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The Greatest Medical Success Story of Our Generation

Posted: 30/11/11 16:40

Human immunodeficiency virus (HIV) first hit the headlines in the medical world in 1981 when five young homosexual men were reported with an pneumonia infection that was known to be associated with a damaged immune system, two of whom died immediately and the other three shortly afterwards.

At this time there were many unknowns including whether or not this was a bug and, if so, how it was passed on from person to person. What was known was that it was likely to be infectious and the disease was rapidly fatal. Looking back it is fairly unsurprising that these unknowns and the speed that those infected were dying combined to create an unprecedented hysteria in the media alongside a tide of stigma, discrimination and homophobia aimed at those with the infection.

Thankfully, 30 years hence we can celebrate enormous progress both in terms of a change in popular attitude and advancements in our understanding of the virus and how to treat it.

It is estimated that by 2012, there will be over 100,000 living with HIV in the UK, (there are approximately 30 million people living with HIV worldwide). Whilst the spread of HIV has been prolific, drug development in the fight against HIV has also been prolific. Three decades of scientific advancements have led to the discovery of the virus, a greater understanding of how the virus affects the immune system, and a plethora of drugs that work effectively against the virus.

Where access to treatment and care exists, HIV has been transformed from a life-threatening infection into a chronic condition which can be managed with medication. In these communities, stigma and discrimination still exist but to a much lesser extent.

The story of HIV drug development probably represents the greatest medical success story of our generation. For approximately five years, no medication existed for the treatment of HIV. In 1987 the first anti retroviral drug AZT was approved in the United States. When taken on its own it had minimal clinical impact and the high doses used were associated with significant toxicity.

In the mid 1990s it was realised that taking cocktails of drugs were more effective than a single drug alone which led to the phrase "triple therapy" being used. Whilst the survival benefit was clear, patients often struggled with taking large numbers of tablets two or three times a day with significant side effects. Recognising this problem, drug companies worked together to produce the "holy grail" of HIV treatment - one pill a day. This alongside enhanced safety profiles is revolutionising care. Even on this very day, we are witnessing the launch of a new product (ironically the 30th), rilpivirine, which continues the innovation story, simplifying the dosing regimen.

Some of the main issues facing the world today revolve around access to effective therapy. Lack of awareness of diagnosis resulting in late diagnosis can have adverse effects on the infected individual but it can also result in onward transmission of the virus. Mother to child transmission is a classic example. In counties where universal access to antenatal HIV testing and treatment exists, HIV has virtually been eradicated in children. Elsewhere, approximately 1000 children under 15 years old are infected every day and an estimated 270,000 children die each year from an HIV related cause, the majority from Sub-Saharan Africa.

What does the future hold? Sadly, the cure remains elusive and there is no effective vaccine in the pipeline so the major challenge is to make everyone aware of their HIV infection and start treatment as soon as possible. Not only does prompt treatment significantly increases the life expectancy of a person living with HIV, but recent studies have shown that effective treatment of HIV+ persons significantly reduces infectivity. In the UK, we need to find a way to reach out to the quarter of the 100,000 currently living with HIV who are unaware of their infection.