Tuesday, November 30, 2010
Statement from the National Institutes of Health on Worlds AIDS Day 2010
Building on Success: Step by Step, Researchers Gaining Ground on HIV/AIDS
On Dec. 1, the National Institutes of Health (NIH) — the U.S. medical research agency — will join the global community in observing World AIDS Day. As we approach the fourth decade of this devastating pandemic, it is time for all involved in the fight against HIV to pause and pay tribute to the 30 million people who have died of this disease; the more than 33 million people, including 2.5 million children, now living with HIV; and all of their loved ones and caregivers.
"Clearly, this disease has taken — and continues to take — a terrible toll on humankind," said NIH Director Francis S. Collins, M.D., Ph.D. "While we’ve made impressive progress in knowledge, treatment and prevention since the disease was first recognized in 1981, HIV/AIDS remains one of the biggest challenges in medical research."
In the 1980s, a young adult diagnosed with AIDS typically survived less than one year. Today, a similar person can expect to live to age 70 or beyond if he or she is diagnosed with HIV infection early, has access to and receives appropriate therapy, and can tolerate the drugs and their side effects. About 30 antiretroviral drugs and drug combinations, many based on findings made by NIH-funded researchers, are now available to suppress HIV infection. Ongoing research is helping define the optimal treatment of HIV-infected individuals and address the many co-infections, co-morbidities and clinical complications associated with HIV disease or long-term antiretroviral treatment, including issues related to aging.
Simultaneously, important research is underway to develop a cure for HIV infection. The effects of a cure would be significant for individuals and society. Patients would be spared the cumulative effects of drug toxicities; a cured individual would have minimal risk of transmitting the virus; and resources would become available for other services.
"We have come a long way in the fight against HIV/AIDS, but we still have much to do, especially in our efforts to cure existing infections and prevent new ones," said National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony S. Fauci, M.D.
"Although progress has been made in reducing the number of new HIV infections globally, the onslaught of new infections is still unacceptably high — 2.6 million in 2009 alone," Dr. Fauci added. "Unless we stem this tide of new infections, and hopefully cure a substantial proportion of those already infected, it will be nearly impossible to control or end the HIV/AIDS pandemic."
During the past year, NIH-supported researchers reported a number of important advances related to HIV prevention strategies — advances that build on the foundation of knowledge generated in part by NIH’s investment in HIV/AIDS research. These strategies include vaccines, topical gels (microbicides) with anti-HIV activity, pre-exposure prophylaxis with antiretroviral drugs, and behavioral and social science interventions.
An effective vaccine is a critical goal in HIV prevention. A large study conducted in Thailand provided the first signs that a vaccine actually could prevent HIV infection, albeit in a relatively small percentage of those vaccinated. Those findings were by no means the final answer, and more research is now underway to understand how this vaccine regimen works and how its efficacy might be increased. In another major step toward development of an effective vaccine, NIH-sponsored researchers discovered several potent human antibodies that can stop most known HIV strains from infecting human cells in the laboratory. These antibodies could be used to design HIV vaccines, or could be further developed to treat HIV infection. The novel techniques used in this research may accelerate HIV vaccine research as well as the development of vaccines for other infectious diseases.
Another significant milestone for HIV prevention came in July 2010, when the Centre for the AIDS Programme of Research in South Africa (CAPRISA) reported that a vaginal gel containing the antiretroviral drug tenofovir reduced the risk of male-to-female sexual transmission of HIV by approximately 40 percent. NIH funding provided the training and research infrastructure for this study.
Pre-exposure prophylaxis or PreP involves giving uninfected people antiretroviral drugs as a possible means of preventing HIV infection. Just last week, the published results of the NIH-sponsored iPrEx study indicated that a daily dose of an oral antiretroviral drug cut the risk of HIV infection by more than 40 percent among men who have sex with men (http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx). The study found even higher rates of effectiveness, up to 73 percent, among those participants who adhered most closely to the PrEP regimen. Ongoing research will determine whether PrEP can work in other at-risk populations, including women and heterosexual men.
Other studies funded by NIH are exploring the possible benefits of frequent testing for HIV among high risk groups and linking those infected with the virus to care. The idea is that earlier detection might curb HIV transmission by enabling infected people to take steps to avoid passing the virus along to others. In addition, it may benefit infected people themselves because of growing evidence that patients who receive early HIV treatment live longer than those who begin treatment later in the course of their disease.
NIH also supports studies to develop and evaluate interventions that directly target the substance abuse and sexual behaviors associated with HIV transmission. Other research seeks to understand and modify the environmental, social and cultural factors associated with HIV infection and disease outcomes. The aim is to develop a "toolbox" of prevention strategies that could be used in various combinations in at-risk populations.
With the announcement of the National HIV/AIDS Strategy this past July, we have a solid roadmap to achieve greater progress toward reducing the number of new HIV infections in the United States by 2015. Through this strategy, greater collaboration and renewed action will help us achieve that goal.
An important obstacle to controlling and ending the HIV/AIDS pandemic is the dire shortage of healthcare professionals and services in many developing nations.
“The United States needs to reach out and help other nations build long lasting research and clinical capacity. Not only will this help combat the global HIV/AIDS pandemic, it will benefit many other areas of human health over the long term,” said Director of the NIH Office of AIDS Research Jack Whitescarver, Ph.D.
To that end, NIH and sister agencies in the U.S. Department of Health and Human Services recently joined with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to launch an initiative to transform African medical education and increase the number of healthcare workers. Over the next five years, the Medical Education Partnership Initiative will award $130 million in grants directly to African institutions in a dozen countries, working in partnership with U.S. medical schools and universities. The goal is to train and retain 140,000 new healthcare workers.
For more information about HIV/AIDS, including federal treatment guidelines, fact sheets on prevention, and how to find and enroll in HIV clinical trials of drugs, microbicides and vaccines, go to http://aidsinfo.nih.gov/.
For information about NIAID’s HIV/AIDS research programs, see http://www.niaid.nih.gov/topics/hivaids/Pages/Default.aspx.
For information about the AIDS research programs of the other NIH Institutes and Centers, go to http://www.oar.nih.gov/hivaids/institutes.asp.
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 http://www.nih.gov.
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