It can sometimes be hard to remember that just a few decades ago, contracting HIV was pretty much a death sentence. In HIV-infected individuals, the disease often progressed quickly to full-blown AIDS, and there was nothing doctors could do at that point except offer supportive care.
Fast-forward to the mid-1990s, when protease inhibitors were introduced and the death rate from HIV began a sharp decline. The multidrug “cocktails” of the 1990s and 2000s have since given way to a much simpler, more streamlined, and more effective treatment regimen that allows individuals with HIV to live a near-normal lifespan with fewer side effects than ever before. Although this is great news, the fact remains that HIV is a particularly stubborn virus. Compared with other lethal diseases such as polio or smallpox, the human body mounts an inefficient immune response to HIV, which is why a preventive vaccine remains elusive. Researchers and patients still hope for the day when HIV can be declared completely cured, but is this a realistic vision, and, if so, how close are we to that goal?
The short answer, according to experts, is “We’re getting there.” However, although prevention strategies such as earlier testing of at-risk individuals and the use of pre-exposure prophylaxis have helped reduce transmission rates, the main driver of the movement to eradicate HIV has been the collection of significant advances in treatment.
Huge Gains in Treatment Spur Optimism
“Treatment has been our biggest success story to date,” said Roger Shapiro, MD, MPH, an associate professor at Harvard School of Public Health in Boston who specializes in reducing the incidence of mother-to-child HIV transmission and reducing morbidity and mortality rates in infants born infected. “Because of effective treatment, what was once a universally fatal disease can now be controlled with 1 pill, once a day,” he told Contagion
™. “Ongoing research is now exploring how to push treatment even further and control the virus with longer-acting treatment or…approaches such as monoclonal antibodies—but we are not there yet.”
Paul Volberding, MD, a professor at the School of Medicine of University of California, San Francisco, who has been studying and treating HIV since its early days, similarly marvels at the gains made in treatment. “All of us who are educators and [gave] lectures to groups used to have in our slide collections [photos of] 2 handfuls of pills,” he recalled to Contagion
™, referring to the unwieldy treatment regimen that was the standard of care years ago. “The pressure has been on drug developers to make drugs more potent, more convenient, and less toxic. One by one, the main side effects [such as diarrhea and nerve damage] have been pretty well controlled. I think there’s a renewed optimism that we can continue to make progress and that we can eventually cure HIV.”