The hard-fought battles already won against this deadly virus, and the importance of the fight that still lies ahead, were a focus of exploration at the Celebration of Science. In a talk given by Anthony Fauci (Director of the National Institute of Allergy and Infectious Diseases), he shared that the initial years of the HIV epidemic were the darkest of his medical career.
Knowing that there was no cure for this terrible disease and that he could only hope to make patients more comfortable was a heavy weight to bear as a medical professional. The rapid spread of HIV/AIDS along with witnessing the consequent suffering of patients inspired Fauci and other infectious disease specialists to wage war against the disease and discover therapies that could effectively treat the virus, not just the resulting infections.
Tracking our Progress
• Understanding the HIV replication cycle. After the disease was discovered, researchers set out to develop an understanding of the HIV replication cycle aEUR" the process by which HIV makes copies of its genome, bundles the genetic material with viral proteins, which then go on to infect various cells. By identifying key steps in the cycle, they were able to design drugs that could block these steps, thereby suppressing viral replication. The result was development of the first HIV antiretroviral, AZT, approved in 1987.
• Targeting treatments to each stage of the cycle. It was evident that AZT could safely slow down HIV replication in patients; however the virus learned to adapt and began to replicate mutant strains that were resistant to AZT and other first generation antiretrovirals. Patients that once found hope in the new antiretroviral therapy were again faced with despair and ailing health as the drugs became less effective. Thus researchers and physicians took up a new charge to slow down replication even further, attacking the virus at different stages of the replication cycle through multiple antiretrovirals. With this discovery came the development of six classes of HIV drugs, one for each stage of the cycle.
• The birth of combination therapies. The increased pill burden of multiple antiretrovirals lead to significant decline in treatment adherence. Not only was this damaging the health and quality of life of patients, it also created the propagation of mutant strains that were resistant to the antiretroviral regimen. To combat this challenge, developers began to think of ways to combine drugs into one pill, leading to the birth of market leading HIV drugs such as Truvada, Atripla, Complera, and Stribild aEUR" all one pill, once a day regimens that contain two or more drugs. The availability of these convenient dosing regimens has led to significant increases in adherence rates among many patients.
Engaging the Community
"We now have the wherewithal through behavioral and preventative modalities to turn around the trajectory of the HIV pandemic," said Fauci. With today's course of combination therapies and efforts towards prevention, the worldwide incidence continues to decline, moving from 2.7 million new cases in 2010 to 2.5 million in 2011. The challenge now is to get everyone involved -- communities, cities, nations aEUR" in screening, testing, and implementing the science.
"We need the black church to get involved; that's the only way weaEUR(TM)re going to break it down in our community" said prominent HIV spokesperson Earvin "Magic" Johnson. With African Americans representing nearly 50% of all new infections in the U.S., getting the churches and pastors on board to help educate their congregants to get tested and get their results is critical. There is a lot to be learned from what the gay community did at the start of this epidemic he pointed out, in terms of mobilizing to get information out and provide support.
Anthony Fauci, Earvin "Magic" Johnson, Greg Simon
Winning the War
Thanks to the scientific advancements of the past 30 years, more than eight million people around the world are receiving effective antiretroviral treatment and the life expectancy of an AIDS patient now approaches the life expectancy of people not infected by the virus. The progress is evident, but the fight isn't over. History has shown that when we try to control infectious diseases with non-vaccine intervention, we eventually lose control because of drug resistance. With HIV/AIDS we should expect the same result -- if we try to continue to control virus with only antiretrovirals, we risk losing control.
To win the war, we must develop a vaccine.
At the end of FauciaEUR(TM)s final session, moderated by HCM Strategists' Michael Manganiello, a member of the audience posed the question, aEURoeWith the incredible progress that we have made in developing effective antiretrovirals, do we really need a HIV/AIDS vaccine?aEUR? FauciaEUR(TM)s answer: "Yes absolutely." It is the heavy artillery we need to eradicate HIV/AIDS altogether.
Heard at Celebration of Science
"I'm functionally healthy, but I still, like many others, need to have a cure. . . . Only then will the promise of life be real. And it will be because science made it happen." Moises Agosto, Director of Treatment Education, Adherence, and Mobilization, National Minority AIDS Council
"14 years and one day after the door to motherhood had been seemingly shut I gave birth to a beautiful, healthy, HIV-free baby girl. This was something that was never possible in 1988 [the year I was diagnosed]." Dawn Averitt Bridge, Founder and Chair, The Well Project; Founder, National HIV Awareness Month
"My story represents the very best of cutting edge science. The cure for HIV is my blue rose. When I received my HIV diagnosis in 1995 I fell to my knees, and in 2007 when I was diagnosed as being cured I fell to my knees again. But this time I prayed that one day the millions of people living with HIV/AIDS worldwide would receive their own blue rose. I will continue to dedicate my life, my blood, my body, my mind and my soul to this expedition." Timothy Ray Brown, "The Berlin Patient"; Founder, The Timothy Ray Brown Foundation of the World AIDS Institute