Resistance to Treatment is an Obstacle
Although the rate of HIV diagnosis in the United States declined by 19% between 2005 and 2014, the situation is grimmer in the rest of the world, particularly in sub-Saharan Africa. More than 25 million individuals there live with HIV, many of them children infected by HIV-positive mothers. Two-thirds of all new HIV infections worldwide in 2015 were in sub-Saharan Africa.
In order to continue progressing towards a global cure for HIV, the disease burden in Africa must be lifted. Although advances are being made, testing and treatment of affected Africans require both large sums of money and the ability to reach everyone at risk. And even when inroads are made, there can be resistance from those who most need help. “[Certain] people don’t want to be tested,” Dr. Volberding noted. “Men especially don’t want to be tested.” What’s more, “young people don’t want to take pills.”
Currently, individuals with HIV who adhere to their treatment regimens can be expected to live just about as long as uninfected individuals and present an almost zero risk of transmission to others, a trend researchers have noticed is rising in the United States. “Increasingly, we’re seeing deaths from cardiovascular disease and cancers,” said Dr. Volberding, referring to the greater longevity of the HIV-positive population in this country and the higher probability that infected individuals will die from something other than HIV, although it’s unknown how much of a role HIV plays in the development or exacerbation of other health conditions. The ability of infected patients to live normal lives, however, does not mean HIV is cured in these patients; soon after a patient stops taking medication, the blood levels of HIV rise.
Suppression, Rather Than a True Cure, May be a Realistic Goal
In order to discuss how close we are to a cure for HIV, it is important to define what scientists mean when they talk about an HIV cure. Only one person has ever achieved a sterilizing cure, in which all traces of HIV were permanently removed from the body. This procedure was achieved through a bone marrow transplant with a very specific donor. For the vast majority of patients with HIV, say experts, a complete eradication of the virus may prove impossible.
“That is a very difficult goal to reach and might not ever be attainable for most,” Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases and a prominent longtime HIV/AIDS researcher, told Contagion
™ in an interview. Instead, he said, the scientific community is focused on post-antiretroviral therapy (ART) sustained remission of viremia, whereby HIV patients are able to achieve suppression of the virus using monoclonal antibodies or other agents that control the infection. According to Dr. Fauci, HIV research is moving towards getting individuals off of ART for as long as possible and putting them back on ART only if they relapse.