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Unformatted text preview: Chapter 17: Outlook for Eradicating AIDS Outlook
Berkley AIDS is uniformly fatal viral disease AIDS caused by human immunodeficiency virus (HIV), discovered in 1984. virus Initially identified in homosexual Initially males At the beginning there was little At precedent for the treatment of viral infections and developing a preventive vaccine seemed to be the solution solution Outlook for Eradicating AIDS Outlook Scientific activism of gay community in response to AIDS was highly effective in galvanizing scientific research “Lead directly to most intense biomedical scientific research effort ever conducted on an infectious agent.” Has resulted in enormous advances in understanding of the virus Outlook for Eradicating AIDS Outlook for Eradicating AIDS Unfortunately, HIV vaccine development has been given relatively low priority. AIDS in industrialized world is under moderate control, but it is out of control in developing world. 9095% of all HIV infections occur in developing countries. In 1999 there were close to six million new infections Recognition of severity of AIDS inspired the creation of a new UN body “UN program on AIDS”, the global effort remains under funded. Outlook for Eradicating AIDS Outlook “Only an effective, safe, and globally Only accessible HIV vaccine has the potential to end the HIV epidemic” p.145. But vaccine research receives only 10% of But research efforts, and only 1% of the global funds spent on HIV. funds To solve this problem, a new paradigm of To public-private, North-South, industrialpublic-private, academic partnership is necessary Author wants this to change. Outlook for Eradicating AIDS Outlook for Eradicating AIDS In 21st century there is a growing sense of complacency about AIDS, and it is incorrectly viewed as a chronic and easily treatable condition With 11 licensed antiretroviral drugs still treatment is complicated and expensive Despite 75,000 new HIV infections a year in industrialized countries. WHY? Outlook for Eradicating AIDS Outlook for Eradicating AIDS Because death rates from HIV are decreasing in industrialized countries, people may be growing complacent. Although treatment can reduce circulating virus to undetectable level, it does not eradicate it. However, a lower death rate means more people are living with HIV—increases in treatment costs and in risk of transmission. Also, resistance to HIV drug therapies is increasing. Outlook for Eradicating AIDS Outlook for Eradicating AIDS UNFORTUNATELY Increases are being seen in minority communities with fewer economic resources to take action against spread of the disease. Unlikely that drug therapy will end the epidemic or become universally available. Outlook for Eradicating AIDS Outlook for Eradicating AIDS In developing countries, the HIV epidemic is accelerating. Prevention inadequate Drug therapy (antiviral) is costly and difficult to administer uniformly. Basic palliative care is not widely available In many countries, HIV remains an untreatable, fatal condition. Outlook for Eradicating AIDS Outlook for Eradicating AIDS Huge impacts on demographics Life expectancies are down by 20 years in six African countries. Disease will devastate health care services, social services, and economic development. Is Global Eradication Possible Is Global Eradication Possible Global eradication of HIV is unlikely if it is not impossible Even with less expensive and rapid testing the vast infected majority will not be identified in a timely manner On the other hand with appropriate interventions HIV could be brought down to a manageable endemic level Outlook for Eradicating AIDS Outlook for Eradicating AIDS Is there any hope? Combination of aggressive High Active Antiretroviral Therapy [HAART] and vaccination is a possibility. Behavior changealways a challenge (Gay population in Australia and drug users in Netherlands) Outlook for Eradicating AIDS Outlook for Eradicating AIDS Recent success in Thailand with a combination of early surveillance, government commitment, and targeted interventions in commercial sex establishment, led to a measurable slow down in the spread of virus Outlook for Eradicating AIDS Outlook for Eradicating AIDS Uganda has also had success in reducing HIV incidence in urban areas. In the rural area were 80% of population lives, HIV is spreading However, globally, “we are losing the war against HIV”. Prevention efforts can help Best outlook is for an HIV vaccine. What can be done What can be done The world needs: to improve prevention technologies where the epidemic spreading Improved barrier methods (condoms use friendly) Female control method of protection (Microbicides) Improved diagnostic and treatment strategies for amplifying cofactors (STD) Author’s policy frame work Author’s policy frame work for 21th century Create the necessary policy and biomedical tools to stop epidemics such as HIV: Information global reporting Global monitoring Prevention education Political commitment, Politicians must be accountable and make commitment for longterm benefits Awareness & openness Providing adequate resources at the early stage Responses must be broad and use all available expertise Author’s policy frame work Author’s policy frame work for 21th century Cont’d Better use of existing technologies Correct use of male and female condom Treating sexually transmitted infection Providing clean needle for injection Access to counseling and testing Treating HIVinfected female with AZT and Neverapine Author’s policy frame work Author’s policy frame work for 21th century Cont’d New technologies: academic and public Develop products such a vaccines sector research institutions are excellent, new prevention technologies are necessary Adequate budgeting for new vaccine product Worldwide effort to create necessary new tools Who Should Take Responsibility Who Should Take Responsibility Who should take responsibility for international public good? Not realistic to expect the highly competitive but less wellfunded public sector to attract and retain the best expertise Author recommends a virtual company “transnational entity” focused on vaccine product development. What has been done What has been done The International AIDS Vaccine Institutes (IAVI) established in1996, with 3 strategies: Creating demand for a vaccine through: Aggressive communication Aggressive education Aggressive advocacy What has been done What has been done
Accelerating scientific progress through a direct product development effort Creating incentives for industrial involvement in HIV vaccine development to insure accessibility IAVI operates as “social venture capitalists” also working with World Bank, to create a guaranteed market for future successful AIDS market What is needed? What is needed?
Over all in summary to prevent HIV virus spread we need to do: Global reporting Prevention education Political commitment for longterm benefits Better use of existing technologies New prevention technologies ...
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