President Barack Obama this week used World AIDS Day to announce that his administration will be redirecting $100 million toward a new initiative at the National Institutes of Health to advance research for an HIV cure. This is a welcome development among researchers and for people living with HIV/AIDS as well.
"We're going to redirect $100 million into this project to develop a new generation of therapies," the president said during his remarks at the Eisenhower Executive Office Building, according to a transcript. "Because the United States should be at the forefront of new discoveries into how to put HIV into long-term remission without requiring lifelong therapies – or, better yet, eliminate it completely."
In the last few years, there have been some scientific advances for an HIV cure. And while that milestone is likely years away, it's worth noting that a commitment to cure research is a good investment that should be pursued. Attempts at an HIV vaccine have faltered to the point that we need to move on; cure research is that next frontier.
A couple months ago, researchers presented the latest news in cure research here in San Francisco. Some media reports were over-exuberant and hyped some developments, contributing to a resurgence in optimism that, as we reported at the time, "is largely attributable to several 'proof-of-concept' cases showing that a functional cure – once deemed all but impossible – is in fact feasible." Much of the media attention focused on Timothy Brown, a former San Francisco resident who has remained free of detectable HIV six years after receiving a bone marrow transplant to treat leukemia from a donor with a natural mutation that makes immune cells resistant to HIV entry. Brown's case is clearly unique, but the medical findings have given researchers a new direction that might someday help many more people living with HIV/AIDS.
But Brown is not alone. Researchers reported on other proof-of-concept cases, including a group of 14 people with HIV in France who started antiretroviral therapy within a few months after infection. They stopped treatment after four or five years and have not experienced viral rebound.
However, as Dr. Steven Deeks with UCSF cautioned at the San Francisco forum, "One critical thing about all these [examples] is that they don't pertain to a typical person with HIV."
The new research that Obama talked about this week may help find strategies to cure HIV, although as we've seen throughout the three decades of the epidemic, HIV is notoriously good at hiding, evading, and rebounding. HIV is, as Gladstone's Warner Greene put it, "a little more complicated than we thought it was."
Treatment, prevention
In his remarks, the president also called for continuing the focus on "investments to communities that are still being hit hardest, including gay and bisexual men, African Americans, and Latinos." To us, that means maintaining funds for HIV prevention and treatment, through various federal programs including the Ryan White HIV/AIDS Treatment Extension Act, which has seen decreases to cities like San Francisco as more of the money is directed to other regions like the South. Although this funding in general could all be negatively affected by sequestration cuts coming early next year.
On the plus side, the implementation of the Affordable Care Act means that millions of insured people will be able to get tested free of charge, the president said, and Americans who are uninsured will soon have access to affordable health care coverage. Beginning in January, no American will be denied health insurance because of their HIV status. That's a welcome development, but it's dependent on the improved rollout of the ACA so that people can sign up for health plans.
There are also inadequate funds for preventions services, although we would argue that HIV prevention messaging itself needs a massive makeover as men who have sex with men continue to find the old recommendation of wearing condoms to be ineffective.
It's critical that people get tested to know their HIV status, and studies have shown that getting into treatment early is beneficial. But many are still reluctant to learn their status due to the stigma associated with being HIV-positive and aging with HIV. To that end, some local organizations recently started groups for men to talk about their hopes and fears as they grow older, and public service campaigns are specifically focused on reducing the stigma associated with HIV. Efforts on both fronts must continue.
Global action
The President's Emergency Program for AIDS Relief, started by George W. Bush, continues to do great things. Earlier this year, Obama said, the program celebrated the one millionth baby born without HIV. There has also been a decline in new HIV infections and deaths from AIDS in sub-Saharan Africa, he said. Compromising this success are draconian anti-gay laws in many African nations that put gay and bi men at risk. Think of what a cure would mean for people in those countries. This week Obama signed the PEPFAR Stewardship Oversight Act, to keep the program going.
It may be a long ways off, but eventually, scientists will make discoveries that will lead to a cure. They need the resources to continue their work. It would be ideal if Obama, instead of redirecting funding, could find new resources for the NIH to bolster those efforts.