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Encouraging News on the Scientific Front; Moving It Forward to Policy and Programs

2011_0729_aidsresearch_m
In last week’s post, I previewed the International AIDS Conference in Rome. This week I’d like to offer some brief reflections on the activity there, and what it means for our PEPFAR programs.

For those of us who have been working in this field for some time — which in my case is about 30 years — the mood in Rome was positive, with a palpable sense of encouragement. This was largely fueled by two things: new evidence of the long-term benefits of antiretroviral treatment efforts to date, and new scientific breakthroughs regarding the benefits of treatment for prevention. These developments are transforming the way we think about AIDS.

HIV/AIDS has had a devastating impact on life expectancy in many African countries, and in turn on their economic and social development. As an editorial in the Annals of Internal medicine recently noted: “Political debate centers on whether, especially given the current global economic downturn, money designated for HIV treatment in Africa would be better spent in [other] areas… But often forgotten in these debates is the unique nature of AIDS as a killer of young adults, of those on whom the very survival of societies depends.”

That’s why a new study published in the Annals of Internal Medicine last week is so encouraging. The study examined the long-term impact of the growing availability of treatment with antiretroviral drugs (ARVs) on life expectancy in patients of a Uganda NGO. The authors found that treatment “increased life expectancy to nearly normal levels,” noting that this finding “underscores the fact that HIV diagnosis in resource-limited settings is no longer a death sentence.”

We have long known that treatment is a life-saver; the impact of this on the lifespan of the individual on treatment — and ultimately on society — is now increasingly clear. Also becoming clear are the dramatic prevention benefits of treatment — saving not only the lives of the people taking the medicines, but the lives of their partners as well.

Data presented in Rome demonstrated the definitive prevention benefits of treatment. HIV-positive individuals who were part of HIV-discordant couples were randomly assigned to either early treatment or treatment that was delayed until they had clinically declined. Among couples where the infected partners received early treatment, transmission to the uninfected partner was reduced by at least 96 percent. This was an extraordinarily powerful result. It is consistent with the well-established fact that with ARVs, HIV-positive pregnant women can nearly eliminate the risk of passing HIV on to their newborns.

In addition to the preventive effect of treatment, two studies demonstrated the impact of oral antiretroviral pre-exposure prophylaxis (PreP) on transmission. One was a Gates Foundation-funded study among HIV-discordant heterosexual couples in Kenya and Uganda, and another was supported by the U.S. Centers for Disease Control and Prevention among heterosexual men and women in Botswana. Both found over 60% fewer new infections among those taking PreP.

These new data add to our knowledge base from studies on topical PrEP among women (a 39% reduction in new infections) and oral PrEP among MSM (a 44% reduction). Taken as a whole, the evidence base for the preventive effect of antiretroviral treatment is now unequivocal. ARV-based tools could be critical for the many people in HIV-discordant relationships and for others who are otherwise at high risk of infection.

Clearly there will be implications of these findings for PEPFAR, and it is important to prepare our programs to incorporate this new research in a careful but rapid way. Many in Rome expressed the view that the U.S. must play a leadership role in this effort, and we are doing so.

Our task is to translate new science into policy to inform programs. To do this, we are working with the World Health Organization and others as they develop normative guidance for the potential use of these tools. We are also supporting critical implementation science research needed for future scale-up of related programs.

Earlier this year, PEPFAR established a distinguished external Scientific Advisory Board. We are working closely with its members to assess the key issues around scale-up of these tools. Some of the big issues we will face include: increasing testing; supporting overburdened providers and health systems; ensuring linkages to care; prioritizing resources; and targeting the right populations. We are fortunate that in recent years we have had the experience of translating research on male circumcision into programs, providing us with valuable lessons as we move forward.

It is apparent that this is an extraordinary moment in the global AIDS fight, and particularly for PEPFAR — a moment in which a path toward an HIV-free generation is becoming clear. Just as America’s support has been essential in so many of the breakthroughs to date, both in terms of scientific research and program implementation, we will continue to be a global leader in this next stage of the fight.

Comments

  1. Seyed Mohsen Khatami says:

    Dear Ambassador, Eric Goosby,
    Hello
    Eric Goosby, Ambassador, U.S. Global AIDS Coordinator offers his reflections regarding the International AIDS Conference in Rome as following:
    “For those of us who have been working in this field for some time-which in my case is about 30 years-the mood in Rome was positive, with a palpable sense of encouragement. This was largely fueled by two things: new evidence of the long-term benefits of antiretroviral treatment efforts to date, and new scientific breakthroughs regarding the benefits of treatment for preventation”.
    According to him: “Taken as whole, the evidence base for the preventive effect of antiretroviral treatment is now unequivocal. ARV-based tools could be critical for the many people in HIV-discordant relationships and for others who are otherwise at high risk of infection”.
    In the following, inevitably, we describe an irony by the citation of some words from a speech of former U.S. President Bill Clinton in the XVIII Annual International AIDS Conference which was held in July 2010 in Vienna. The citation follows as:
    This is unacceptable. We know that HIV/AIDS is a disease that we can diagnose, treat, and prevent.

    Dear Ambassador, Eric Goosby,
    As molecular biologist and specialist in the field of infectious diseases, we must strongly emphasize that the issue of HIV/AIDS in the human community is not a political issue for the case of political priority or economic issue for the case of economic priority. It is more and more a scientific entity regarding the survival of human kind that must be considered as scientific priority.
    After thirty years since the beginning of the HIV/AIDS epidemic, there is still no simple solution to break the dimensions of pandemic in the world.
    The ideal HIV drugs would not just suppress the virus, but would eliminate it from the body. No independent scientist in the world can come with confirmation regarding the prescription and initiation of HAART in order to eliminate the HIV virus. And there is no independently scientific evidence to verify the optimal CD4 threshold at which to initiate HAART. At the same time, there is no independently scientific evidence to verify the significant protection against HIV transmission among partners by the efficiency of the drugs despite the reduction of viral load.
    HIV has a remarkable ability to resist antiviral drugs and hide in the body and form a non-eradicable reservoir, so the idea of eradicating the virus appears to be impossible. If treatment is interrupted, HIV rapidly springs back into action, rising to detectable levels within weeks. Meanwhile, no matter how effective the available drugs, the harsh reality is that they must be taken for life which makes the administration of drugs unbearable for patients and at the same time the costs of the drugs become terribly expansive. And if we as the neutral observer don’t conceal the harsh reality that the patients on HAART suffer also from a host of conditions including heart, kidney, liver and bone disease, cancers and serious cognitive problems.

    As molecular biologist and specialist in the field of infectious diseases, we must strongly emphasize that the development of a safe and effective preventive vaccine for HIV aiming for the ultimate control of the worldwide AIDS pandemic remains as a priority for scientific community and its development have presented significant challenges. The challenges include the extraordinary diversity and hypervariability of HIV-1, the early establishment of latent viral reservoirs and the lack of clear immune correlates of protection.
    By unequivocally experimental evidence in our hands, we believe that the development of an effective HIV vaccine is an achievable goal but the introduction and marketing of HAART transform HIV virus to a globally gigantic confusing problem to deter the development of an HIV Vaccine.
    We declare in a clear cut statement that the introduction of Highly Active Antiretroviral Therapy (HAART) is not in the interest of human being’s survival. The reason is that the treatment by these kinds of drugs leads to a condition that HIV evolves and enhances its pathogenic characteristics more and more. HAART cannot overcome the HIV virus ultra-extensive capacity for adaptation and diversification under an evolutionary period. Don’t create a HIV/AIDS viral sunami of unknown dimensions circulating in the world by marketing of HAART for the case of short-term interest.
    In order to curb the HIV pandemic it must be a way to protect against HIV transmission. Neither HARRT nor any other preventive method can exhibit capacity to protect effectively against HIV transmission.
    It is not possible to fight a war without resources. The great resources in order to fight and curb HIV are the scientific capacities.
    According to our view the world community lacks at the present time the scientific capacity to sketch such visionary utopia indicating a world free of HIV and its infections. Or to promises reduction of new infection even though in its minimum scale by 2015 or 2016.
    It is possible to manipulate statistics as it sometimes emerges by corrupt rulers and media or to portray a fabricated reality by the media in order to manipulate the opinion but the concrete world and its cruel reality after a while feels differently by the people from manipulative imagination of corrupt rulers or media.
    It must be also emphasized that the incidences of miracles do not associate with scientific endeavors.

    Dear Ambassador, Eric Goosby,
    As scientists in the field of infectious diseases, we must strongly emphasize that the genuine scientific enterprise suffers dynamically from a serious structural problem today. The reason is that scientific shareholders in biotech and pharmaceutical companies cannot act as free and sincere scientists but act as archbishops of “interests” in the realm of science for the purpose of dominance in market. And as it is obvious for everybody they kill the dynamic of scientific enterprise. The consequence is the dominance of censorship and self-censorship so that the true scientific enterprise changes its character into sub-scientific enterprise.
    However we have learned a great lesson from the history of science and that lesson is that the advance of science doesn’t obey the rules dictated by science’s archbishops. As transparent evidence, we refer to the history of HIV/AIDS. Indeed there are many apples that falling from the tree in this field but the archbishops of science pretend that everything is normal and under control by demonstrating a feeling of dislike and abnormal confusion to new idea and innovative solutions.

    Hopefully,
    Drs. Seyed Mohsen Khatami and Peter Wallenberg

  2. Keaty T. Mwachiro says:

    i have read the information and understood each and everything
    i am on Arv’s and i am leading a positive life no sickness
    but cant the Medics do somthing and improve side effects of Efiverance tabs.

    • Wango Magdalene says:

      Dear Ambassor Eric Goosby
      As a couselor and service provider for HIV/AIDS for over twenty years, I am getting discourage, and accepting Aids as an endermic disease that can only be controlled and not eliminated.As science is putting in all its efforts to find a lasting solution to the elimination of HIV/AIDS,those infected, especially in the African society turn to forget their role in the field of prevention.With provision of ARVS that improves and maintain a stable health condition,almost 75% of them become very sexually active, with the aim of having children before their end.This idea leads to more spread of the infection than control.The physical wellbeing covers the hiden agenda.It is so dishearten, to hear,I quote’ I must leave behind someone to replace me in my family.’Leaving behind someone to replace you, indicate infecting another person.I read of management of the discordant couples, some of these couples did not get there by accident, one of the parteners was very conscious of his/her status but needed to fulfill a desire.The funding bodies may put in all the monies and energy to eliminate HIV/AIDS,but if the target population,good follow up,education and other control methods are not well handled,the reseach results will not meet the expected effects on the virus elimination.The laboratory results should not only look into the test tubes but evaluate the effects on the users at different stages.Cousellors and service providers experinces should be of added values to reseach findings.

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