HIV is a 20th-century disease that needs 21st-century research

Alan Bernstein and Peter Piot
The Globe and Mail (Canada)
Tuesday, August 10 2010

We need smarter approaches to clinical trials that test more concepts in less time, for less money, while preserving safety, community engagement and ethical guidelines.

The fight against HIV-AIDS turned an important corner with the recent announcement of new data from South Africa that a vaginal gel significantly reduced HIV infections in women. The gel, known as a microbicide, contains a drug that reduced infections by 39 per cent among all women in the study, and by more than half in women who used it regularly. This major step forward in AIDS prevention research comes less than a year after a vaccine regimen tested in Thailand reduced infection risk by 31 per cent.

Neither experimental product is good enough to use today. The microbicide requires at least one more large-scale clinical trial. The vaccine’s modest, short-term protection must be improved on with better approaches. But both studies, along with other research advances being reported with increasing frequency, provide clear evidence we have entered a highly promising era in HIV-prevention research. Microbicides, vaccines and other new approaches will one day join proven HIV-prevention strategies, including condoms, male circumcision and clean needles. How soon that day comes will depend on whether funders and the scientific community can develop the more collaborative approaches to HIV prevention research needed to address this fast-moving epidemic.

For years, global attention has focused on enhancing access to AIDS treatment. Thanks to programs such as the U.S. PEPFAR initiative, the Global Fund to Fight HIV, TB and Malaria, United Nations programs and foundation efforts led by Bill Clinton and a handful of others, the number of people receiving life-saving HIV treatment has grown from 400,000 at the start of the decade to five million people. As a result, AIDS-related mortality has dropped 18 per cent in sub-Saharan Africa.

Despite Herculean efforts to expand access to treatment, however, only a third of those who need HIV drugs receive them – a proportion sure to drop as millions more are infected each year. While access to treatment deserves increased support, treatment alone will not end this pandemic. Smarter, more nimble, better-funded research is needed to build on recent successes and develop practical tools that can slow and one day end this epidemic.

How do we do that? With new approaches to bring funders and scientists from around the world working together to advance HIV prevention and other major public-health goals. The Global HIV Vaccine Enterprise is a unique approach that brings together major funding and policy organizations committed to accelerating the development of an HIV vaccine. HIV vaccine and microbicide research is supported by only a handful of funders, with the U.S. government and the Bill and Melinda Gates Foundation at the head of the list. Many countries with the scientific, financial and social resources necessary to invest in prevention research are still not doing so.

Canadian science has a particular contribution to make. The recent announcement by Health Minister Leona Aglukkaq of the renewed alliance between the government and the Gates Foundation to support HIV vaccine research is welcome news. This will challenge other G20 countries, which need to contribute more to this global effort.

As it becomes clearer that vaccines, microbicides or other drug-based approaches may hold the key to HIV prevention, the pharmaceutical industry can no longer watch from the sidelines. HIV-prevention research requires systematic, strategic approaches that maximize the scientific value of public-private partnerships, minimize risk for industry and permit the sharing of research findings and data.

HIV-prevention trials typically take three to seven years to plan, fund, conduct and analyze. With nearly three million people newly infected each year, we need smarter approaches to clinical trials that test more concepts in less time and for less money, while preserving safety, community engagement and ethical guidelines. This requires a new spirit of global collaboration among funders, researchers, communities, local and national governments, and trial volunteers, as well as a new generation of HIV researchers, encouraged to enter this field by the conviction they can help end this epidemic.

HIV is too great a challenge, and the results of these trials too promising, to continue with hesitant approaches to prevention research. This epidemic is a holdover from the 20th century. It is time for 21st-century research approaches that will speed the effort to end it.

Alan Bernstein is executive director of the Global HIV Vaccine Enterprise and former president of the Canadian Institutes of Health Research. Peter Piot is chair of the Global HIV Vaccine Enterprise, director of the Institute of Global Health at Imperial College, London, and former executive director of the Joint United Nations Program on HIV-AIDS (UNAIDS).

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