HIV drug, drop in new cases give hope for prevention

By Steve Sternberg, USA TODAY

The global AIDS epidemic has taken a turn for the better with fewer new infections than a decade ago, but overall progress is slow and much work lies ahead, the United Nation's leading AIDS agency reported Tuesday.

A new report by UNAIDS says that 2.6 million people became infected with HIV, the AIDS virus, in 2009, about 20% fewer new infections than 1999 when the epidemic was at its peak. The news comes a day after researchers reported that a daily dose of a widely available HIV drug, Truvada, can prevent infections in gay and bisexual men.

Greater access to treatment has also driven down AIDS deaths and increased the number of people living with HIV. Deaths dropped from 2.1 million worldwide in 2004 to 1.8 million last year, a drop of nearly 20%. By the end of last year, 33.3 million people were estimated to be living with an HIV infection, up from 32.8 million a year earlier.

"The decline in HIV infections globally is encouraging news," says Kevin Fenton, director of HIV prevention for the Centers for Disease Control and Prevention. "But real challenges lie ahead. For example, the 5 million people on treatment today represents only a third of the people in need."

"The reality is, because there's no cure, there's no vaccine, the only way to end the epidemic is by ending new infections," Fenton says, adding that's going to take a global push to adopt new approaches to prevention, expand HIV counseling and testing, and combat the stigma and discrimination that breeds risky behavior and keeps people from seeking preventive services and treatment.

Researchers say the Truvada drug could prove to be a key factor in the battle against HIV. A major study showed for the first time that Truvada, a drug duo widely used to treat the AIDS virus, can block HIV infection.

The drug duo consists of tenofovir and emtricitabine, packaged as a once-daily pill and sold in drugstores. It reduced HIV infections by an average of 44% among gay and bisexual men who took the drug, compared with those taking a placebo. Men who reported being the most diligent about taking their pill each day reaped an even bigger benefit, reducing their risk by 73%.

"This is a huge step forward," says lead researcher Robert Grant, at the J. David Gladstone Institutes at the University of California-San Francisco, a non-profit research foundation that carried out the study.

David Paltiel of Yale University says that his research shows that Truvada could be as cost-effective a prevention method as those used to combat heart disease diabetes and cancer, despite its $8,700 annual cost.

The findings have bred new enthusiasm in a field where, for years, optimism was rare. Over 30 years, HIV has infected 40 million people. But this year alone, researchers have demonstrated that a pill and a vaginal gel (containing a component of Truvada) can prevent HIV and shown that a vaccine could work.

"This is a very exciting, dynamic time in HIV prevention research," said Alan Bernstein, head of the Global HIV Vaccine Enterprise, a non-profit effort to accelerate vaccine research. "It couldn't come at a better time. There's clearly a growing realization that we're not going to be able to treat our way out of this epidemic."

Over the next two or three years, researchers hope to determine whether Truvada also works in heterosexuals and drug users.

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