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Antiretroviral Therapy Does Not Completely Eliminate the Risk of HIV Transmission between Heterosexual Couples

It is well known that by lowering HIV viral load in the blood and genital fluids, effective combination antiretroviral therapy can dramatically lower the risk of transmitting the virus. Some researchers, in fact, have suggested that expanded use of early therapy might significantly reduce HIV incidence on a population basis.

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AIDS Healthcare Foundation Calls for Halt to U.S. Government Funding of HIV Vaccine Research

Michael Weinstein, director of the AIDS Healthcare Foundation (AHF) of Los Angeles, the nation's largest provider of HIV/AIDS medical care, has called for the U.S. government to stop funding AIDS vaccine research and instead focus on funding that provides anti-HIV treatment to patients in need.

As previously reported by HIV and Hepatitis.com, the National Institutes of Allergy and Infectious Diseases (NIAID) held a meeting with HIV researchers in late March to re-evaluate the agency's nearly $500 million vaccine research program, in the wake of disappointing results that led to the cancellation of the STEP vaccine trials.

Following is the text of Weinstein's editorial published in the April 4, 2008 Los Angeles Times:

Stop AIDS Vaccine Research: The U.S. Should Focus Its Funds on Providing Treatment to People in Need

As the catalyst for the call to halt U.S. government funding of AIDS vaccine research, I was somewhat dismayed by The [Los Angeles] Times' recent editorial, "Revamping AIDS vaccine research," that took issue with the AIDS Healthcare Foundation's position without fully understanding it.

Our position is this: In light of over 20 years of failed AIDS vaccine research on which billions of dollars of U.S. taxpayer money have been spent, we believe it is simply unconscionable for the U.S. government to continue such wasteful funding while millions worldwide die for want of access to the AIDS research breakthrough that occurred more than 10 years ago -- life-saving antiretroviral treatment.

There are not just two or three AIDS vaccine candidates that have failed. Every AIDS vaccine candidate to date has failed. Leading scientists, including Nobel Prize winner Dr. David Baltimore, have even gone so far as noting that we are no closer to the discovery of an AIDS vaccine today than we were 20 years ago.

In fact, not only have all the AIDS vaccine candidates failed, the latest was hurriedly pulled from clinical trial after the vaccine was found to actually put people at a significantly increased risk of contracting HIV. Twenty-seven years into the AIDS pandemic, countless billions in taxpayer (and private) vaccine funding later, and our leading researchers can't even meet the most fundamental tenet to "do no harm."

Meanwhile, as AIDS vaccine candidates repeatedly fail, consensus continues to build that successful antiretroviral treatment offers a vaccine-like effect -- rendering most HIV-positive people noninfectious. This treatment offers a far more enduring benefit than anything that AIDS vaccine research has or will offer. At the same, more than 33 million people worldwide continue to live with -- and die from -- HIV/AIDS. Barely 2 million in the developing world have access to the treatment that we know works to save lives -- and reduces the likelihood of transmission.

The Times' editorial mentions the billions the U.S. gives to AIDS research and relief. While at first blush this seems like a generous amount, this funding provides treatment and support services for only a small fraction of the people worldwide living with HIV/AIDS who may be in need. With lifesaving antiretroviral treatment costing as little as $300 per patient per year in Africa and elsewhere in the developing world, the $700 million or so the U.S. currently spends annually on fruitless AIDS vaccine research could save an additional 2.3 million lives around the world each year. As successful antiretroviral treatment renders people less infectious, it would also help break the chain of new infections globally and bring the number of new infections down.

To be clear, what the AIDS Healthcare Foundation called for last week is a halt to U.S. government funding of AIDS vaccine research. Private donors and foundations may continue to fund whatever vaccine research they may deem appropriate. Regarding The Times' support for the NIH getting back to basic research (which the NIH appeared to commit to last week), Times' readers -- and writers -- should know that the NIH already funds basic AIDS research to the tune of several hundred million dollars per year, separate from its $700 million annually in AIDS vaccine research funding.

Early next week, the AIDS Healthcare Foundation will call on congressional leaders in Washington to demand a Government Accountability Office report on the history and current state of AIDS vaccine research. It is our hope that through the lens of dispassionate third-party investigators, a clearer light will be shone on the folly of government largesse continuing to blindly fund AIDS vaccine research.

Currently, the AIDS vaccine establishment continues its taxpayer-funded, repeatedly unsuccessful search for a preventive AIDS vaccine while an alternative many have seen work on multiple levels -- successful antiretroviral treatment as both treatment and prevention -- goes unchampioned.

This is why the AIDS Healthcare Foundation believes that it is time to pull the plug on U.S. taxpayer financing of the search for a vaccine, and leave it to private donors to back what has been and continues to appear to be a fruitless goal. To continue to invest hundreds of millions of dollars in a government-funded search for an AIDS vaccine in the vain hope of success someday while millions worldwide suffer and die is simply unacceptable when other currently available strategies offer practical -- and effective -- alternatives.

4/04/08

Sources

M Weinstein. Stop AIDS Vaccine Research: The U.S. should focus its funds on providing treatment to people in need (Editorial). Los Angeles Times. April 4, 2008.

Los Angeles Times. Revamping AIDS vaccine research (Editorial). April 1, 2008.

Adult Circumcision Reduces Men's Risk of HIV Infection

Adult male circumcision is emerging as a potentially important public health measure for reducing the risk of HIV transmission to men during heterosexual sex. A previous study in South Africa showed that elective circumcision reduced men's HIV infection rate by 61% (Auvert et al 2005).

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Swiss Experts Claim HIV Patients with Undetectable Viral Load Who Adhere to Treatment Cannot Transmit the Virus to HIV Negative Partners

Several HIV/AIDS advocacy groups and scientists have expressed dismay and disbelief about the findings of a report from The Swiss AIDS Commission, based on several studies, that individuals using anti-HIV drugs cannot transmit HIV infection to their sex partners, if they have undetectable viral loads (< 40 copies/ml) for at least six months and if they remain adherent to their treatment regimens.

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