Despite Advances, HIV Still Threatens U.S., Globe

From the WebMD Archives

Sept. 29, 1999 (Washington) -- Unless methods of prevention become more successful, the worst of the HIV pandemic still lies ahead -- in the 21st century -- according to the director of the National Institute of Allergy and Infectious Diseases, an organization under the umbrella of the National Institutes of Health. In an article that appears in today's New England Journal of Medicine, Anthony S. Fauci, MD, chronicles the history of HIV from its calamitous introduction to humans from chimpanzees to today's promising research into 27 different vaccines now being tested in 50 studies sponsored by the NIH.

The number of new HIV diagnoses is growing by 40,000 a year in the United States and 14,000 a day worldwide, Fauci tells WebMD. "Treatment has already taken major strides," he says, "But we need to get better drugs. [And] they are available to less than 10% of the infected population, ... because [the remaining 90%] live in underdeveloped nations. If we don't turn things around, this will be beyond historic in its proportions."

According to Fauci's article, HIV is believed to have existed among chimpanzees for centuries, and may have been passed to humans many times before causing a full-blown pandemic. Chimpanzees are a traditional source of food in parts of Africa, and it is likely that the virus was transmitted when an infected chimpanzee was being killed. The disease spread rapidly, due in part to societal factors, including migration to cities for employment, the break-up of families, sexual promiscuity, and the contamination of the blood supply.

Once the disease entered the United States, he writes, it took hold among homosexual men residing in large concentrations in New York City, San Francisco, and Los Angeles. Today there are an estimated 650,000 to 900,000 Americans with HIV, including 200,000 who have not yet been diagnosed. Some 410,000 have died of AIDS in the United States. Worldwide, 33 million people were believed to be infected by the end of 1998; 43% of those are women. AIDS caused an estimated 2.3 million deaths worldwide last year. In 1998, 5.8 million new infections occurred -- a rate of about 16,000 per day.

"In many countries the epidemic is depleting a limited pool of skilled workers and managers and will neutralize previously realized gains in development by slashing life expectancy," Fauci writes. "It is also clear that this epidemic will produce political instability in some nations and communities within those nations."

Although the FDA has approved 16 anti-HIV drugs, they are costly and have serious side effects that can cause people to stop taking them. Resistant strains of HIV are also beginning to emerge. A safe, effective vaccine is the key to controlling the pandemic, Fauci writes, noting that the NIH has allocated $194 million in fiscal 1999 for vaccine research.

Among the more promising is the use of "vector vaccines," which are generally harmless vaccines that have been altered to produce HIV proteins. Results of preliminary studies involving human volunteers have been encouraging, Fauci writes. Some vaccines have produced an "immune response that may have a role in providing protection from HIV infection," according to Fauci. Researchers are also developing and testing topical medications that women could use vaginally before intercourse to prevent the transmission of diseases.

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