Glimmers of Optimism on AIDS at International Conference
By George E. Curry
Dr. Helene Gayle remembers how disappointed she and some other delegates to the ninth International Conference on AIDS in Berlin felt as they stuffed their luggage with clothes and bulky scientific handouts before taking the long flights home, some lasting 10 hours or longer.
Earlier in 1993, U.S. tennis star Arthur Ashe and Russian ballet star Rudolf Nureyev had died of AIDS. The highly publicized Concorde trial had failed. At the end of the clinical trial, researchers concluded that zidovudine, better known as AZT (azidothymidine), in asymptomatic patients did not prolong the onset of HIV or lengthen the infected patient’s life.
“That was the lowest I felt leaving an AIDS conference,” said Gayle, president and chief executive officer of CARE, the international poverty-fighting organization, and former president of the International AIDS Society. She was not the only one despondent. Dr. James W. Curran, then-director of AIDS programs at the Centers for Disease Control and Prevention in Atlanta, told reporters that he had left Berlin “dispirited by the restless assault of the virus.”
Today, with 2.7 million new infections every year, including 56,300 - or one every 91/2 minutes - in the United States, HIV remains as restless as ever. However, delegates leaving the 18th International Conference on AIDS in Vienna this summer departed optimistic about the possibility of finding a cure for AIDS. They know that a cure may still be years away; the long journey to progress against this three-decades-long “restless assault” is measured in baby steps, not leaps and bounds.
“This is a scientific conference and there is a lot of great science being presented with fantastic results, which are giving us new hope for prevention, treatment and control of HIV,” said Dr. Kevin Fenton, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.
By far, the most significant finding was announced by the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and involved a microbicide, which is anything that kills microbes such as bacteria and viruses.
Researchers released a study showing that a microbicide gel containing tenofovir lowered the risk of HIV infection among women by 39 percent in one group and by 54 percent among women who used the gel more frequently. Tenofovir is an antiretroviral drug that blocks a key viral protein called reverse transcriptase; HIV needs the protein to reproduce once it has entered the cell.
Nearly 900 women in the study, known as CAPRISA 004, were instructed to use the gel 12 hours preceding intercourse and again 12 hours after having sex. It was the first trial to unequivocally show that a vaginal gel blocked the transmission of HIV.
“This is breaking ground into a new area of prevention technology, which is female control methods where the woman can empower themselves and use these methodologies to protect themselves against HIV,” said Fenton of the CDC.
Even with other medical advancements in the pipeline, HIV will continue to present an enormous challenge around the world. According to UNAIDS, the United Nations’ joint program on HIV/AIDS, for every person placed in treatment in a given year, 2.5 people become infected, thus expanding the pool of people in need of treatment.
At a time when the United States and other countries have insufficient treatment slots, some nations - Canada, France, Germany, Italy, Ireland, and the Netherlands, among them - are reducing their contributions to fighting global AIDS.
“Reductions in investment on AIDS programs are hurting the AIDS response,” said Michel Sidibé, executive director of UNAIDS. “At a time when we are seeing results in HIV prevention and treatment, we must scale up, not scale down.”
The United States is the largest donor nation to global AIDS relief with 58 percent of the contributions. The United States increased its donations from $3.9 billion in 2008 to $4.4 billion in 2009. But it was the exception.
“Donor nations essentially were treading water last year on AIDS relief, but did not cut back overall as they dealt with the economic tsunami that sparked a global recession,” said Drew Altman, president of the Kaiser Family Foundation, the organization that analyzed international funding levels. “Time will tell whether support will resume its rapid growth once the global recovery takes hold.”
In the meantime, unlike when she left the Berlin convention, Dr. Helene Gayle is upbeat.
“There are over five million people in poor countries that have access to antiretroviral therapy - that’s about a 12-fold increase in less than a decade,” she said. “I think the continued demonstration that men will go for circumcision is important. We know that circumcision can reduce transmission to men by 60 percent, so it’s incredibly effective. And there’s more evidence that putting people on treatment will also have a preventive effect. The more in treatment, the more they help prevention.”
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George E. Curry is a former Washington correspondent and New York bureau chief for the Chicago Tribune and was editor-in-chief of Emerge magazine.
