July 22, 2012 at 8:50 AM ET
Could it really be possible to cure AIDS?
The virus has been decimating populations since the “gay plague” first started spreading in the early 1980s. It insinuates itself into the body’s deepest recesses, hiding out to evade drugs and vaccines alike. It spreads in blood, breast milk and sperm -- making the most intimate human encounters deadly.
It has exploded across the world -- killing 25 million people, infecting a million more every year, and moving from gay and bisexual men into wives and mothers, to their children, and among drug users.
But experts think it might be possible to stop the spread and even to speak of curing the infection in those with human immunodeficiency virus (HIV), which causes AIDS. And they see a hopeful symbolism, as well, in the return of the giant international conference, held every two years, to the United States, where it hasn’t been in 22 years.
The International AIDS Society decided to bring the conference to Washington after President Barack Obama lifted a much-criticized ban on visas for HIV-infected travelers in 2009.
Starting today, 25,000 researchers, activists, patients and officials meet for the colorful conference to trade ideas, demonstrate and float policy ideas. As is always the case with AIDS meetings, protesters will gather to point to inequalities -- the lack of funding for treating women, the startlingly high rates of infection among U.S. blacks, high prices charged for AIDS drugs, discrimination against sex workers and the stigma that still surrounds the disease.
In the days before the conference, researchers and activists issued what they call the Washington, D.C. Declaration. “Through new scientific advances and societal, political and human rights gains, it is possible to turn the tide against the AIDS and begin to end the epidemic in our lifetimes,” it reads.
“It’s time to start thinking about the end of AIDS,” said Michel Sidibe, head of the United Nations AIDS agency UNAIDS.
“We do have these amazing scientific tools at hand that are really enabling us for the first time to begin thinking about a generation free from AIDS,” Dr. Ronald Valdiserri, U.S. Deputy Assistant Secretary for Health, told reporters in a conference call last week.
To ever cure HIV infection, researchers still have to figure out how to roust it from its hiding places in the body and kill it. HIV is a retrovirus, and it invades the very immune cells that the body sends to fight it off, turning them into little virus factories. Cocktails of drugs called highly active antiretroviral therapy -- HAART or ART for short -- can hijack this process in various stages and some of the drugs can even protect a person from being infected in the first place.
While HAART can keep patients healthy and can help keep them from infecting others and even protect people who aren’t yet infected, it can’t fully eradicate HIV.
But the case of Timothy Brown, once called the “Berlin patient”, shows it is in theory possible. He was infected with HIV, developed leukemia, and got his immune system replaced with a bone marrow transplant. Luckily for him, the bone marrow donor had a genetic mutation that provided resistance to HIV.
Bone marrow transplants are drastic treatments, expensive and dangerous, and no one thinks it’s possible to use them to treat HIV patients in general. But the science shows a cure is possible.
The best way to eradicate a disease is, of course, with a vaccine. Researchers wowed themselves and the world in 2009 when tests on a vaccine no one really expected to work lowered the risk of HIV infection by more than 30 percent over three years. More study published this year shows that the volunteers who were protected produced certain antibodies -- the first clue to breaking through HIV’s ever-changing disguises. They’ll present more details of what they have found at this week’s conference.
There also will be more details on studies that find treatment can be used as prevention. Taken properly, the drugs can reduce by 96 percent the chance that an infected person will infect someone else sexually. They can protect someone at high risk -- say a woman married to an infected man -- from ever becoming infected.
UNAIDS issued a report ahead of the conference that shows a 20 percent drop in death rates from HIV. Better treatment is a big part of this, according to the report. A big success has been in protecting babies -- 100,000 fewer babies got the virus at birth from their mothers or in breast milk, the report showed. Treating mother and baby with ART drugs worked.
It won’t be all good news at the conference. New details will shed light on how quickly the epidemic is moving back into the gay community, with black and Hispanic men at especially high risk and less likely than ever to have been tested or treated. A batch of reports in the Lancet medical journal this past week showed behavior may not be entirely to blame -- biology shows that men may be more susceptible to sexual transmission of the virus.
And there are two sides to the symbolism of holding the conference in Washington, D.C. Washington has one of the highest rates of HIV infection in the world -- more than 3 percent of the city’s residents over the age of 12 are infected -- about the same rate as in Congo. About 6.3 percent of black men in Washington are infected -- comparable to Uganda’s 6.5 percent rates. About half a percent of people in North America are infected. CDC estimates 1.2 million Americans are infected, and that 20 percent of them don’t know it.
Washington, D.C., is working hard on its epidemic, however, distributing free HIV tests widely, even offering them in supermarkets. Officials are distributing condoms, clean needles and providing health benefits to virtually all residents.
Conference organizers had hoped President Obama could travel the few blocks to the conference, but the best he offered is a video greeting. He’ll send Secretary of State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius instead.
A entire session at the conference will focus on another tough issue -- money. The global recession has hit AIDS efforts in the pocketbook.
“Regardless of where you work or live, if you are devoted to making a difference in the HIV epidemic, you are trying to do more with limited resources, “ said CDC’s chief AIDS official, Dr. Jonathan Mermin.