The 30 years war

Hard pounding is gradually bringing AIDS under control.

IT WAS not quite a birthday present, but it was pretty close. On May 12th the HIV Prevention Trials Network (HPTN), an international research collaboration, announced that its most important project was being terminated-not because it had failed, but because it had succeeded. The study, led by Myron Cohen of the University of North Carolina, Chapel Hill, had looked at 1,763 couples, most straight, some gay, from Africa, Asia and North and South America, in which one partner but not the other was infected. All were counselled in safe sex, given free condoms and offered regular medical check-ups. In half, the infected partner was also offered anti-retroviral drugs, even though he or she did not show actual symptoms of AIDS and would thus not normally have been treated. Over the course of six years there were 28 cross-infections. Of those, only one was in the group receiving the drugs.

On June 5th, a little over three weeks after HPTNs announcement, AIDS will be 30 years old-or, more accurately, it will be 30 years since Americas Centres for Disease Control and Prevention reported a cluster of unusual infections in Los Angeles that were the first medically recognised cases. On June 8th a meeting of the United Nations General Assembly, expected to be attended by 40 heads of state and government, will discuss progress in fighting the pandemic and wrestle with the question of what to do next. HPTN052, as the trial in question is known, points the way.

What HPTN052 shows is that the drug treatment used to prolong the lives of those infected with HIV, by stopping the virus reproducing in their bodies, can also stop the viruss transmission. It might therefore be the key to bringing the pandemic under control. The crucial word is “might”. People do not like taking medicine, particularly if they have no symptoms. And drugs cost money. The war on AIDS has done well, financially, over the past decade (see chart 1), but people are feeling the pinch and the cash is no longer increasing. That is ironic, as there are now several clear ways of attacking the problem, above and beyond the usual exhortations of chastity, fidelity and condom use. It is no time to give up the fight.

The past decade has seen real progress. Though it is true that there are two new infections for every new person put on anti-retroviral drugs, and that AIDS is killing 1.8m people a year (see chart 2), it is also the case, according to UNAIDS, the United Nations agency responsible for monitoring and combating the disease, that 6.6m people in low- and middle-income countries are on such drugs, and that the rate of new HIV infections in 33 poor countries has fallen by a quarter or more from its peak. In 2001 the number on drugs was trivial (see chart 3) and the peak number of deaths, in 2005, was 2.1m.

At the moment, only those showing symptoms of AIDS, or whose level of a crucial immune-system cell has fallen below a certain threshold, are offered treatment. Even so, there are reckoned to be about 9m people who need treatment but are not receiving it. Add those who have no symptoms and that becomes about 27m. At $100 for a years course of the drugs, plus around $400 for the cost of administration, they would need a lot of money. In 2010, according to UNAIDS, the world spent $16 billion on the epidemic. Treating all 34m people infected might mean almost doubling that.

More at

The Economist. 2 June 2011.

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