by Bob Roehr
The year 2007 was the best of times and the worst of times for HIV/AIDS.
The good news – two new classes of drugs for treatment were approved by the FDA and became available for use. It was the most important addition to therapy since the introduction of protease inhibitors more than a decade ago.
The CCR5 entry inhibitor maraviroc came first, approved in August. It prevents HIV from entering the cell in the first place. In October the integrase inhibitor raltegravir followed, it blocks the virus from becoming part of the cell DNA and making additional copies of the pathogen. Both must be used in combination with other active drugs or the virus will quickly develop resistance to them.
Prevention science took a double blow this year. In January, a trial of microbicides in Africa was stopped when women using the vaginal gel were found to be more likely to become infected with HIV than those using a placebo gel.
More shocking was the news in September that the leading HIV vaccine trial, run in North and South America, was being stopped for the same reason–those who received it were more likely to become infected than those who did not. Researchers still do not understand why.
There was at least the appearance of some good news on the prevention front as UNAIDS cut its estimate of the number of people infected with HIV from 40 million to about 33 million in its annual report issued in November. The numbers reflected better estimates, not a change in the number of people living with the virus.
Even while international estimates were falling, there were rumblings that estimates of new infections in the US were going up – by as much as fifty percent, to 60,000 a year. This reflects better data from testing and names reporting that results in cleaner data. But the Center for Disease Control (CDC) refused to release those new numbers until they undergo outside expert review.
Prevention activities continue to fade away in the US, as the CDC budget has been held steady since 2000, with the purchasing power of those dollars declining by 19 percent.
The treatment side has fared little better. The modest increases in funding for AIDS services under the Ryan White CARE Act have not kept pace with the larger number of people the program must serve due in part to the drugs working so well with more people living longer, healthier lives.
The pressure on services will likely get worse in 2008 as the CDC's program to test more people at risk to learn of their HIV status, kicks into higher gear. More people will learn they are HIV-positive and need services. Finally, even the modest increase in funding gained in the appropriations process may be at risk with Congress' failure to pass a budget the President will sign.
