Scroll down to comment on this story.
October / November 2010
From Mice Into Men
by Regan Hofmann with Tim Horn
Why should we cure AIDS? While every disease deserves to get adequate funding to be cured, there isn’t enough money to cure all ills. Since we have to make brutal choices anyway, one way to do it is to fund solutions that will save the most lives. HIV/AIDS is the No. 1 cause of disease and death among woman and girls ages 15 to 44 worldwide. Nothing kills more women in the prime of their lives. And given that nearly 50 percent of the 33.4 million people estimated to be living with HIV on the planet are men, the death rate for men isn’t far behind.
Also, unlike many fatal diseases that affect people at life’s end, HIV impacts young people, especially in the developing world. Which means HIV is drastically undermining the global workforce. And, when young people die, they often leave behind infants or young children and aging parents who, in turn, become a cost burden to society. And, by striking down millions in their prime, AIDS can greatly reduce nations’ gross national products.
There are those who argue that a cure isn’t needed because treatment has rendered HIV infection a manageable, chronic condition. It can be for those who can get, afford and tolerate care. ARV treatment has been so successful that public health officials and researchers are considering “treatment as prevention.” By lowering people’s viral levels to a point at which they become considerably less infectious, the thinking goes, treatment could help stop the spread of AIDS. The use of ARVs to protect HIV-negative people from the virus (an approach known as “PrEP” for “pre-exposure prophylaxis”) is also being studied. (It has already been proved that when HIV-negative people take a 28-day course of ARVs starting within 72-hours of potential exposure to HIV, their risk of infection is greatly reduced. This approach, known at “PEP” for “post-exposure prophylaxis,” was the grounds for PrEP.)
But for many reasons, lifelong treatment is far from the optimal solution for dealing with HIV. As we’ve already mentioned, it’s prohibitively expensive. The estimated lifetime cost of ARV medications can top more than $600,000 per person in the United States, according to a November 2006 study conducted by Cornell University researchers. And treatment doesn’t alleviate the many tough issues people living with HIV face. Pills don’t eliminate the threats of stigma, discrimination and criminalization. They don’t take away the fear that people will be unwilling to be your friend, to date or marry you or to take you home to their families. ARVs don’t remove the worry that you may inadvertently transmit the disease to someone else, including your baby. And given that we don’t know the long-term impact of the drugs themselves, compounded by the fact that people with HIV and on treatment are still at a higher risk than HIV-negative people for certain life-threatening diseases—like cardiovascular disease and cancer—ARVs are no guarantee against sickness and death.
Ideally, all people living with HIV should be aware of their status, be educated about treatment options and be given access to care should they choose to take it. But, the drugs aren’t the ultimate answer for those of us lucky to get our hands on them. And they’re certainly not the answer for the 5.5 million people who need drugs right now to stay alive and can’t get them.
Stopping AIDS with treatment may seem like a sound public health strategy, but at this point it’s purely academic theory. Universal access to treatment for all who require it has, to date, proved impossible. According to UNAIDS, less than half of the 33.4 million people with HIV who need ARVs are on them. Not only have we fallen short to meet current need, but we’re highly unlikely to play catch up considering that for every two people we put on treatment, three more become infected. And then there are the challenges associated with getting people tested and linking them to care. In the United States, one person in five living with HIV doesn’t know his or her status, and of the nearly 750,000 Americans who know they have HIV, an estimated 350,000 of them are not accessing care and treatment. If we can’t achieve universal access in the United States, our prospects for achieving it globally seem dim.
Ironically, the survival of more people with HIV makes it less likely, long term, that we will be able to care for them. And, because there are few new classes of treatment in the drug development pipeline, the number of people who exhaust the current set of treatment options will only grow. And more and more people contract HIV every day. The problem is getting exponentially worse on many fronts, daily.
Positioning treatment as prevention is a persuasive argument for justifying the cost of getting the drugs to everyone who needs them. Given that universal access is an integral part of one of the United Nations’ eight Millennium Development Goals, anything that supports that goal is likely to be embraced by global health leaders. But as noble as the goal of treating all who require it is, putting the entire global population of positive people on pills seems to be virtually impossible.
All roads, it seems, lead back to the necessity for a cure.
Which is why perhaps, after many years of the cure being viewed as a pipe dream, the word is increasingly on the tips of more people’s tongues today. Are we close? While we’re not likely to see a cure in the near future, what we do in the next year or two will impact whether the cure comes soon—or not soon enough. To fast track the cure, we’ve got to get more people talking about it.
As proof of how reticent people have been to say “cure,” consider that mainstream media barely covered the recent case of a man who has possibly been cured of HIV (albeit through impractical means). While speculation that combo-therapy could ring in the end of AIDS once appeared on the cover of Newsweek, data showing that HIV may have been eradicated for the first time in a person appeared on a small poster at the far end of the exhibit hall at the 2008 Conference on Retroviruses and Opportunistic Infections in Boston.
The poster told the story of an HIV-positive American, living in Berlin, who received a bone marrow transplant to cure his leukemia. The procedure, performed by Gero Hütter, MD, a German hemotologist at Berlin’s Charité Medical University, had a twist: The doctor re-introduced stem cells taken from a person with a certain genetic mutation that renders them (and theoretically the person to whom their cells are given) incapable of producing CCR5 receptors. Because HIV needs CCR5 to connect to and infect CD4 cells, not having it essentially renders a person immune to HIV.
Two-plus years after the procedure, “the Berlin patient” as the American is colloquially known, remains apparently HIV-free. Certainly many questions remain. Has the patient really been cured? The jury is still out. Doubters wonder whether the diagnostic tests that probed for latent HIV in places like the lining of his gut and his brain were effective, meaning that he could still harbor the virus. There is discussion about whether it was the high-dose chemotherapy, the CCR5-deficient stem cells or a combination of the two that seems to have chased HIV from his body.
No one knows whether the procedure can be successfully replicated, and the cost (up to $200,000 per patient) and health risks of such a procedure are high.
One thing’s for sure: Whether the Berlin patient proves that a “functional cure”—near-complete immune system control of HIV in the absence of HIV treatment—is possible or whether his body holds the grandest grail of them all—a “sterilizing cure” in which every scrap of HIV is eradicated from the body—he is proof of concept that HIV may be able to be controlled by something other than ARVs.
Few, including Hütter himself, are willing to say that AIDS has been cured, functionally or otherwise. But the findings of the Berlin patient and the research that contributed to Hütter’s gambit now inform current research. And they have helped invigorate the discussion around the cure.
The case of the Berlin patient also illuminates another key point: It’s not up to the NIH alone to find the cure for AIDS. And money does not necessarily force scientific discovery, and throwing cash against research projects with little promise is a waste. The high-stakes and high-cost responsibility should be spread between mighty giants like the NIH and other outfits like amfAR (of which Hofmann is a board member), ADARC, AVAC, IAVI, France’s Agence Nationale de Recherches sur le Sida, the Canadian HIV Trials Network and independent academic centers throughout the world. It will take the combined efforts and resources of multiple governments and a lot of public-private partnerships. Private funding of independent biotech companies has always been a critical link in the solution to any disease. In a recession-struck world, high-risk funding dries up quickly whether that’s on the part of individuals, venture capital firms or even the pharmaceutical companies themselves. It is unfortunate, to say the least, that at a time when we need to spend most aggressively, we face a dearth of resources and willingness.
Though we have long passed the tipping point at which it became clear that we needed to pour considerable funds into cure research, we haven’t invested the money. (Here’s where people cry, “Conspiracy!”) Indeed, the creation of a global market of tens of millions of patients who could live a full, healthy life as long as they took pills every day for the rest of their days does seem to be a pharmaceutical company’s dream. It is important to point out that the global HIV drug market is potentially becoming less profitable for the companies that make the drugs. If there were a way to pay for ARVs for 33.4 million people for the course of their lifetimes, it would pay to make the drugs. But given that the need for treatment expands as the resources to pay for the meds shrink, pharmaceutical companies are being forced to lower their prices (even abandoning patents earlier than before or, in some cases, coming straight out of the R&D pipeline to low-price-tag generic formulations). A Wall Street Journal opinion piece by Alec van Gelder suggested that “trampling over intellectual property rights removes drug companies’ incentives to invest billions of dollars in the development of the next generations of [ARVs].” And, as imperfect compliance leads to more drug resistance, there is an ever-increasing need for new compounds in general, and for getting a wide variety of drugs to the world at large. Historically, drugs with expired or nearly expired patents were offered to the developing world. Now, brand new formulations are required increasingly by nations and people who can’t pay for them. It’s another giant pink elephant in the room. Drug companies are for-profit. What will happen when it is no longer lucrative for them to make and distribute the meds? Already, we are seeing it happen. The pipeline for new treatments for HIV is nearly empty.
Pages: 1 | 2 | 3 | 4
Search: cure, research, AIDS, advocacy, antiretrovirals, ARV, UNAIDS, Ryan White CARE Act, ADAP, amfAR, IAC, Kevin Frost, AIDS Policy Project, Kate Krauss, Paula Cannon, protease, vaccine, NIH, PrEP, leukemia, CCR5, Berlin, Martin Delaney, Anthony Fauci, Sean Strub, Francoise Barre-Sinoussi, zinc-finger nucleases, ZFN, CD4, RNA, CD-1, DermaVir, Merck, cell-based, genetic therapies, Sangamo BioSciences, Paula Cannon, CD8 cells, Genetic Immunity, HDAC, ERAMUNE
Scroll down to comment on this story.
comments 1 - 11 (of 11 total)
Mark, Toronto, 2012-03-10 12:43:47
After 22 years I have yet to see any evidence that Pharma's could block a cure even if they wanted to. The fact remains HIV is complex and wily, and our science is just not quite there yet. But its easier to blame the invisible man behind the curtain.
Berry, Amsterdam, 2011-05-09 06:40:42
I loved this articale. I am some one who has probably been infected with HIV(have to wait 2 more months on the outcome) Now I know there realy is hope of finding a cure
vc, , 2011-03-21 15:43:49
I'm sure as hell in times of wikileaks the big pharmas couldn't hide a cure, but i can't answer in terms of pharmas slowing down the process. i'm also sure about that pharmas will have an occupation.
papilword, atlanta, 2011-03-11 16:10:57
such an interesting article. but should the next article/poz cover be about conspiracy theories and if they're true or not? for every person who gives positive information about a cure, there is another who says pharmacies are in control. is this true? should we believe this when so many are suffering. it scares me to think that a cure would be witheld because of pharma or gov. is making money. can anyone help me with these questions?
ethanwilson, Nashville, 2011-03-02 01:02:20
I am a fan of Ms. Hofmann's writing. And it made my heart sing, to read this brilliant article.Are we going to stand up and fight for a cure, when we are so close? The answer is yes! But we need to do it now,when the berlin patient has shown us the way. More and more, i hear the commom conspiracy theories...i ask...what good is this doing for those who are positive and who are sick? No. We need to direct our energy and commom sense toward the cure now. Please let's take a stand.
James, Winnipeg, 2011-02-22 13:29:22
I truly agree with Harsha. I believe after 20 years of intense research we know enough about HIV. We know plenty. I think a cure could be developed quickly, but these meds are a great safety net for many drug companies. I think it's a crime we don't have a cure yet. We need to stand up and start to stir the porriage.
kenny, Fort Collins, 2010-12-08 14:16:15
The Fact of the matter is that many people will loose their jobs if thier is a cure and that would hurt a lot of people and their neg families Do they really care about the impact on positive people and their families. I think not If they could live the life that people like myself who is raising two children and taking all the meds just to stay healthy they might chage thier minds.But That woin't happen and if their is a cure i would bet my life they would only give it to people who could pay.
Harsha, , 2010-10-27 15:50:26
VEry true, Who knows what the hell s happening on the name of RESEARCH AND CURE OF HIV AND AIDS, I am sure there is cure but the multinational companies wont let it out as they want to earn by selling their meds.... thats all,, or else is there not 1 genius in this world who can find cure to this desease....
Karen W, Sanford, Florida, 2010-10-12 13:01:45
You GO Waldon A.!!! We need patients like you to stand up and show what you want - not bitch about what you do or do not do, have or do not have. I want allof my patients to know they still have LIFE and make something of it. My clinic can;t even get consumer advisory boards to activate. We need people like you - God Bless. Karen W Florida
scott sproat, pacheco, california, 2010-10-09 18:18:07
our government has had a cure for AIDS but they want to weed out gay people first. gay men would have never got infected had it not been for heterosexuals who actually started this epidemic. still today-most heteros NEVER use a damn condom. they continue to blame us gay men for all of it. its a bunch of BS.
Waldon, dc, 2010-10-08 06:06:32
comments 1 - 11 (of 11 total)
Being a rapid progresser, currently having a spat of good health, I love it when people start talking cure. Most of diseases have walks for the cure. You almost never hear that word when it comes to AIDS. I just won the courage award in the dc aidswalk this year, and am willing to do anything I can to promote funding for a cure!!!! I plan to run a marathon every year, when I can afford it, until there is a cure. My name is Waldon ADAMS,and I have a AIDS diagnosis!! I run for AIDS cures!!