Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases
Jack Whitescarver, Ph.D., Director, NIH Office of AIDS Research
Francis S. Collins, M.D., Ph.D., NIH Director
In the 25 years that have passed since the first annual commemoration of World AIDS Day, extraordinary scientific progress has been made in the fight against HIV/AIDS. That progress has turned an HIV diagnosis from an almost-certain death sentence to what is now for many, a manageable medical condition and nearly normal lifespan. We have come far, yet not far enough.
In 2012, more than 2 million new HIV infections and 1.6 million AIDS-related deaths occurred globally. Although these numbers represent a decline from previous years, they also reflect a grim reality: far too many people become HIV-infected and die from the effects of the disease. On World AIDS Day, the National Institutes of Health (NIH) reaffirms its commitment to finding improved HIV treatments and tools for preventing infection (including a vaccine), addressing the conditions and diseases associated with long-term HIV infection, and, ultimately, finding a cure.
Over the years since HIV was established as the cause of AIDS, NIH-funded researchers—in partnership with academia and the biotechnology and pharmaceutical industries—have developed more than 30 life-saving antiretroviral drugs and drug combinations for treating HIV infection. Moreover, as the landmark HPTN 052 clinical trial proved, antiretroviral treatment can also effectively prevent HIV transmission by lowering the amount of virus in infected individuals, thereby making them less able to transmit the virus to their sexual partners. Today, we are working to improve upon these medicines by developing drugs that are longer-acting, simpler to use, and with fewer side effects. Further, NIH scientists and grantees are exploring the administration of anti-HIV antibodies as a way to treat infection. This approach was recently shown to be effective when used in monkeys infected with a genetically engineered version of simian HIV. Additionally, NIH researchers have begun early stage human testing of a monoclonal antibody (called VRC01), which in the laboratory, protected human cells against infection by more than 90 percent of known HIV strains.
However, advances in antiretroviral therapy or the discovery of new treatments are of little value if HIV-infected individuals do not know they are infected, do not have adequate access to HIV treatment and the necessary medical care to control their virus levels, or do not adhere to their treatment regimen. For example, of the 1.1 million people living with HIV infection in the United States, only 25 percent receive ongoing medical care and have virus levels that are adequately controlled by taking antiretroviral medications as prescribed. The NIH is funding studies in the United States and internationally to explore new approaches to addressing this problem. The HPTN 065 study (also known as TLC-Plus), is assessing the feasibility of conducting widespread voluntary HIV testing, linking HIV-infected individuals to care and antiretroviral treatment, and providing incentives to individuals to adhere to treatment. The study is being conducted in New York City, and Washington, D.C.—both of which have communities at greater than average risk of HIV infection. Internationally, the recently launched HPTN 071 study, also called PopART, is examining whether offering expanded voluntary HIV testing along with enhanced delivery of antiretroviral treatment and prevention services can substantially reduce the number of new infections in South Africa and Zambia. The study will involve 21 communities and 1.2 million people in those countries.
NIH-funded research has proven the effectiveness of such HIV prevention strategies as voluntary medical adult male circumcision and pre-exposure prophylaxis, or PrEP (taking a daily antiretroviral pill to prevent HIV acquisition). In order to be effective, these strategies must be used consistently under strict guidelines. NIH supports behavioral and social science research designed to better understand how to foster adherence to medications, promote acceptance and overcome barriers to the use of effective HIV prevention tools.
The NIH also continues to investigate new HIV prevention tools for those groups most at risk for HIV infection, including women and men who have sex with men. The multinational ASPIRE clinical trial, launched in 2012, is testing whether a vaginal ring containing the experimental antiretroviral drug dapivirine can prevent HIV infection in women. The recently launched MTN 017 clinical trial is examining the safety of a rectally applied gel containing the antiretroviral drug tenofovir for men who have sex with men.
A cornerstone of our HIV prevention efforts continues to be the search for a safe and effective vaccine. The pathway to an effective HIV vaccine has been challenging and marked by disappointments; however, basic research advances this year are charting the course for a new generation of investigational HIV vaccines. Through the work of NIH scientists and grantees, we have gained insights into how HIV and a strong antibody response to the virus co-evolve in an infected person and improved our understanding of how B-cells create potentially protective immune system responses. Further, NIH-funded researchers have developed a new tool for identifying broadly neutralizing antibodies against HIV that could help speed vaccine research and illuminated in exquisite detail the protein largely responsible for enabling HIV to enter human immune cells and cause infection.
Additionally, ongoing analyses of the landmark RV 144 HIV vaccine trial conducted in Thailand are providing important information about human immune responses and other factors that may explain why the investigational vaccine regimen reduced the risk of HIV acquisition by 31 percent. Large-scale investigational clinical trials to build on the RV 144 results are being planned for South Africa and Thailand.
We have reached the point when the thought of an HIV cure is not unrealistic. Several cases, including that of a toddler, have demonstrated the possibility of sustained remission, in which patients control or perhaps even eliminate HIV without the need for a lifetime of daily antiretroviral therapy. NIH continues to focus on the important area of research toward a cure through basic science and clinical testing that is underway or in development.
On this World AIDS Day, we take stock of what has been achieved and look forward to what can be accomplished in the near future toward the universally shared goal of ending the HIV/AIDS pandemic.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at https://www.niaid.nih.gov.
The Office of the Director, the central office at NIH, is responsible for setting policy for NIH, which includes 27 Institutes and Centers. This involves planning, managing, and coordinating the programs and activities of all NIH components. The Office of the Director also includes program offices which are responsible for stimulating specific areas of research throughout NIH. Additional information is available at https://www.nih.gov/icd/od/.
The Office of AIDS Research, part of the Office of the Director, plans and coordinates the scientific, budgetary, legislative and policy elements of the NIH AIDS research program. Additional information, including the trans-NIH strategic plan and budget, is available at https://www.oar.nih.gov/.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
A recently discovered HIV strain leads to significantly faster development of AIDS than currently prevalent forms, according to new research from Lund University in Sweden.
The period from infection to development of AIDS was the shortest reported among HIV-1 types, at around five years.
There are over 60 different epidemic strains of HIV-1 in the world, and geographic regions are often dominated by one or two of these. If a person becomes infected with two different strains, they can fuse and a recombined form can occur.
"Recombinants seem to be more vigorous and more aggressive than the strains from which they developed", explained Angelica Palm, a doctoral student at Lund University.
The recombinant studied is called A3/02 and is a cross between the two most common strains in Guinea-Bissau, West Africa - 02AG and A3. It has previously been described by Joakim Esbjörnsson, a postdoctoral fellow at the University of Oxford, who is a co-author of the study.
So far, the new strain has only been identified in West Africa, but other studies have shown that the global spread of different recombinants is increasing. In countries and regions with high levels of immigration, such as the US and Europe, the trend is towards an increasingly mixed and complex HIV flora, unlike in the beginning of the epidemic when a small number of non-recombinant variants of the virus dominated. There is therefore reason to be wary of HIV recombinants in general.
"HIV is an extremely dynamic and variable virus. New subtypes and recombinant forms of HIV-1 have been introduced to our part of the world, and it is highly likely that there are a large number of circulating recombinants of which we know little or nothing. We therefore need to be aware of how the HIV-1 epidemic changes over time", said Patrik Medstrand, Professor of Clinical Virology at Lund University.
The research is based on a unique long-term follow-up of HIV-infected individuals in Guinea-Bissau, a project run by Lund University. In future research, Angelica Palm and her colleagues hope to be able to continue researching the characteristics of recombinant viruses and the presence of these among HIV carriers in Europe.
For health services, the new research results mean a need to be aware that certain HIV-1 types can be more aggressive than others, according to the research team.
A message from the Acting Surgeon General
As we celebrate the Nation’s 10th annual Family Health History Day this Thanksgiving, I encourage everyone to spend time talking with their family members about their health. National Family Health History Day is a great opportunity to draw attention to the importance of sharing family health history.
Both rare diseases and common ones, like heart disease, cancer, and diabetes, can run in families. Understanding your family health history can help you and your health care provider predict your risk for health problems and keep you and your family healthy.
As a physician, I know that a patient’s family health history is an easy, quick and inexpensive way to get a rough estimate of how strongly a particular disease runs in a family. Knowing your family health history can help your clinician identify screening and treatment options that are personalized for you. For example, heart disease, which is the number one cause of death in women, can run in families. If someone in your immediate family — mother, father, sister or brother — has heart disease, you have twice the risk of developing heart disease as someone without that family history. Thanks to the Affordable Care Act, many preventive screenings are now covered under health insurance with no cost share for Americans.
While you can’t change your family health history, you can act to reduce your disease risk and keep yourself and your family healthy. Making healthy choices is important for everyone, but it’s especially important for those at higher risk because of a family history of disease. If you or others in your family have a history of heart disease or stroke, you can take steps to reduce risk by discussing with your physician the “ABCS” of the Million Heart Campaign: Aspirin for people at risk, Blood pressure control, Cholesterol management and Smoking cessation. These are all steps that can help prevent heart attacks and strokes.
The Surgeon General’s My Family Health Portrait tool provides consumers with a free and easy way to record their family health information. Consumers are able to organize their family history information and share it with their family and health care professionals.
During this Thanksgiving holiday, I hope you and your family will take a few minutes to create a family health portrait. Learning your family’s health history is a great way to invest in the future of your health and your family’s health.