In the 1980s and early 1990s, AIDS was a virtual death sentence. Patients had to endure numerous hospitalizations to treat opportunistic infections before they eventually succumbed to the illness. The disease was also very costly to the health care system and society as a whole. Discovery and introduction of new medicines over the past 15 years have greatly improved the outlook for HIV patients and reduced the need for costly health care services.
In the 30 years since the discovery of the HIV virus, 31 medicines have been approved to treat HIV infection, and a 20 year old diagnosed with HIV can expect to live 50 years.[i] With nearly 90 medicines in development for the treatment of HIV/AIDS, promising treatment gains are on the horizon.
“There is a stunning contrast between how I felt as a physician-scientist in the 1980s and the optimism I feel today as more infections are prevented and lifesaving drugs increasingly become available throughout the world.” —Anthony Fauci, MD, Director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Washington Post, 2011[ii]
Medical Advances in HIV/AIDS
Life with HIV/AIDS has changed dramatically.
Patients diagnosed with AIDS in 1990 could expect to live only months, during which time they would be likely to contract a number of opportunistic infections. The only treatment available had to be taken every four hours—around the clock—and had serious side effects. Since the approval of the anti-retroviral treatments (ART) in 1995, the AIDS death rate has dropped by 83%.[iii] If diagnosed today, a range of treatment options, including different combinations of drugs, often keep patients symptom-free for years.
"The development of [antiretroviral therapy (ART)] has been the one of the greatest accomplishments of basic and translational research: approximately 30 anti-HIV agents are licensed and evidence-based guidelines have been developed for their optimal use. Combination ART with at least 3 drugs has resulted in substantial reductions in morbidity and mortality in both rich and poor countries. Antiretroviral therapy has been simplified to the point where treatment with a single, multidrug pill once a day is possible with generally manageable adverse effects. With improvements in ART, the estimated life expectancy of certain HIV-infected patients now approaches that of uninfected individuals. Antiretroviral therapy also has proven efficacious in HIV prevention, reducing the risk of mother-to-child transmission and serving as postexposure prophylaxis for individuals exposed to HIV.” —Gregory K. Folkers, MS, MPH; Anthony S. Fauci, MD, National Institute of Allergy and Infectious Diseases, Journal of the American Medical Association, 2010[iv]
HIV is a rapidly mutating virus but new treatments are keeping ahead.
Researchers are always in a race against time with HIV because the virus adapts to existing treatments making them less effective. In recent years new HIV treatments have continued to be approved, including a new personalized HIV treatment which represents a new class of medicines.[v] New treatments such as this one represent important options for patients whose infection is not responding to available medicines.
Thanks in part to continued treatment advances, HIV death rates are continuing to fall.
The most dramatic drops in HIV death rates occurred following the introduction of ART with decreases averaging 33% per year between 1995 and 1998. From 1999 to 2008, death rates continued to drop by 5% per year. The most recent data has shown continued decline in death rates: between 2009 and 2010, death rates fell another 13%.[vi] Among people aged 25-44 years death rates fell by more than one-half in 2007 alone (the most recent age group-specific data).[vii]
Hospitalizations have dropped.
Since ART became available the number of people with HIV increased by 28% between 1996 and 2000 primarily because of rising survival rates. Hospital rates, however, fell by 32% over the same period.[viii]
University of Chicago economists report that each patient with HIV now lives 15 years longer than they would have in the 1980s.[ix]
Earlier use of medicines recommended.
Based on growing evidence that unchecked HIV virus is a greater risk than adverse reactions to the medicine,[x] new guidelines issued by the International AIDS Society are recommending earlier initiation of ART even in many cases when the patient is asymptomatic.[xi] These guidelines recommend treatment when the CD4 cell count drops below 500/microlitre and should even be considered before blood count drops to the level. Previous guidelines had recommended treatment when the CD4 count fell to 350/microlitre.[xii]
Use of HIV medicines helps prevent transmission.
A recent study reported in The Lancet and carried out in Africa found that initiation of ART reduces the risk of transmission from an infected individual to their sexual partner by 92%.[xiii] A large new study sponsored by the National Institute of Allergy and Infectious Disease echoes this result, finding that early initiation of ART reduced transmission by 96%. The international study was stopped and unblinded four years early because the findings were so robust.[xiv]
Medicines have become easier to use – adding to their effectiveness.
The first once-daily one-pill combination tablet was approved for treatment of HIV in 2006.[xv] This medicine combines the active ingredients of three widely used antiretroviral drugs into a single dose. The single-pill treatment regimen is a marked improvement over previous HIV/AIDS treatments, which often require patients to take multiple pills every day. Missing doses can lead the virus to mutate and become resistant to medicines. Because this new pill will make it easier for patients to remember to take their medicine it is believed that “widespread use of the combination drug could potentially even slow the spread and evolution of the AIDS epidemic itself."[xvi]
"Antiretroviral therapy of HIV infection has changed a uniformly fatal into a potentially chronic disease…. Patients who can access and adhere to combination therapy should be able to achieve durable, potential lifelong suppression of HIV replication.” —Paul Volberding, MD and Steven Deeks, MD, University of San Francisco, The Lancet, 2010[xvii]
Innovation in HIV/AIDS: The Story of Selzentry®
The 2010 Discoverers Award was awarded to Manos Perros, Ph.D., Anthony Wood, Ph.D., and Elna van der Ryst, Ph.D. for the discovery of Selzentry® (maraviroc). When it was approved in 2007, Selzentry was the first oral HIV drug in a new class in over a decade. For patients running out of options either because the virus had become immune to existing medications or they could not tolerate existing drugs, Selzentry offered new hope. Read more
New HIV/AIDS Medicines Offer Hope for the Future
To help fight the global HIV/AIDS epidemic, biopharmaceutical researchers are testing nearly 90 medicines to treat HIV/AIDS and related conditions and intensifying their efforts to develop preventative vaccines. These include 27 vaccines and 49 antivirals now in human clinical trials or before the Food and Drug Administration awaiting approval. Read more
HIV/AIDS Disease Resources
To view a listing of additional resources on HIV/AIDS available at Innovation.org—including charts, a medicines in development database, clinical trials resource, and much more—check out the HIV/AIDS disease resource page. Learn more
[i]A. Fauci, "After 30 years of HIV/AIDS, real progress and much left to do," Washington Post, 27 May 2011.
[iv]G. Folkers and A. Fauci, “Controlling and Ultimately Ending the HIV/AIDS Pandemic: A Feasible Goal,” Journal of the American Medical Association, 304 (21 July 2010): 3, 350-351. [v]Food and Drug Administration, “FDA Approves Novel Antiretroviral Drug,” 6 August 2007, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108960.htm [vi]S.L. Murphy, et al., “Deaths: Final Data for 2010,” National Vital Statistics Reports 60, no. 4 (2012): 43 (table 2), http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf (accessed 2 March 2012). [vii]Center for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2010 with Special Feature on Death and Dying, page 39,(Hyattsville, MD: 2011) http://www.cdc.gov/nchs/data/hus/hus10.pdf. [viii]F.J. Hellinger, “HIV Patients in the HCUP Database: A Study of Hospital Utilization and Costs,” Inquiry, 2004.
[ix]A.B. Jena, T.J. Philipson, Innovation and Technology: Adoption in Health Care Markets, The AEI Press, Washington, DC, 2008. [x]M.M. Kitahata et al, NA-ACCORD Investigators, “Effect of Early Versus Deferred Antiretroviral Therapy for HIV on Survival,” New England Journal of Medicine, 360 (2009): 18,:1815-1826.
[xi]M.A. Thompson, et at., “Antiretroviral Treatment of Adult HIV Infection: 2010 Recommendations of the International AIDS Society – USA Panel,” Journal of the American Medical Association, 304 (21 July 2010): 3, 321-333. [xii]S.M. Hammer, et al, “Antiretroviral Treatment of Adult HIV Infection: 2008 Recommendations of the International AIDS Society – USA Panel,” Journal of the American Medical Association, 300 (6 August 2008): 5, 555-570. [xiii]D. Donnell, et al., “Heterosexual HIV-1 Transmission After Initiation of Antiretriviral Therapy: A Prospective Cohort Analysis,” The Lancet, 375 (June 2010): 9731, 2091-2098. [xiv]National Institute of Allergy and Infectious Diseases, “Treating HIV-infected People with Antiretrovirals Protects Partners from Infection: Findings Result from NIH-Funded International Study,” NIH News, 12 May 2011, http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx. [xv]Food and Drug Administration, “FDA Approves the First Once-A-Day Three-Drug Combination Tablet for Treatment of HIV-1,” press release, 12 July 2006, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108689.htm. [xvi]D. Hamilton, “New AIDS Pill Simplifies Treatment – FDA Is Close to Approving A Once-a-Day Medicine That Combines Three Drugs,” Wall Street Journal, 10 July 2006. [xvii]P.A. Volberding and S.G. Deeks, “Antiretroviral Therapy and Management of HIV Infection,” The Lancet, 376 (3 July 2010): 49-62.