Thirty Years of HIV and AIDS: Future
Challenges and Opportunities
This article is
from the June 2011 issue of Annals of Internal Medicine. This article discusses
the future challenges and opportunities in HIV and AIDS research. It also gave
brief information about HIV and AIDS from the last 30 years.
Experts say that
60 million people have been infected in the last 30 years, with 25 million
people having died from the infection. An estimated 33 million are currently
living with HIV or AIDS. Progress in basic and clinical research and prevention
methods has been successful. This is in part due to the fact that researchers
now understand HIV and its pathogenesis. Advancements include being able to rapidly
and specifically diagnose infection, suppress HIV replication with
antiretroviral therapy (ART), having nearly eliminated mother – child
transmission in many parts of the developed world and reduced incidence of HIV
infection in some developing – world settings.
There are 3
essential research and implementation goals in HIV/AIDS research. The first is
to provide currently available treatments quicker. The most important treatment
is ART. The second goal is to explore approaches to eliminate HIV and to aggressively
pursue a cure. The third goal is to develop new prevention tools that can be
used with or enhance current approaches.
Prior to ART,
survival was measured in weeks and months. Patient care was diagnosis and
treatment of the opportunistic infections and AIDS related cancers. Since 1987,
5 classes of antiretroviral drugs have become available. Combinations of these
drugs suppress HIV replication in the body. Now, if a 20 year old is diagnosed
and begins ART, they may live another 50 years.
ART has limitations.
In order to be successful, there must be daily dosing for the remainder of the
patients life. Health care delivery systems must manage HIV treatment different
than others.
The US agenda for
AIDS research includes cost – effective ways to increase HIV testing, maximize
services, and increase adherence to treatments. This includes fully
implementing the recommendations of the Center for Disease Control and
Prevention on HIV testing. The agenda also includes establishing incentives for
organizations that conduct testing.
By September
2010, The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) alone
provided ART to more than 3 million HIV-infected people, provided
antiretroviral mother-child transmission prophylaxis to more than 600,000 and
care to an estimated 11 million people, including orphans of AIDS patients.
Approximately 2.5
million people are infected each year. This means for every 2 patients who
begin ART, another 5 are infected. Approximately 1/3 of all HIV-infected
patients needing ART are actually receiving it.
There have been
no documented cases of a true cure induced by ART. There has been 1 claim that
an HIV – infected person was cured after receiving a stem cell transplant for
leukemia. This claim does not present a practical approach for treatment but it
does prove that under certain circumstances HIV can be controlled without ART.
When discussing a
cure for HIV, the important goals are developing a true cure with complete
eradication of the virus and a functional cure (permanent suppression of the
virus). The goals of HIV prevention are improving current methods; ART based
prevention methods, and a HIV vaccine. There have been numerous attempts to
create a vaccine.
In the 30 years
of known HIV/AIDS existence, there have been successes in research. However,
there are many more advances to be researched and developed.
I was aware of ART and its success. I was also aware of the goal and trials of a cure for AIDS/HIV. I have heard of attempts at a HIV vaccine.
What are your comments about it i.e. was it interesting? Surprising? Shocking? Etc.
I really enjoyed the article. It was interesting to read about the advancements made in 30 years. It was also interesting to read about the goals in research. I got a little lost when it came to the medical talk (cells, etc), but overall I understood the main ideas.
Plagiarism:
Using someone else's work without giving proper credit, is plagiarism. If you use my work, please reference it.
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