Enough is enough

The Baltimore Sun

To control AIDS, funding must be invested in strategies that work: effective prevention efforts, routine testing and universal access to treatment - and not spent on expensive vaccine research that over 20 years has yielded little of promise other than discovering how not to make an AIDS vaccine.

The latest round of vaccine trial failures (including a large-scale Merck trial halted when the vaccine turned out to have possibly increased subjects' risk of acquiring HIV) has added to a growing consensus in the scientific community that an AIDS vaccine is a decade or more away, if one can be developed at all.

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, recently stated: "We have to leave open the possibility ... that we might never get a vaccine for HIV." That view was shared by leading AIDS expert David Baltimore, who conceded last month that the scientific community is no closer now to discovering an HIV vaccine than it was 20 years ago.

Twenty years of research and the fact remains: A vaccine against a retrovirus, the family of viruses HIV belongs to, has never been successfully developed. It is highly unlikely that there will be an AIDS vaccine - certainly not by any current definition of the word.

Despite this record of failure, the U.S. budget for HIV vaccine research continues to increase, more than doubling between 2000 and 2006 from $327 million to $854 million.

Meanwhile, funding for HIV/AIDS care in the U.S. has flat-lined. And around the world, millions are dying for lack of access to a 5-cent condom, a $15 HIV test or antiretroviral therapy costing as little as 50 cents a day.

It is time to stop the waste.

We already know what a successful AIDS control program looks like: effective prevention, routine testing and access to treatment. Government funding of AIDS vaccine research should be ended and this money put to more productive, and lifesaving, uses. If funding being poured into HIV vaccine research were applied to these strategies, much could be achieved.

Though undiagnosed HIV infection is responsible for most new cases, routine testing is still far from reality in the U.S. or abroad. It is estimated that one-quarter of the over 1 million Americans living with HIV/AIDS are unaware they are infected; if the majority of the 250,000 undiagnosed cases were diagnosed over the next five years, new infections could be reduced by as much as 50 percent. Likewise for the estimated 20 million people in the world who are HIV-positive but do not know it: Applying $1 billion toward the rapid scale-up of HIV testing worldwide would likely prevent millions of new infections.

Achieving universal access to treatment would make the most significant contribution to a drop in AIDS deaths and in HIV transmission rates worldwide.

Largely because of programs such as PEPFAR (the President's Emergency Plan for AIDS Relief), 2 million people in the developing world are receiving treatment - a tremendous feat. However, this is only a small fraction of those who need it and who will die without it. A billion dollars a year in U.S. vaccine funding will do nothing to prevent that.

Bolstering the case for increasing access to treatment is a recent study conducted by the U.S. Centers for Disease Control and Prevention indicating that AIDS drugs render an HIV-positive person significantly less infectious. The study of married couples, conducted over three years in Uganda, assessed the long-term effect of antiretroviral treatment on HIV transmission. Results demonstrate up to a 90 percent reduction in the likelihood that an HIV-positive husband will infect his partner if he is receiving prevention counseling services and antiretroviral drug treatment.

Inhibiting the virus' ability to replicate, antiretroviral drugs lower what is known as the viral load in a person's system, often to such a degree that the virus, while not eliminated, becomes undetectable. Scale-up of treatment worldwide must be our highest priority.

On Tuesday, Dr. Fauci will convene a summit of top leaders in Bethesda to "rethink strategy and perhaps plot new directions for the flow of federal tax dollars" for HIV vaccine research. Their course should be clear.

Suspending U.S. funding for an HIV vaccine and investing in strategies that save lives and stop new infections is the wisest and most effective use of limited public resources. And with thousands of lives lost daily because people around the world lack access to proven, effective and relatively inexpensive prevention and treatment options, it is also the only moral choice.

Dr. Homayoon Khanlou is chief of medicine in the U.S. for the AIDS Healthcare Foundation, the nation's largest nonprofit HIV/AIDS organization and a global health care provider. Michael Weinstein is president of the foundation.

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