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Mid-2014, news broke that the “Mississippi Baby,” the infant thought cured of HIV, had yet again detectable levels of virus in her blood. This makes her the second child thought cured through early intervention with medications who turned out to still harbor the infection.
Only the “Berlin Patient” — a leukemia patient who received radiation, chemotherapy and a complete bone marrow transplant from a donor with an HIV-resistant genetic variation — has appeared to have been “functionally cured” of HIV. But in the meanwhile, we’ve spent millions of dollars trying to cure the disease when the money could’ve been better spent on other proven prevention and treatment options. So can we stop trying to cure HIV already?
HIV is a is a retrovirus that specializes in hiding out in our DNA and defeating short term cures. The “Mississippi Baby” had been given triple therapy anti-retrovirals soon after her birth when doctors detected HIV in her system. She continued taking the medications until she was 18 months old. Once the medications stopped, the HIV reactivated and began replicating and mutating with high frequency. And sure enough, it surfaced again in her body.
Even one of our most sophisticated efforts — a small trial done by doctors at Emory in Atlanta which tested bone marrow transplants and radiation in three monkeys with Simian-HIV — have proven unsuccessful. When our most cutting edge attempts fail, it’s worth considering whether we just don’t have the level of science and understanding to create a safe and effective cure.
As a scientific community, is it worth using precious (and limited) research money on searching for a cure that may never come? About $40 million of research money has been devoted to “cure” research in 2009, which is a small, but significant, portion of the $2.8 billion of federal money given to the National Institute of Health for HIV research.
Instead of throwing the money away on a cure that many never come, prevention can achieve the same goal with the bonus of possible HIV-eradication in a generation or two, much as Hilary Clinton suggested in her “AIDS Free Generation” plan — a plan which focuses on prevention rather than a cure.
We have good, effective and relatively safe treatments for HIV, making an immediate cure unnecessary in the short term. The triple and quadruple drug therapies contained in once-a-day pills can suppress the virus for life, as long as they’re taken everyday. Modern medicine has turned HIV into a chronic disease similar to diabetes or herpes, and patients are living full lives.
So let’s stop trying to cure this disease and start focusing on stopping anyone else from getting it. With better testing, removing stigma through education and public awareness programs and making more prevention options like Truvada widely available — especially to those at most risk, like low income families, folks with poor healthcare access and high risk populations like sex workers and the homeless — new infections can be prevented.
Stopping the spread of HIV should be the focus, and, in this way, will make a cure unnecessary.
Dr. Swales is a family physician working in Northern California, and a newly minted blogger writing about healthcare issues for all.