This year, we commemorate World AIDS Day during the 30th year since the first reported cases of AIDS, a milestone that has led many to reflect on how far we have come since those dark days when HIV infection was almost always fatal. Remarkably, three decades of scientific progress in HIV/AIDS prevention and treatment have brought us to a time when we can begin to imagine an AIDS-free generation.
In those 30 years, the National Institutes of Health (NIH) has established and supports the world?s leading research program on AIDS. Beginning with a drug called zidovudine, or AZT, NIH scientists and grantees, in partnership with pharmaceutical companies, have developed more than 30 antiretroviral drugs for the treatment of HIV/AIDS and determined optimal combinations for their use. In parts of the world where HIV infection can be accurately diagnosed and where individuals have access to and can afford, tolerate and adhere to these medications, life expectancy can be dramatically increased.
Yet we know that to end the HIV/AIDS pandemic, we must not only treat HIV infection but also prevent new infections from occurring. No single HIV prevention modality will suffice. Rather, a combination of scientifically proven HIV prevention tools will be required to end the pandemic. In collaboration with our sister agencies of the Department of Health and Human Services, other governments, nongovernmental organizations and scientists around the world, the National Institutes of Health is leading the effort to develop the scientific basis for an HIV prevention toolkit robust enough to support the goal of realizing a generation without AIDS.
As a result of NIH-sponsored research, we have known for some time that the use of antiretroviral drugs during pregnancy can prevent HIV transmission from mother to child. More recently, medically supervised adult male circumcision was shown to decrease by more than half the risk of female-to-male sexual transmission in communities where men are not circumcised. We also have long known that correct and consistent condom use can prevent sexual transmission of the virus.
But an extraordinary burst of new scientific advances in HIV prevention during the past 18 months is fueling additional prevention research that could accelerate the pace toward our ultimate goal of ending the HIV/AIDS pandemic. For example, several clinical trials have shown that taking an antiretroviral pill as pre-exposure prophylaxis (PrEP) once a day could reduce the risk of HIV infection in certain HIV-negative populations. In addition, scientists are beginning to uncover the mechanisms behind the modest first success of a vaccine regimen against HIV infection.
Moreover, a carefully controlled clinical trial conducted this past summer by the NIH HIV Prevention Trials Network demonstrated that treating an HIV-infected person with antiretroviral drugs can dramatically reduce the likelihood that the individual will transmit HIV to his or her heterosexual partner. This study provided further evidence that HIV treatment is prevention and can be a critical component of the HIV prevention toolkit.
Mathematical models indicate that the use of parallel approaches to HIV prevention in a community could dramatically change the trajectory of the HIV/AIDS pandemic. Such approaches could include scaling up medically supervised adult male circumcision, consistent and proper use of condoms, the prevention of mother-to-child HIV transmission, and substantially increasing the number of HIV-infected individuals who receive antiretroviral therapy.
Despite these advances, critical challenges remain. Recent epidemiologic studies continue to show an increasing incidence of HIV co-infections such as tuberculosis and hepatitis C; HIV co-morbidities; AIDS-defining and non-AIDS defining malignancies; and complications associated with long-term HIV disease and its treatment. NIH will continue to support basic research to better understand the HIV disease process and to hasten the development of new strategies to prevent or control HIV infection and potentially find a cure.
With great anticipation, we plan to gather with our colleagues from around the world next summer at the XIX International AIDS Conference in Washington, D.C., to determine the next steps in research that will help translate the recent advances in HIV prevention into action toward ending the pandemic. NIH will eagerly participate in this international dialogue and will continue to support and promote the discovery, development and scientific validation of HIV treatment and prevention tools until we achieve a world without HIV/AIDS.
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 http://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 http://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 http://www.oar.nih.gov/.
Information about federally-approved HIV prevention and treatment guidelines as well as access to HIV clinical trials can be found at http://www.aidsinfo.nih.gov/.
