USIS Washington File - June 2, 2006
Charlene Porter, Washington File Staff Writer

Five young, previously healthy homosexual men had turned up with Pneumocystis carinii, a form of pneumonia that only affects people with suppressed immune systems. The significance of the report at the time was unknown. Twenty-five years later, we know that MMWR report was the first entry in the historical record of HIV/AIDS, a disease that has been called "the most devastating disease humankind has ever faced," by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Since 1981, about 65 million people have been infected with HIV, leading to25 million deaths from AIDS. Some 39 million people worldwide were living with HIV at the end of 2005, although millions of them do not yet realize it. An estimated 4.1 million became newly infected in 2005 and 2.8 million died, according to a survey on the disease's toll released by UNAIDS May 30.

"For 25 years, the suffering has been great, but the scientific and public health advances have been substantial," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), one of the National Institutes of Health (NIH).

"However, the next 25 years will be that [period] upon which we are judged," said Fauci in a telephone press conference from Washington, as he commented on the need to increase treatment care and prevention for people living with HIV/AIDS in the developing world.

THE EARLY YEARS

"I myself was personally involved from literally the first day in seeing HIV infected individuals -- which we did not know was HIV at the time -- here at NIH," Fauci said, recalling the early years of the pandemic as a "discouraging" time.

Breakthroughs came in 1983 and 1984 as groups of French and American researchers were able to identify a virus as the cause for the immune system breakdown that was stealing the health of AIDS patients.

Further progress came in 1985 as a test for the virus was developed, and the first effective drug was identified, even though limitations of the therapy were quickly recognized.

A "dramatic turnaround" in the capability to treat AIDS patients came in the 1990s when multiple drug therapies were concocted, bringing "a breathtaking difference in life capabilities and life span of people," said Fauci.

One study recently has calculated that combination anti-retroviral therapy (ARV) has saved 3 million life years of people in the United States who have access to the drugs. Broadening the availability of those drugs to all who need them, however, remains the world's greatest challenge in coping with the pandemic.

THE SCIENTIFIC OBSTACLE

When a virus dubbed HTLV-III was identified as the cause of AIDS in 1984, the U.S. secretary of health at the time expressed the hope that a vaccine could be developed within two years. History has proven that hope futile.

"A vaccine has been very elusive because of the fundamental nature of this virus which has an uncanny ability to elude the immune system," Fauci said. Vaccines work because scientists find a way to make the immune system produce a resistance to a given disease. HIV presents them with a puzzle like none other.

"It is relentless in destruction of the body's immune system, and we just don't know why," said Fauci. "That is the last of the real major scientific obstacles."

The International AIDS Vaccine Initiative reported in May that 30 vaccine trials are under way around the world currently, but Fauci says it is still impossible to predict how long it will take to find a vaccine that is safe and effective.

"Science is unpredictable in this regard," he said.

THE FUTURE

As the search for a vaccine proceeds, an array of tools remains available to combat and contain the pandemic. How well and how widely those tools are used will define how the future judges current efforts to abate the misery caused by the pandemic, said Fauci, who has served as director of this leading agency in the fight against the pandemic since 1984.

"We need to get drugs to [HIV-infected] people," throughout the world, Fauci said. Resource-rich nations must work with poor countries to make that happen.

How to prevent spread of the virus is also well understood. Monogamy, safe sexual practices, abstinence or condom use are all effective in avoiding the spread of the disease, but ensuring that those messages are distributed widely and thoroughly remains problematic in regions where stigmatization, superstition or discrimination against women are still prevalent, Fauci said.

"Leaders of developing nations must not stand in the way of progress against HIV by being close-minded, or not removing the stigma or not appreciating the seriousness of the problem," said the NIAID director.

One of the U.S. benchmarks in the 25-year history of the pandemic was an analysis in 2000 that defined the disease's potential to create international security risks. If fatal disease debilitates a high proportion of a nation's young adult population, reasoned the national security adviser, economic success, social progress, security and stability all can be at risk.

Six years later, Fauci said some nations still are slow to recognize fully the scope of the disease's potential to debilitate not only those infected with HIV, but their entire communities.

"There needs to be realization of the seriousness of the problem and the seriousness does extend to national and global security," Fauci said.

U.S. ACTION

With the President's Emergency Plan for AIDS Relief, the United States is committed to investing $15 billion in foreign assistance to help other nations contend with HIV/AIDS. With $3.3 billion budgeted to PEPFAR programs in 2006 alone, the United States is well on track to meet that goal. The United States is supporting AIDS programs in more than 100 nations, with especially targeted efforts in 15 nations having the world's largest numbers of HIV infected persons.

The long-range goals of the program are to provide treatment for 2 million people, care to 10 million people, and to prevent 7 million HIV infections. First lady Laura Bush announced at a U.N. Special Session on HIV/AIDS June 2 that U.S.-backed treatment programs are now reaching 561,000 HIV-infected persons. (See related article.)

For additional information, see HIV/AIDS.

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