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Thirty Years On, A Stark Choice on AIDS

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Co-authored by Dr. Mathilde Krim, Ph.D.

The report that ushered in an epidemic 30 years ago this week was startling: Five otherwise healthy gay men in Los Angeles had come down with a rare form of pneumonia, and two of them had already died. Unnerving as this news was, none of us could have predicted the horrors ahead.

Described in the June 5, 1981, Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, these five cases heralded a new disease that some scientists soon realized was effectively destroying the body's immune system. As more patients were identified, first by the dozen and then in droves, it became clear that we were facing a new and very deadly enemy -- one that came to be called AIDS.

In the 30 years since that first report, 25 million people have succumbed to AIDS-related illnesses. Today, more than 33 million people are living with HIV/AIDS. We continue to struggle to treat those living with the virus -- 22 million of whom are in Sub-Saharan African -- and the epidemic has so far outpaced all prevention efforts. Here in the U.S., more than 56,000 people contract HIV each year.

Yet we've come a long way in 30 years, and in many respects progress on AIDS is one of the most remarkable success stories in the history of biomedical research.

In 1981, nothing was known about the cause of the disease, how it was transmitted, how to prevent its transmission or how to treat it. It was not known whether it was confined to a certain risk group or groups, or if the general population was at risk. Nothing as virulent and deadly had been encountered since the "Spanish Flu" epidemic of 1918.

Thanks to a slow-to-start but subsequently robust research effort, today a treatment armamentarium numbering more than 30 antiretroviral (ARV) drugs enables those on treatment to live relatively healthy lives.

Prevention research has delivered a raft of useful interventions. Early studies showed that condoms were highly effective barriers to HIV infection. Mother-to-child transmission of the virus has been virtually eliminated in the developed world and we are working to replicate that success elsewhere. Male circumcision has been shown to reduce the risk for males of contracting HIV through heterosexual sex.

Last July researchers showed that a vaginal microbicide gel that women can use before heterosexual sex can sharply decrease their risk of contracting HIV. In November, a study showed that high-risk men who have sex with men who diligently took an ARV while HIV-negative reduced their chances of contracting the virus by more than 90 percent. And in May a clinical study finally confirmed what many in the scientific and medical communities have believed for years, namely that a healthy HIV-positive person on ARVs is much less likely to pass on the virus to his or her partner.

None of these interventions alone will end the epidemic. But if used in combination and scaled up among vulnerable populations in particular, they could lead to quick, substantial and worldwide reductions in the incidence of HIV infection. Furthermore, smart investments in HIV prevention will pay off handsomely not only in lives saved, but also in treatment costs averted.

Ending the global AIDS epidemic will ultimately require an effective vaccine or a cure. Developing an effective vaccine has proven difficult, not least because HIV has multiple strains and mutates rapidly. A couple of recent developments, however, offer a glimmer of hope. In 2009, a clinical trial for the first time identified a modest preventive effect from an experimental vaccine. And a group of scientists has discovered two potent human antibodies that can stop more than 90 percent of known global HIV strains from infecting human cells. Follow-up studies are being conducted in both of these areas.

Finally -- and perhaps most excitingly -- research is generating increasing optimism that a cure for HIV/AIDS is now within the realm of possibility. The so-called "Berlin Patient" is living proof that it's technically feasible. Though the procedure this patient underwent isn't likely to be replicable on a meaningful scale, he is the first to have been cured of HIV through a stem-cell transplant. This and other promising scientific advances have led research organizations, including amfAR, the National Institutes of Health and the International AIDS Society, to establish collaborative teams of researchers racing toward a cure.

Thirty years into the AIDS epidemic, we are faced with a choice. Are we content to tinker at the fringes of the epidemic, spending untold billions to treat a fraction of those in need for decades into the future? Or can we summon the political will to effectively deploy the prevention interventions that are already available to us and to make the necessary investments in research that could end this epidemic in our lifetime?

Dr. Mathilde Krim, Ph.D., is the founding chairman and Kevin Robert Frost is the chief executive officer of amfAR, The Foundation for AIDS Research.

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