SEATTLE, WA — On the morning before the science-centered Conference on Retroviruses and Opportunistic Infections opened today, former U.S. Global AIDS Coordinator and now United Nations Special Envoy on TB Eric Goosby reflected on the “long, strange trip” of responses to HIV/TB. He was speaking at a discussion about HIV/TB research and noting that while science has supplied the capacity to diagnose, treat and cure the disease, inconsistent policies and inadequate political will often challenge realizing the benefits. Still, he said, he has seen positive responses to progress that has allowed science to inform policy, and policy to support programs that put that science to work.
But, as conference chairs and opening speakers discussed the findings of the scientific research that brought them here, they also discussed the realities that challenge those advances.
Consider the strides in treating hepatitis C over the last quarter century, the subject of an opening talk by Charles Rice of The Rockefeller University. From identifying the virus in 1989, to identifying treatments with 95 percent cure rates in six months, then three months, scientists’ progress gained momentum in recent years that contributed to his talk being subtitled “Light at the end of the tunnel.” But then consider the costs of treatments that range from $60,000 to $84,000 to take, but only from $68 to $130 to produce. That’s one of the reasons that few of the estimated 175 million people with the virus get treated, another being that many go undiagnosed.
Consider the “Past, present and future” of antiretroviral treatment, the subject of this year’s N’galy-Mann lecture by Dr. David Cooper of the University of New South Wales. That story, too, is one of incremental steps, breakthroughs and momentum, from investigations into the impact of drugs on early infection, to toxic treatments only recently ruled out, to earlier treatment demonstrating individual and public health benefits, to treatment optimization that could lower costs and side effects, to hopes for long-acting treatments. Those advances, which have shown the potential to reduce illnesses and transmissions across communities are meeting the realities of the more than 13 million people on treatment, the 28.6 million people who need to be, and the realities of the flat-funded President’s Emergency Plan for AIDS Relief and Global Fund to Fight AIDS Tuberculosis and Malaria.
And consider the continuing roles of stigma, criminalization and neglect in keeping science from reaching those who need its answers the most. Those too will be addressed here, discussions of stigma-driven barriers to services faced by sex workers, people who inject drugs, men who have sex with men, and people who live with HIV. What about transgender women, among whom the highest rates of HIV have been seen? Yes, conference vice-chair Susan Buchbinder of the University of California, San Francisco said, that population is probably the most impacted by HIV, but will be the subject of no presentations, “not because we didn’t accept any, but because there has been so little funded in this important area.”
And, finally, consider what the world learned from the ongoing Ebola crisis in West Africa, also the subject of a special session this week. Gilles Van Cutsem of Médecins Sans Frontières gave a preview on Monday of some of what he will discuss, from March, when MSF called for help, to June when MSF let the world know that with outbreaks in the capital cities of three countries the situation was out of control, to August when WHO recognized the crisis as an emergency, to now, when outbreaks continue, with the potential still to spread to other countries. The 23,000 cases and 9,000 dead, including at least 800 health workers, he said, “leave a scar that will persist for decades that will remind us of the international communities failure to respond.” The crisis highlighted, he said, that no functioning international public health mechanism exists to counter pandemics in countries with fragile health systems.
This is a big week for prevention, we’ve been told, with findings on PrEP — pre-exposure prophylaxis, or preventive use of antiretroviral drugs — PROUD and Ipergay trials, as well as on microbicidal vaginal gels to prevent HIV acquisition among women with the FACTS 001 trial. Studies already have shown the preventive potential of PrEP and antiretroviral based microbicides, but they also have yielded information about realities on the ground.