AIDS Is Not Over

Left to right: Dr. Lishomwa Ndhlovu, chair of amfAR’s Scientific Advisory Committee, with three of the people who have been cured of HIV—Marc Franke, Adam Castillejo, and Paul Edmonds­—and amfAR grantee Dr. Jonah Sacha

By Jeffrey Laurence, M.D.

People have heard that AIDS is over. After all, we’re not in crisis mode now as we were in the 1980s and early 1990s. Antiretroviral therapy (ART) is highly effective and available to many. And didn’t yesterday’s newsfeed report on a cure?

True, we’re not in crisis mode. People living with HIV (PLWH), along with researchers, policy makers, and other stakeholders, have led the charge to make sure a compassionate, evidence-based response to HIV/AIDS is the standard that governments should meet.

True, ART has improved the health of PLWH immensely by suppressing the virus to the point where they are capable of living a normal lifespan without the constant threat of opportunistic infections. Today we even have regimens that require only one pill a day or one injection every couple of months.

All five (and a possible sixth) were cured via stem cell transplant, a form of bone marrow transplant. However, this procedure is high risk—a last-ditch option for people living with both HIV and certain blood cancers and justified because the primary goal is to cure their cancer.

In addition, the procedure is not scalable as it’s dependent on donor banks that are vastly under-represented in terms of stem cells from people of color and who lack the critical mutation that makes these cure efforts possible. We need a cure that works for everyone, everywhere.

We need a cure because ART is not a perfect solution—anti-HIV meds and the continued presence of HIV in the body can have negative impacts. Despite maintained undetectable viral loads and high T cell counts with ART, PLWH are still prone to develop certain  cancers and heart conditions at greater frequency than people, matched for age and cancer/cardiac risk factors, without HIV.

And while many governments have bettered their track records in responding to the needs of people living with and at risk for HIV, AIDS responses are still compounded by such factors as inadequate health-care infrastructure and pockets of bigotry mired in morality around sex and drug use.

AIDS is not over, but why we need a cure deserves more context and nuance than this slogan. That’s why over the next few pages this special feature draws on the attitudes and insights of the American public, researchers, and members of the HIV community to answer the question: Why do we need a cure?

Dr. Laurence is amfAR’s senior scientific consultant and a professor at Weill Cornell Medical College.