U.S. Efforts To Curb HIV ‘Insufficient,’ ‘Drastic Action’ Needed, Fauci Says in Opinion Piece

U.S. efforts to prevent the spread of HIV "clearly" have been "insufficient," as "the annual number of new HIV infections in the United States -- about 56,000 -- has remained fairly constant for more than a decade," Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, writes in a Washington Post opinion piece. Although vaccines have been "mankind's best weapon against the worst infectious diseases" in the past, HIV's "unique and formidable nature has presented challenges to the development of an effective vaccine," Fauci writes, adding that a "licensed product is not likely to be available in the near future." According to Fauci, "[d]rastic action and new approaches are needed" to address HIV/AIDS in the U.S.

Fauci writes that in the "absence of a vaccine, three bold new approaches to controlling the HIV/AIDS pandemic are being discussed by those working in medicine and public health." The approaches are "still in the conceptual and testing phases, but if applied as a group, it's possible they could have a dramatic effect." The first approach, pre-exposure prophylaxis, "would provide a daily dose of antiretroviral medicines to people who are not infected with HIV but are at high risk of becoming infected," Fauci writes, adding that the approach is based on "the concept that blocking HIV's replication immediately after exposure to the virus may prevent infection." Clinical PrEP trials among several at-risk populations are currently being conducted by NIH and other groups, with the initial results expected sometime this year, he adds.

The second approach is providing "universally available, voluntary, annual testing" for HIV and "immediately providing antiretroviral therapy to those who test positive," which could result in better health and longer life expectancy, Fauci writes. "Plus, it has been clearly shown that those who have less HIV in their blood are less infectious to others," Fauci writes, adding, "New modeling research suggests that implementing a voluntary 'test and treat' approach could dramatically reduce new HIV cases beginning within a decade and ultimately halt the pandemic." The third approach, he writes, "relates to the lifelong treatment that most people with HIV eventually need," which "imposes financial and other burdens on patients, their families and health care systems." However, "now, for the first time, AIDS researchers are pursuing major efforts to cure HIV infection," Fauci writes. He continues that perhaps the "more likely" approach would be a "functional cure," in which "therapies that suppress the virus to such low levels that an HIV-infected person would no longer need treatment because his or her immune system could keep the residual virus in check."

It is "too early to predict the success or even the feasibility of such a three-pronged approach," Fauci writes, adding, "Just the research to determine feasibility would be extremely costly." He continues that it is "clear ... that new methods of fighting infection must be pursued, and it is encouraging that new NIH funding provided through the American Recovery and Reinvestment Act offers the chance to at least explore such an approach." The "hope" is that "an end to the HIV/AIDS pandemic could be within our reach," Fauci concludes (Fauci, Washington Post, 4/16).