Nearing the Goal Line?

Considering how many options have been added recently to the HIV prevention arsenal, is it time to start talking about an endgame?

Chris Collins, the vice president and director of public policy at the Foundation for AIDS Research in New York, raised this question during a panel discussion this morning that dealt with the United States’ domestic and international AIDS response, and which was held in conjunction with the 2011 High Level Meeting on AIDS that is taking place this week at the United Nations. 
“What’s it going to take,” Collins asked the panel, which included US Global AIDS Coordinator Eric Goosby and Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases. 
Fauci said finding a vaccine that is moderately effective could be “the game-changer” in terms of ending the epidemic because it could be used in combination with other prevention strategies, such as oral or topical pre-exposure prophylaxis (PrEP) circumcision or treatment of infected individuals, all of which have been shown recently to be moderately to very effective in preventing HIV transmission rates. Last summer, a study found that a microbicide gel formulation of an ARV was able to reduce HIV infection rates in women. Subsequently, another trial showed that a daily dose of a combination ARV tablet was able to reduce HIV infection rates among men who have sex with men. Finally, researchers reported last month results from a trial known as HPTN 052—which Fauci described this morning as a “slam-dunk study”—because it indicated infected individuals on ARVs are 96% less likely to transmit HIV to their uninfected partner. 
While the science looks promising, finding the money to implement these strategies will not be easy at a time of such constrained resources. Fauci said while early treatment of HIV is costly, studies have shown that it is still more economical than waiting until a person has full-blown AIDS and is therefore more likely to contract opportunistic infections that require more hospitalizations. “Either you are going to pay a lot now or an awful lot later,” said Fauci.
Goosby, who oversees the President’s Emergency Program for AIDS Relief (PEPFAR), which now supports treatment for over 3.2 million HIV-infected people, said PEPFAR has changed the course of the epidemic in nearly every country that has a generalized epidemic. At the start of the High Level Meeting, global AIDS leaders, including Goosby, said they expected that by the time the meeting concludes tomorrow they would likely agree to a goal of getting 15 million people on ARVs by 2015. 
United Nations Secretary-General Ban Ki-moon upped the ante. He called for the end of AIDS by 2020, citing progress over the last 30 years since the first AIDS cases in the US were first reported.