When the first cases of what would become known as AIDS were reported in 1981, scientists and physicians did not know the cause and had no therapies to treat those who were infected. Times have changed and today physicians can offer their patients highly effective medicines that work as both treatment and prevention. We can now speak credibly about having within our sights the end to the HIV/AIDS pandemic, when new HIV infections and deaths due to AIDS are rare.
Ending the HIV/AIDS pandemic as we know it will require using antiretroviral therapy (ART) to treat all infected people upon diagnosis, facilitating the implementation of an array of prevention tools including pre-exposure prophylaxis, and eliminating mother-to-child HIV transmission. While recent scientific advances demonstrate these objectives are all possible, we must encourage universal HIV testing so that people know their status and are linked to care if infected and linked to a prevention program if at risk of infection.
Approximately 50,000 people in the United States are newly infected with HIV each year, and about 1 in 8 of the 1.2 million who currently are infected do not know their status. Tragically, nearly a third of all new HIV infections in this country are transmitted by people who are unaware of their infection; another 60% of infections arise from people who are diagnosed but not in care.
We need to intensify our efforts to connect infected and at-risk people with needed health services to treat or prevent HIV infection. If all people infected with HIV were made aware of their status and began receiving consistent treatment and medical care, most new infections in the United States could be prevented. Additionally, connecting people to the “prevention continuum,” in which people at high-risk for HIV infection are regularly tested, counseled and provided a variety of prevention options, could reduce the spread of the virus even further.
Research supported by the National Institutes of Health has provided solid scientific data showing that once an HIV-infected person has been diagnosed and connected with medical care, immediate antiretroviral therapy should be initiated. Taken together, the findings from the NIH-funded SMART study reported in 2006, the HPTN 052 study in 2011 and the START study earlier this year conclusively demonstrate that starting ART promptly after HIV diagnosis protects the health of the infected person while preventing HIV transmission to uninfected sexual partners.
NIH continues to investigate the best methods of connecting high-risk people with comprehensive prevention packages containing highly effective tools such as pre-exposure prophylaxis (PrEP). The HPTN 067 and PrEP Demo studies also show that people can follow the recommended daily PrEP dosing regimen routinely, further validating PrEP as a practical component in achieving widespread HIV prevention alongside condom use, testing and treatment for other sexually transmitted diseases, behavior change and needle exchange.
While increased HIV testing and immediate treatment or connection to prevention strategies can substantially decrease new HIV infections and HIV-related illness and deaths, developing a safe and effective HIV vaccine or cure would accelerate a durable end to the global HIV/AIDS pandemic. Earlier this year, the National Institute of Allergy and Infectious Diseases (NIAID) and its collaborators launched HVTN 100, a clinical trial in South Africa that is testing an investigational HIV vaccine regimen based upon the findings of the RV144 trial, conducted in Thailand, which demonstrated a modest degree of success. The HVTN 100 vaccine regimen was designed to increase the magnitude and duration of vaccine-elicited immune responses observed in the RV144 trial, and is the first of several additional planned vaccine trials and research studies that will begin in the coming years.
Scientists at NIH continue to learn more about the virus as we work to find a cure. For example, studies are underway to boost the immune response of HIV-infected people whose viral load has been suppressed by ART using passive transfer of broadly neutralizing antibodies as well as therapeutic vaccinations to determine if it is possible to withdraw ART without viral rebound.
On this World AIDS Day, there is considerable optimism that an end to the HIV/AIDS pandemic is achievable. However, to do this, we must have the will to apply established scientific findings and continue to follow the science. We must build on the promising achievements made through the dedication of researchers, health care professionals and clinical trial participants, and continue to work together to fill the gaps that remain.