AIDS Juggernaut Continues Unabated.
Dec. 28, 1999 (Atlanta) -- On the last day of 1999, HIV will infect 15,000 people worldwide, according to estimates from the Joint United Nations Program on HIV/AIDS. By the first day of 2000, the AIDS pandemic will be spreading even faster.
Of the 16.3 million AIDS deaths since the beginning of the epidemic, 2.6 million occurred in 1999. At year-end, an estimated 33.6 million people worldwide are living with HIV infection. For 95% of these people, potent new anti-HIV drugs are completely unavailable. But 1999 brought bad news even to those fortunate enough to have access to potent anti-HIV drugs known as highly active antiretroviral therapy (HAART): sooner or later, the drugs will fail to contain the AIDS virus.
"There is no greater challenge facing people treating HIV than the management of antiretroviral [anti-HIV] treatment failure," said, John Mellors, MD, University of Pittsburgh. "The time will vary, but eventually immunologic [immune system] failure will occur. Those who believe this will not occur -- the burden of proof is on them."
It once was hoped that HAART would be able to eradicate HIV. A better understanding of the dynamics of HIV infection now shows that the virus is able to lie dormant in various reservoirs such as genital secretions and certain immune cells from which it periodically emerges to reseed itself. Because anti-HIV drugs act only on an active virus, these reservoirs are not affected by HAART.
"HIV eradication is now seen as a rare possibility -- or impossibility," said leading AIDS researcher Michael Saag, MD, of the University of Alabama School of Medicine, in Birmingham. "This has made us rethink everything from the possibility of eradication to when to start therapy."
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, agreed with this assessment. "Eradication is predicated on no ongoing viral replication -- which we now see isn't going to happen," says Fauci.
Early attempts to flush HIV from its hiding place with chemicals called cytokines show promise but require a great deal more refinement before they lead to approaches in humans. Better immunologic tools also reveal another grim fact about HIV infection: While immune responses to infections that occur due to a suppressed immune system by HIV, or opportunistic infections, improve in patients receiving HAART, immune responses to HIV itself remain depressed.
There have been exciting reports from patients who, for one reason or another, stopped taking HAART at various times. Nearly all such patients had their virus surge back during these drug 'holidays.' However, a few of these individuals have developed potent anti-HIV immune responses that can control (but not eliminate) the virus. Researchers are frantically trying to understand what it is that went right for these few patients, but they warn AIDS patients not to try this dangerous experiment on their own.