Today, December 1, is the annual observance of World AIDS Day. The epidemic continues to take an enormous toll, even as scientists have developed a range of medicines that have turned an AIDS diagnosis from a likely death sentence to a manageable condition ... at least for those who can get the right treatment.
The editor of the health policy journal Health Affairs, Susan Denzler, said HIV/AIDS remains a huge, global concern.
"More than four million people, as we know, worldwide are now alive and more-or-less well because they are on anti-retroviral drug therapy," said Dentzler. "An estimated seven million more worldwide probably should be. And then, of course, as we know, another 2.7 million people become infected with the virus every year."
Health Affairs examines the battle against AIDS in its current issue.
In an article on financing the fight against AIDS, Robert Hecht said current funding mechanisms aren't working very well. Hecht is managing director of the Results for Development Institute, a Washington non-profit that studies economics and health policy, among other issues.
"We need to move out of the emergency mode, the hand-to-mouth approach to AIDS, which has characterized the last decade, and take a long-run view of AIDS financing and of the epidemic in general if we're going to do the right things now - today, tomorrow, over the next few years - to change the course of AIDS," Hecht said.
Without a more strategic approach, Hecht says, there may be some progress against AIDS, but not a decisive victory.
Even without that decisive victory, AIDS researcher Dr. Anthony Fauci says researchers have posted some very significant gains.
"The advances in HIV/AIDS research from the very beginning, from 1981 to 2009, is something that is really unprecedented, said Fauci. "It's unprecedented likely because it was a new situation with enormous opportunities and a phenomenal amount of resources from the research standpoint were poured into that."
Fauci, who heads the U.S. National Institute of Allergy and Infectious Diseases, says those advances have changed the outlook for many young patients.
In what he calls the "darkest years of his medical career," during the '80s and early '90s, Fauci said that an AIDS patient with pneumocystis pneumonia survived on average only six months after the diagnosis. Today, it couldn't be more different.
"If someone walks into my clinic now at the NIH and is 20 years old and is newly infected, they will likely live to older than 69 years old. I don't think there is a medical intervention that we've had, at least in the last several decades, that has had that profound impact."
Better treatments notwithstanding, a vaccine is the real goal, but success on that front has been elusive. HIV is a particularly challenging opponent that can hide out in the body and avoid the body's own defenses.
When scientists develop a vaccine for a disease, they try, in a sense, to replicate what the body's own immune system does, "which means that the body has already proven the concept that [a] it can eradicate the virus, it can create an immune response that will be protective for the rest of your life. Not the case with HIV. So we have to do better than what the natural infection does," said Fauci.
A recent vaccine trial conducted in Thailand showed some limited results for some of the people in the study, but even if that approach pans out, it will still be years before the vaccine gets to market.
In the meantime, Dr. Fauci outlined several other strategies for fighting HIV/AIDS that are in the works, but he said all have their drawbacks.
Topical microbicides are medicines applied to the genitals, typically by women before sexual intercourse. There are significant traditional obstacles in many places, and women who use them often have to use them covertly. But Fauci says such medicines are an important way to prevent the spread of HIV.
"Topical microbicides [are] an absolute must that we must do for so many reasons, not the least important of which is that we do need something, particularly in the developing world, where women can take into their own hands their prevention of something that, up to now, has essentially been beyond their control in certain cultures."
Fauci said tests are underway to see if a prevention method called pre-exposure prophylaxis is effective. In theory, giving anti-AIDS drugs to people who haven't been exposed to HIV should be an effective strategy, but he said it's difficult enough in many places for health workers to reach and treat people who are sick; it's likely to be even more difficult to get people who are healthy to accept anti-AIDS medicines as a preventive measure.
Another approach is called "voluntary test and treat," which involves mass testing and treatment of everyone who tests positive for HIV, regardless of whether they are sick or their blood count suggests they are likely to get sick.
Anthony Fauci and Robert Hecht spoke about the fight against AIDS at a symposium sponsored by the journal Health Affairs.