IDSA 2011: A Brief History of HIV/AIDS, Part II


Pioneering researcher Michael Saag, MD, finished his whirlwind tour of the history of HIV and AIDS and looked toward the future-and the end of AIDS.

BOSTON, MA—Having taken the audience at the opening plenary session of the annual meeting of the IDSA from the roots of AIDS in a Cameroonian chimp up to the discovery of the virus that causes it (HIV) and the first effective treatment (AZT), Saag continued on toward the present. (To read the first part of this article, click here.)


Saag recalled the days when AIDS activists bitterly criticized researchers and the government for failing to develop an effective treatment for AIDS and posited that both sides—activists and investigators—misunderstood the other. However, he acknowledged that activist Larry Kramer, whose group ACT UP took “Silence=Death” as its motto and was famous for its confrontational style, did more than anyone to help push for better AIDS treatments.

As AZT was found to lose effectiveness within 18-24 months, other anti-retroviral drugs were developed that could precipitously reduce the viral load. When used during pregnancy, they could even eliminate perinatal transmission.


Yet more drugs were developed, making possible the sort of therapy that is common today and, when used properly, can keep people with HIV alive for a near-normal lifespan.


Still more medications were developed, including some that combined multiple drugs in a single pill. The importance of early treatment and treatment regardless of CD4 level was established, with ongoing evidence of complications found in those who delayed treatment.


Challenges remain, and important new discoveries continue to be made. The importance of circumcision, for instance. Studies have shown that there is a roughly 50-60% reduction in HIV risk for those who have been circumcised. The notion of treating those who are at high risk of contracting HIV, or pre-prophylaxis, has also gained ground, as has a push to increase diagnosis rates. Currently, 21% of those with HIV are undiagnosed, and those who don’t know they are infected account for 50% of new transmissions.

Looking toward the future, if anti-retrovirals are successfully provided in Africa, death rates can be radically reduced. “We’re going to have to take a long view over the next 30 years,” Saag said. “But I think if we keep our energy going and we keep our focus, and we stay true to the cause, we might actually be able to say, ‘We were a part of the end of AIDS.’”

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