based advances are both needed in the fight against AIDS.
After more than 30 years, aren't most people getting proper treatment?
Nearly half of the HIV-infected people living in low- and middle-income countries who are eligible for therapy still are not receiving needed medicines. 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 obtaining medical care and sustained treatment.
Is there a way of improving the treatment process?
Yes, through community-based programs. For example, one program in rural Rwanda treated and monitored 92 percent of its HIV-infected patients for two years. At the end, almost all of the patients had minimal HIV levels. We need to figure out how to duplicate this success on a much broader scale and in different settings.
To Find Out More
What are some of the scientific research hurdles?
Major research challenges remain, notably in developing a vaccine and a cure for HIV. But even without a vaccine or a cure, science has given us the tools we need to dramatically change the course of the HIV/AIDS pandemic and ultimately lead to the end of AIDS. Any argument that this cannot be achieved because we do not have evidence-based tools is no longer valid. Science has given us the tools. Now they must be applied.
What will it take to end AIDS?
We will not end AIDS without a major global commitment. We have a historic opportunity—with science on our side—to make an AIDS-free generation a reality. It will require continued basic and clinical research, and the implementation of testing, as well as treatment and HIV prevention measures; and, importantly, scaling up this implementation on a global level.
We must enhance what works and eliminate what does not. And, we must overcome legal and political barriers, and remove the stigma associated with HIV.
Fall 2012 Issue: Volume 7 Number 3 Page 2-3