Advances in AIDS treatment spur clinicians to focus on prevention

From: The Providence Journal – Providence, R.I.
Author: Bryan Rourke
Date: Dec 2, 2011, Page: A.1 Local News

Another year passes. Another 100 Rhode Islanders contract HIV, the cause of AIDS. Thursday was World AIDS Day.

Rhode Island officials expressed both concern and hope over improved medications.
“We’re concerned people aren’t protecting themselves against HIV,” said Dr. Karen Tashima, director of Miriam Hospital’s HIV Clinical Trials Group. “Is it that they’re not aware of how serious an HIV infection can be or that they think can just take a pill a day?”
People should maintain precautions, officials say, and increase testing. That can not only curb the virus, they say, but eliminate it. That’s the hope.

We have something right now that can cure HIV around the world,” said Dr. Annie De Groot, founder and scientific director of Global Alliance to Immunize Against AIDS, based in Providence, and director of the University of Rhode Island’s Institute for Immunology and Informatics. “It’s treatment.” In January, De Groot said, she hopes to prove this in Mali, which she calls “the frontline of HIV.”

Closer to home, HIV persists in Rhode Island. Every year, for the last 10 years, 106 to 124 Rhode Islanders have contracted HIV. “The young guys now, who I call the Facebook generation, may perceive HIV as an older man’s disease,” said Thomas Bertrand, director of AIDS Project RI. “There are generational issues.”

A generation ago, an HIV diagnosis was a death sentence. Now, it’s a long, pill-filled life.
“Because we have such great therapies now, we can confidently tell them you will do well,” Tashima said.

Prevention is preferred. Testing is essential. Of the 1.2 million Americans infected with HIV, 20 percent don’t know it, according to the Centers for Disease Control and Prevention.

AIDS Project RI offers free and fast testing: results in 20 minutes.

Tashima said she hopes for more HIV testing in Rhode Island as a result of the state dropping its written-consent requirement. “The written consent set up a barrier,” Tashima said. “It made it seem like a bigger deal.”

Of the 106 new HIV cases in Rhode Island last year, 6 involved drug users, 13 involved heterosexuals and 54 involved gay men; 33 were of unknown origin. “It’s a persistent challenge,” Bertrand said. “That could be a result of how the doctor asks the question, or the patient’s comfort with the doctor.” Dismissing HIV as a manageable disease, Bertrand said, misses the emotional stigma and the financial expense. HIV, he said, costs $650,000 to treat over the course of an average patient’s life.

Immediate and aggressive treatment, De Groot said, is the answer. She founded Global Alliance to Immunize Against AIDS in 2001. “Every vaccinologist’s dream is to develop the vaccine,” De Groot said. “Why not have that dream?”

That dream, De Groot reports, is fast becoming reality.

De Groot’s organization, which has received $3 million in funding from the National Institutes of Health, has developed four vaccines that “showed promise,” and is working on a fifth. However, De Groot said, the solution to the HIV problem already exists.
“If you treat people the minute they are HIV infected and bring down their virus to zero with current medications, there’s no transmission of HIV,” De Groot said.

This approach was promoted last May in the New England Journal of Medicine
. The author of that article, Dr. Myron Cohen, a professor of medicine at the University of North Carolina, and a promoter of that approach, Dr. Julio Montaner, a professor of medicine at the University of British Columbia, are this year’s winners of Global Alliances’s “Hope is a Vaccine Award.”
Applying the approach, De Groot said, simply requires the directing of funding.
We lack political will,” she said. “There are those who think it’s perhaps more important to spend billions of dollars on defense.”

In January, De Groot said, she intends to approach the government in Mali, where her organization operates a clinic, and seek permission to apply the aggressive testing/treatment approach. “We’re in one of the poorest villages in the world,” De Groot said. “If it can work in Mali, it can work anywhere.”

AIDS and HIV in Rhode Island
Here is a statistical picture of AIDS and HIV in 2010.
4,140 to 4,533 Number of people living with HIV and AIDS
106 New HIV cases diagnosed
54% Percentage with male-to-male sex as “risk factor”
30% Percentage of cases with unidentified risk factor
1,486 Number of AIDS deaths, 1990-2010
75% Decline in AIDS cases, 2004-2010
The Providence Journal / Bob Thayer (401) 277-7267
Credit: Bryan Rourke, Journal Staff Writer