December 1, 2012
Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases
Jack Whitescarver, Ph.D., Director, NIH Office of AIDS Research
Francis S. Collins, M.D., Ph.D., NIH Director
The International AIDS Conference in Washington, D.C., this past summer energized HIV/AIDS researchers and focused on the potential benefits of broadly implementing scientifically proven HIV prevention and treatment tools. On World AIDS Day, the National Institutes of Health joins with our global partners to maintain this momentum toward a world without AIDS. As the world’s leading funder of HIV/AIDS research, NIH is vigorously pursuing promising research in therapeutics, prevention (including efforts to develop a vaccine), and work toward a cure, while also studying how best to deliver these interventions to people who need them.
NIH-funded researchers have contributed to the development of the more than 30 antiretroviral drugs and drug combinations currently available, which have saved millions of lives. Additionally, NIH partners with pharmaceutical companies to identify optimal treatment regimens. We continue to pursue the development of new antiretroviral drugs that are longer acting, simpler to use, and less toxic than currently available therapies.
NIH also supports studies on how to improve HIV treatment outcomes and how to manage and reduce the incidence of diseases and complications associated with long-term HIV disease and antiretroviral therapy.
But with 2.5 million new HIV infections in 2011 alone, we must not only treat people living with HIV but also continue efforts to prevent new infections. In collaboration with our partners in the U.S. government, other governments, nongovernmental organizations, and scientists around the world, NIH is leading the effort to further develop a robust combination of HIV prevention strategies that could bring about the end of AIDS.
To that end, we have learned that the treatment of HIV-infected individuals with antiretroviral drugs can — by lowering the level of virus in the treated individual — also prevent HIV infection of sexual partners, as the NIH-supported HPTN 052 clinical trial demonstrated last year. Yet less than a third of HIV-infected people in the United States are being treated successfully for their infection such that the virus is fully suppressed, and similarly low percentages have been observed in other countries. To address this problem, the NIH-funded HPTN 065 study in the United States is assessing the feasibility of widespread HIV testing, immediately linking HIV-infected individuals to care, and providing incentives to suppress the virus through treatment. Beginning in 2013, the NIH co-funded HPTN 071 study will examine whether the implementation of a comprehensive set of HIV prevention strategies including universal, voluntary HIV testing and linkage to care can reduce the annual number of new HIV infections among 1.2 million South Africans and Zambians.
Other landmark studies funded by NIH and its partners have tested and proven the effectiveness of powerful HIV prevention strategies. These include using antiretroviral drugs to prevent mother-to-child transmission of the virus; performing voluntary adult medical male circumcision; and taking a daily oral dose of one or two antiretroviral drugs as pre-exposure prophylaxis. We have long known that correct and consistent condom use can prevent sexual transmission of the virus, but the success of many proven HIV prevention modalities now rests to a great extent on how well we can promote adherence to them. Consequently, NIH supports a substantial portfolio of behavioral research to achieve these goals. In addition, NIH is partnering with the President's Emergency Plan for AIDS Relief, or PEPFAR, on implementation research to determine how best to put scientifically validated HIV prevention and treatment tools into use on an increasingly wider scale.
One key HIV prevention research challenge is to build on the progress made in developing and testing microbicides — that is, substances that can be applied topically to prevent sexually transmitted HIV infection. Such tools would be particularly helpful to women by giving them control over HIV prevention. This year NIH launched the multinational ASPIRE clinical trial to test whether the drug dapivirine can safely prevent HIV infection when continuously released from a silicone cervical ring replaced once a month. The ring was designed to reflect women's potential preference for a device that is more convenient and easier to incorporate into their lives than a gel that must be applied daily or before and after sex.
A major remaining HIV prevention research challenge is the discovery and development of a safe and effective vaccine. Widely implementing combinations of existing scientifically proven HIV prevention strategies and introducing a highly effective HIV vaccine would cause the annual number of new HIV infections to plummet, according to mathematical models. This year, NIH-supported scientists studying specimens and data from the landmark RV144 clinical trial discovered that participants who produced relatively high levels of a specific antibody after vaccination were less likely to get infected with the virus than those who did not. In addition, NIH scientists and grantees have discovered powerful antibodies that can neutralize a broad range of HIV strains and are working to design vaccines that can elicit such antibodies in HIV-uninfected people.
Along with a vaccine, another key remaining HIV research challenge is to find a cure for the 34 million people infected with the virus. NIH-supported scientists are pursuing two strategies: eliminating HIV from the body, and suppressing HIV to the point that medication is no longer needed.
The International AIDS Conference of 2012 generated heightened awareness worldwide that although HIV/AIDS is still with us, the end of AIDS may be within reach. NIH will build on this pivotal moment in science by continuing to support the research essential to turning the tide in the fight against HIV/AIDS. Now is the time to accelerate our commitment to ending the pandemic.