Anthony S. Fauci, M.D.
Since the beginning of the HIV/AIDS pandemic more than 36 years ago, major biomedical research advances have led to highly effective interventions to fight this modern-day plague. Reaching this goal, however, will require implementation of the tools that biomedical research has provided with the discovery of new tools for our armamentarium.
Effective treatment and prevention
With the treatments available today, a person with HIV who takes prescribed antiretrovirals daily can expect to live nearly as long as someone without the infection. Rigorous research also has demonstrated that treatment that suppresses HIV below detectable levels in blood can prevent transmission to uninfected sexual partners.
For uninfected people, taking a single pill daily as pre-exposure prophylaxis, or PrEP, can reduce the risk of acquiring HIV by more than 90 percent. Emergency post-exposure prophylaxis, or PEP, can prevent HIV from taking hold if taken within three days of exposure.
The need for implementation
These and other treatment and prevention tools could significantly reshape the epidemic. However, implementation challenges impede their effectiveness.
By precisely applying these interventions, some communities are dramatically decreasing the incidence of new infections. San Francisco is leading the nation, working to diagnose all people with HIV and immediately link them to treatment, while making prevention tools available for those at risk of infection. As a result, the city has made great progress toward its goal of zero new HIV infections by 2020.
This success is mirrored elsewhere, even in certain low- and middle-income countries, including Swaziland, Malawi, Zambia and Zimbabwe. These countries have been significantly affected by HIV and are now substantially reducing new infections through testing, treatment and prevention.
Scientific challenges remain
New treatment and prevention approaches are under investigation to make an even bigger difference. Long-acting therapies, including antiretrovirals and novel antibody regimens that eliminate the need for daily dosing, are being tested for both treatment and prevention. Last year, the National Institutes of Health launched the first HIV vaccine efficacy study in seven years, building on earlier trial results that identified a promising vaccine candidate. We are cautiously optimistic about this ongoing trial.
Although significant scientific and implementation challenges remain, it is possible to relegate the HIV pandemic to the history books. There is a light at the end of this tunnel. It is just up to us to follow it.