Wednesday, April 12, 2017 The Nugget Newspaper, Sisters, Oregon
17
Vaccine, improved treatment key to control of HIV pandemic
By David Statth
Oregon State University
C O RVA L L I S
–
Development and widespread
use of a vaccine that’s even
partially effective against
HIV, along with more prog-
ress toward diagnosis and
treatment, offer the best
hopes for turning the corner
on a global pandemic that’s
still spiraling out of control,
researchers reported today.
Even though HIV and
AIDS can now be effectively
treated in most cases, actual
control of the epidemic is elu-
sive – not just in the develop-
ing world, but also the United
States, scientists said today
in a report in Proceedings
of the National Academy of
Sciences.
A new analysis of the pos-
sible future of HIV/AIDS, and
what steps might best help
address the issue, was pub-
lished by researchers from
Oregon State University and
the Yale School of Public
Health, in work supported
by the National Institutes of
Health.
Scientists have developed
a model of HIV progression,
transmission and interven-
tion tailored to 127 countries
around the world.
Data in the report show
that HIV infections are surg-
ing, millions of people who
have been diagnosed are not
getting treatment, and the
battle against the epidemic
would be hugely aided by a
vaccine.
Just since 2010, the global
prevalence of HIV infections
has increased to 37 million
individuals.
In 2014, 1.2 million people
in the U.S. were infected. The
good news is that 87 percent
of those infections have been
diagnosed, which is near the
United Nations target estab-
lished in 2013. The bad news
is that of those diagnosed
cases, only about half – 52
percent – of people known
to have HIV in the U.S. are
being treated. The U.S. is 50th
in the world in reaching U.N.
goals for diagnosis, treatment
and effective control.
“Both around the world
and in the U.S., HIV and
AIDS are still nowhere close
to being under control,” said
Jan Medlock, an associate
professor and mathemati-
cal epidemiologist in the
OSU College of Veterinary
Medicine, and lead author on
the new study.
“Given the efforts made
against HIV/AIDS and the
fact it can now be treated, the
continued rate of spread is sur-
prising,” Medlock said. “Even
the cost of drugs, at least for
the initial treatments, is rela-
tively low. But this problem is
still getting worse, not better,
and our research suggests the
value of prospective vaccines
could be very significant.”
Under the “status quo”
levels of intervention, the
research found, the world
may expect about 49 million
new cases of HIV infection
during the next 20 years. If
ambitious targets for diagno-
sis, treatment and viral sup-
pression are reached, 25 mil-
lion of these new infections
could be prevented, the study
concluded.
Adding a vaccine by
2020 that was even 50 per-
cent effective could prevent
another 6.3 million infections,
and might have the potential
to reverse the HIV pandemic.
A concern is that the goals
set by the United Nations for
diagnosis and treatment “may
be more aspirational than
practical,” the researchers
wrote in their study. The lat-
est U.N. targets, established
in 2014, are “95-95-95,”
meaning a 95 percent success
rate, by country, in diagnosing
HIV infections; treating those
infected; and achieving viral
suppression in those being
treated.
Some countries are near
that, others not even close. In
Botswana, 22 percent of all
people over age 15 have HIV,
but the diagnosis and treat-
ment goals are at 80-97-90.
South Africa has a similar rate
of infections but much less
effective treatment.
Civil unrest in Afghanistan
and Yemen, as well as harsh
drug laws in Indonesia, have
hampered screening and diag-
nosis, the researchers said
in their study. Malaysia, the
United States and India have
high rates of diagnosis but
struggle to engage people in
actual treatment.
“The U.S. approach to
controlling HIV infections
and treatment is grossly inad-
equate,” Medlock said. “We
diagnose people, but then they
aren’t getting the treatment
they need.”
Due to these concerns and
the large gap between goals
and current reality, the search
for an effective vaccine gains
even more importance, the
researchers said. They point
out that even achieving the
U.N. goals in many coun-
tries — including the U.S.
— would not be sufficient to
reverse the growth of people
living with HIV.
Vaccines already exist, but
are mostly in clinical trials
and have less effectiveness
than hoped for. One existing
candidate has about 60 per-
cent efficacy for the first year
after vaccination, dropping to
31 percent efficacy 3.5 years
later. Last November, a modi-
fied version of this vaccine
began large-scale, phase-three
trials in South Africa, with
hopes for higher efficacy.
However, even lacking
complete efficacy, vaccines
could be crucially important,
the new analysis showed.
Even without improvements
in current global levels of
diagnosis, treatment and viral
suppression, the study sug-
gested that a vaccine with 50
percent efficacy could avert
17 million new HIV infec-
tions during the next 20 years.
A combined approach of
better diagnosis, treatment
and a vaccine is still the best
bet, the report concluded.
Especially helpful would be
to target interventions to high-
risk groups.
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