San Francisco Chronicle - December 1, 2008
Jay A. Levy

Yet while therapies against HIV have been developed, their distribution throughout the world is very limited. In resource-limited regions, only 5 percent of infected individuals who need the drugs are receiving these life-saving therapies. Even in those countries where antiretroviral therapy is available, the cost of treatment for a lifetime far exceeds the resources that would be provided through the industrialized countries.

Moreover, the virus continues to spread. For each new person treated, six more become infected. In the United States last year, at least 56,000 people became infected - a much greater number than was expected. About one to two people are infected in this country every 15 minutes. In San Francisco, three to four new infections occur every day.

Importantly, up to 25 percent of infected people in the United States do not know they are carrying the virus. In this regard, one must recognize that virus levels circulating in the blood may not indicate accurately the amount of virus in genital fluids. Thus, people practicing risky sexual behavior because they have very low virus levels in their blood are not making a responsible and prudent decision. All these findings portend very poorly for current approaches at treating and preventing this global epidemic.

What to do? As researchers, we must continue our efforts to find a cure for this disease and a vaccine to prevent HIV infection. We should be testing more of the public for infection since that knowledge can curtail transmission. Information about HIV/AIDS should be taught in schools, particularly the middle and high schools.

Treatment and prevention programs must be directed at controlling not only the free virus but also HIV incorporated into infected cells. A cure requires elimination of all those infected cells. Current antiretroviral therapy prevents new cell infections but does not directly affect the infected cell. In many respects, this challenge resembles cancer in which survival of just one cancer cell can begin the disease process again.

We can learn a great deal from HIV-infected people who have remained healthy at least 10 years (some 30 years) without therapy. These long-term survivors have strong antiviral immune responses, both natural and induced. They control HIV and provide insights into the correlates of protection from disease.

Obviously, the best solution for this worldwide epidemic that has affected more than 60 million people worldwide is an effective vaccine. That vaccine ideally would protect from infection and certainly the development of AIDS. Almost all current vaccines (e.g. measles, mumps, chickenpox) do not prevent the infection, but protect against development of disease.

Moreover, this AIDS vaccine should decrease viral levels in blood and genital fluids so that HIV transmission is greatly reduced, thus curtailing the epidemic. There are groups of subjects who have been exposed to HIV on many occasions without getting infected. These high-risk exposed individuals can give valuable information on defense mechanisms, mostly immune, that can be used in developing a vaccine.

Complacency about AIDS threatens our progress toward finding new directions in HIV treatment and prevention. We should quickly develop for infected individuals approaches to restore an immune system capable of controlling the virus for a lifetime. Our ultimate aim is a cure and a vaccine.

At this 25th anniversary of the identification of HIV, researchers, clinicians, public health workers, and others throughout the world need to reaffirm their commitment to stopping this devastating epidemic in its tracks.

Jay A. Levy, a professor of medicine at UC San Francisco, is an executive member of the UCSF AIDS Research Institute and was one of the first to identify the AIDS virus.

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