. . . And Will We Ever Cure AIDS?
by DR. DAVID HO
Predicting the future is risky business for a scientist. It is
safe to say, however, that the global AIDS epidemic will get much
worse before it gets any better. Sadly, this modern plague will
be with us for several generations, despite major scientific
advances.
By January 2000, the AIDS epidemic will have claimed 15 million
lives and left 40 million people living with a viral infection
that slowly but relentlessly erodes the immune system. Accounting
for more than 3 million deaths in the past year alone, the AIDS
virus has become the deadliest microbe in the world, more lethal
than even TB and malaria. There are 34 developing countries where
the prevalence of this infection is 2% or greater. In Africa
nearly a dozen countries have a rate higher than 10%, including
four southern nations in which a quarter of the people are
infected. And the situation continues to worsen; more than 6
million new infections appeared in 1999. This is akin to
sentencing 16,000 people each day to a slow and miserable death.
Fortunately, the AIDS story has not been all gloom and doom. Less
than two years after AIDS was recognized, the guilty agent--human
immunodeficiency virus, or HIV--was identified. We now know more
about HIV than about any other virus, and 14 AIDS drugs have been
developed and licensed in the U.S. and Western Europe.
The epidemic continues to rage, however, in South America,
Eastern Europe and sub-Saharan Africa. By the year 2025, AIDS
will be by far the major killer of young Africans, decreasing
life expectancy to as low as 40 years in some countries and
singlehandedly erasing the public health gains of the past five
decades.
It is Asia, with its huge population at risk, that will have the
biggest impact on the global spread of AIDS. The magnitude of
the pandemic could range from 100 million to 1 billion,
depending largely on what happens in India and China. Four
million people have already become HIV-positive in India, and
infection is likely to reach several percent in a population of
1 billion. Half a million Chinese are now infected; the
trajectory of China's epidemic, however, is less certain.
An explosive AIDS epidemic in the U.S. is unlikely. Instead, HIV
infection will continue to fester in about 0.5% of the
population. But the complexion of the epidemic will change. New
HIV infections will occur predominantly in the underclass, with
rates 10 times as high in minority groups. Nevertheless, American
patients will live quality lives for decades, thanks to advances
in medical research. Dozens of powerful and well-tolerated AIDS
drugs will be developed, as will novel means to restore the
immune system.
A cure for AIDS by the year 2025 is not inconceivable. But
constrained by economic reality, these therapeutic advances will
have only limited benefit outside the U.S. and Western Europe.
A vaccine is our only real hope to avert a disaster unparalleled
in medical history. A concerted research effort was launched
three years ago in the U.S., and hints of promising strategies
are emerging from experiments in monkeys. But even if an AIDS
vaccine is developed before 2025, it will require an
extraordinary effort of political will among our leaders to get
it to the people who need it most.
Dr. David Ho, director of the Aaron Diamond AIDS Research
Center, was TIME's1996 Man of the Year |
