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Thu July 24, 2014
Effective New HIV Treatment Makes Researcher 'Hopeful' In Fighting Epidemic
MICHEL MARTIN, HOST:
This is TELL ME MORE from NPR News. I'm Michel Martin. We'd like to start today's program by talking about the latest developments in the fight against HIV and AIDS. The 20th annual International AIDS Conference is currently taking place in Melbourne, Australia. It's happening at a time when new options are being introduced to treat and prevent the virus. And one of the most talked about treatments is known as PREP. That stands for Pre-Exposure Prophylaxis. It's sold under the brand name Truvada. It involves taking a pill once a day to prevent HIV infections in populations that are at high risk, such as men who have sex with men. But even with all of the excitement at treatment breakthroughs, the conference started on a sad note. A number of longtime HIV-AIDS researchers were killed in the crash of Malaysia Airlines Flight 17 in Ukraine last week. We wanted to hear more about the conference and the latest developments in AIDS research, so we've called Dr. Anthony Fauci. He's the director of the National Institute for Allergy and Infectious Diseases at the National Institutes of Health. He's just back from the conference. And he's with us now. Dr. Fauci, welcome. Thanks so much for joining us once again.
ANTHONY FAUCI: Good to be with you. Thank you.
MARTIN: And I do want to express my condolences on the loss of these colleagues. You were close to a number of the people. So I'm so sorry, you know, for that.
FAUCI: Thank you.
MARTIN: I did want to ask what the mood was like at the conference. Did it cast a pall over things?
FAUCI: Well, it did in the beginning because, as everyone was getting off their own planes from all parts of the world - this is the international meeting that occurs every two years - the news spread throughout the conference immediately. And there was a deep feeling of sadness and loss. So expectedly, you would see that rather than the somewhat festive atmosphere that you usually see when people gathered together at the beginning of a meeting, it really was rather sad with a deep feeling of loss. As the meeting went on, it really transformed into - from a feeling of sadness and loss to one of inspiration to get the job done because colleagues who were lost really were the kinds of people that were very much enthusiastic about getting to the endgame of controlling this epidemic. So it became more of an inspiration as the days of the meeting went on.
MARTIN: And one of the reasons it was so tragic is that you do feel - as I understand it - within the community of HIV-AIDS research is that you are kind of closing in on it. Is that right?
FAUCI: Well, there's no doubt that this is an epidemic that was first recognized just about 33 years ago. So 33 years of work on this when the dark days of the early years were going in the wrong direction now is starting to make considerable progress in the arenas both of treatment and saving people's lives but also with prevention - and preventing infections that were at a terribly high rate in the mid-80s, the early 90s that are not throughout the world - in many cases- starting to turn around with the deflection and the curve due to the advances in treatment and prevention.
MARTIN: We talked about PREP three years ago on this program, and the World Health Organization recently recommended that those of high risk of contracting HIV should take the pill. Why is the public health community particularly excited about this developed?
FAUCI: Well, they're excited about because the clinical trials have now incontrovertibly shown that if used properly and people take the pill - and this is a pill that has two drugs in it that are highly effective against HIV. It's taken by people who are not infected as a prophylaxis or prevention to get infected and to prevent infection. And when you look at the data - if people actually take the pill - and one of the problems is people don't like to take pills, but those who do - the efficacy is greater than 90 percent. And that is very very impressive. So the World Health Organization and our own Centers for Disease Control and Prevention here in the United States are recommending that people in a few subcategories who are at particularly high risk should seriously consider taking this pre-exposure prophylaxis.
MARTIN: You know, I understand that in the scientific community there's a strong consensus behind it, but I understand that culturally among some groups, it's actually kind of a controversial thing for a number of reasons. I mean, you know, there are some people who think that it encourages more risky behavior - it could. And then there are other people who just look at the cost. At present, it costs about $35 per pill. That's about $13,000 a year. People say well, you know, condoms are cheap. So what do you think about that?
FAUCI: I think if you balance the advantages versus the disadvantages, in my mind and in the mind of virtually all of my colleagues in the scientific and public health arena - feel that it weighs heavily towards being beneficial. There are - there are those who say, understandably, that you're supposed to be using condoms. Everyone who is at risk should be using condoms. They feel that if this pill becomes available, people will stop using condoms. And yet, follow-up studies in the cohort from the original study show that by taking this pill or by having the pill available - this has not led to a behavior change in putting people at greater risk. It's just not the case. You can understand how people might feel that way, but it is not the case. It doesn't encourage risky behavior. And besides, it's not supposed to be used as a substitution for other types of prevention. It should be used to complement. But there are people who just won't use a condom. As much as you try to convince them how important it is, they don't. And this is a methodology of prevention that clearly works if used properly, and that's the reason why we're enthusiastic about the circumstances where people can benefit if they use it.
MARTIN: If you're just joining us, I'm speaking with Dr. Anthony Fauci. He's one of the country's leading HIV-AIDS researchers. He's director of the National Institute of Allergy and Infectious Diseases, and he just got back from the annual International AIDS Conference which is taking place in Melbourne, Australia right now. You know the new infection rates in this country have been relatively stable since the mid-1990s. I mean, obviously, we understand that this is a worldwide health issue. But just looking at the United States, the rates have grown among African-American men who have sex with men. And they're - you know, African Americans as a group are the ethnic group in the country still most affected and that the rates among young African-American men are particularly worrisome. Why is that, do you think?
FAUCI: It's a complicated array of sociological issues. The population of African-Americans in the United States is about 12 to 13 percent. And if you look at the number of new infections in general in the United States each year, about 50 percent of them are among African-Americans, and when you talk about African-American women, about 55 to 60 percent of all new infections among women are among African-American women. So what you said is entirely correct. The reason for that is really because of the predominance in African-American men who have sex with men. And the disenfranchisement of that population - the stigma associated with that among African men who have sex with men compared to Caucasians - men who have sex with men is really striking - a relative lack of community support - a stigma that is clearly out of proportion when you compare it to the Caucasian population. So we've got to, you know, access and embrace these people to get them involved in testing and counseling, to avoid infection if they are not infected - and if they are infected, to get them into therapy because we know, from this phenomenon called treatment as prevention, that when you treat people who are infected and get their viral load to below a detectable level, you dramatically diminish the likelihood that they will infect their sexual partners. So by accessing a relatively disenfranchised population and getting them into the care continuing and getting them into counseling and getting them into treatment can go a long way to reversing this really profound health disparity which is really - disfavors or puts at greater risk the African-American population.
MARTIN: Is it that this - is it that the networks to reach this particular group don't exist because they tend to be medically disenfranchised, right? - or as well as culturally disfranchised? Or is it that the networks exist but people don't use them?
FAUCI: It's a combination of both. If you compare the networks among African-American men who have sex with men compared to white men who have sex with men, the networks are much, much less in existence, and those that are in existence are not nearly as effective as they can be. So not only it's the stigma - it's when one looks, for example, in certain inner city areas - economically deprived people - people who have a variety of other sociological issues that impact on them - drug use - crime economic problems. All of those things contribute together with the stigma to make this a much more difficult population to be able to get into a program that would help them in counseling and getting them into care.
MARTIN: So at this juncture in our history and in the history of the fight against this epidemic, what are you most challenged by and what are you most hopeful about?
FAUCI: Well, I think what we're challenged by relates very much to what we're talking about right now. It's accessing populations - special populations. One of the most important discussions that took place in the Melbourne meeting was that rather than look at the AIDS pandemic as a homogeneous phenomenon - it's just not. It's really quite selective. There are hotspots of infection. There are global hotspots, and within countries, there are regional hotspots. And even within cities, there are hotspots, and what we need to do is to focus on people to try and access them to get them into a healthcare continuum. And so we have the tools. We just need to apply them. And what makes me hopeful is that I think if we put our energy and our commitment - our political and moral commitments - into this, it will happen.
MARTIN: That was Dr. Anthony Fauci. He's director of the National Institute of Allergy and Infectious Diseases. He's one of this country's top AIDS researchers. He's just back from the International AIDS Conference in Melbourne, Australia and was nice enough to join us from the National Institutes of Health, which is in Bethesda, Maryland. Dr. Fauci, thanks so much for speaking with us.
FAUCI: You're quite welcome. Nice being with you. Transcript provided by NPR, Copyright NPR.