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 percent 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
NIAID conducts and supports research — at NIH, throughout the United
States, and worldwide — to study the causes of infectious and
immune-mediated diseases, and to develop better means of preventing,
diagnosing and treating these illnesses. News releases, fact sheets and
other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH):
NIH, the nation's medical research agency, includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and Human
Services. NIH is the primary federal agency conducting and supporting
basic, clinical, and translational medical research, and is
investigating the causes, treatments, and cures for both common and rare
diseases. For more information about NIH and its programs, visit www.nih.gov.
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