How to Fight AIDS: Dazzling New Drugs Are Not Enough; Prevention Is Still Our Best Weapon

Article excerpt

Dazzling new drugs are not enough; prevention is still our best weapon

EARLY IN JULY I TOOK PART IN THE 11TH INTERNATIONAL Conference on AIDS. In the past, the mood at these meetings has generally been somber. But as the 15,000 participants from more than 125 countries gathered in Vancouver, there was a new spirit of optimism in the air, almost cause for celebration. For the first time, research teams were able to demonstrate real progress in the treatment of HIV infection. They showed that the daily administration of a combination of three antiretroviral drugs, costing about $15,000 a year, can clear an HIV-infected person's bloodstream of any detectable virus for at least 300 days. This news was so exciting that physicians, researchers and journalists spoke openly of a "cure" for this presumed fatal disease.

I can only express admiration for the advances made possible through biomedical research. In 15 years we've learned an enormous amount about the AIDS virus and the way it infects our white cells. This basic science has allowed rapid development, testing and licensing of these new drugs that inhibit viral replication. As someone who has seen firsthand, in scores of countries, the suffering brought about by the disease, I feel great joy that some HIV-infected persons can now live a longer life than was dreamed of two years ago.

Despite these achievements, there are still unknowns and potential long-term problems in controlling the disease. One major concern is whether HIV strains resistant to the new drugs will eventually develop, especially if the drugs are not taken in full dosage and on the required schedule. The three-drug regimen--as many as 20 pills a day- is daunting and can cause debilitating side effects. We've had antibiotics for treatment of gonorrhea for 50 years, but because of their inappropriate use, we have been forced repeatedly to develop new drugs to treat resistant strains. Tuberculosis has been treated with triple-drug therapy for more than 25 years, yet it is still a leading cause of death among adults worldwide and has only recently been brought under control by having health workers stand over patients at home or in clinics to make sure they take all the prescribed pills.

Another hurdle is making these costly drugs available to those who need them. This will be difficult in the United States and virtually impossible in developing countries, the home of more than 90 percent of the world's HIV-infected population. Beyond that, monitoring the level of virus in a medicated patient's blood to determine the drugs' effectiveness will be expensive.

But the most serious downside to the latest therapeutic break-through could be its impact on AIDS prevention. I can hear it now. If we are close to a cure, people may say, why bother with politically sensitive activities such as condom promotion, sex education in schools or disease-prevention programs for illicit drug users. Let's not invest further in trials of protective vaginal products or genetically engineered vaccines. …