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“The treatment was already very effective back then”, he said, “but it was not convenient nor well tolerated. It continues to be effective, but is now much simpler. The number of pills per day has dropped and side effects, both a short and long-term, have been addressed. Lipodystrophy used to be a very important side effect, and has now almost disappeared.”
He said that another major step had been in improving life expectancy. “A person infected with the HIV virus probably now has a similar life expectancy than a same age and gender person in the general population” he said.
Jose Gatell, MD, said the advances in development of effective medication had an enormous impact in the fight against AIDS. “The pharmaceutical companies have done an extraordinary job,” he pointed out. “In less than five years they have put out 20 effective drugs. You can’t blame them for not doing their duty. The drugs are expensive, certainly, but the job has been done and the drugs are there. We now have to settle the price negotiation.”
The challenge remains, however, to secure the necessary commitment from the international community to improve access to anti-HIV treatments. “We are very fortunate to work in a western European country with no barriers to access treatment,” he said. “All therapy is free for everyone who needs it. This is not the situation in many other countries. What we can do is provide scientific evidence that anti retroviral treatment is very effective. It is also good for public health because it will reduce overall transmission of viruses. But policy makers need to move ahead and make the treatment available to everyone who needs it. The evidence is there and the ball is in the court of the politicians and policy makers.”
According to Jose Gatell, a top priority for HIV research and care should be on prevention through pre exposure to prophylaxis. “This can come through preventive vaccine, changing the behavior of the patient and extending the number of patients with access to treatment in order to limit HIV transmission,” he said. “There are classic ways to prevent infectious disease, through education and economic improvements. It is imperative to change people’s sexual behavior, the habits of the populations. I think that there are two components. The first is to have access to information, and the second is to be in a position where you are able to use that information.”
He explained that one aspect does not necessarily give rise to the other. “Women in sub-Saharan Africa may know that having sex without condoms is dangerous for transmission but they may or may not be empowered to apply that to their daily lives,” he said. “This is one of the big problems in places like SE Asia, also. Often, women are not empowered enough to be able to apply the knowledge they have.” Worldwide guidelines do exist regarding providing treatment and care, but the persistent question is how could we improve the implementation of the guidelines in these countries?
As a practicing clinician in Europe, Jose Gatell is not in a position to directly influence remote communities in developing countries, yet the process is the same. “I work in a large hospital,” he said. “From my desk, I can contribute to AIDS prevention by educating our patients and encouraging them to get treated. I can ask our patients to communicate their situation to their partners. Our contribution to prevention is mainly to treat as many patients as possible to avoid transmission. If a patient receives treatment then their viral load will be lower.”
Strikingly, though, in Europe, many patients newly diagnosed with HIV are already at an advanced stage, resulting in calls for a more coordinated action to improve early diagnosis. “Sometimes patients come late to their doctor for diagnosis,” Jose Gatell explained, “and others, despite knowing they are HIV positive; don’t seek medical attention until years later. We need to improve education and let people know they must seek treatment as soon as they are diagnosed.”
“There are various recommendations by private and public agencies towards trying to improve the situation of early diagnosis. Every year in the western world we are trying to quantify this problem of late diagnosis to improve the situation one way or another.”
He explained that within Europe, countries sometimes choose different methods. “In France, they are moving towards an aggressive approach towards early diagnosis, whereas in Spain it is more conservative. In France, they are considering the recommendation of annual HIV testing for everyone, irrespective of medical history, unless you deny permission. A more conservative way is to educate health professionals and doctors so they bring up the question to all patients, especially if the patient has been engaged in risky activity.”
Finally, Dr Gatell was quietly hopeful for the future of preventative vaccines. “The good news is that about two years ago there was one trial on preventative vaccine that shows protection capacity of 30%,” he explained. “This is a proof of concept but it is far from what we need. The majority of effective preventative vaccines have 80-90% success rate to be viable. A preventative vaccine may be feasible but there is still a long way to go until this will become a reality.”
You can hear more from Jose Gatell and our world-class faculty at ISHEID 2012, as we search together for a cure to AIDS and other emerging infectious diseases.
If you want to join the debate and hear the latest on global HIV treatments join us for the ISHEID Congress in Marseille, 23-25 May 2012.
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