AIDS is now a manageable chronic disease — at least in developed countries — but there is no room for complacency as HIV infection rates remain steady or might even be increasing.
A JAMA editorial coinciding with the 17th International AIDS Conference in Mexico City noted that 25 million people had already died of AIDS and more than 30 million were currently infected with HIV. A ‘steady state’ of 40,000 new infections each year in the United States had been “quietly acknowledged”, but recent estimates suggested there was a substantial jump to 50,000 new cases in 2006.
“Despite remarkable successes, the stage is set for trouble far into the future,” it said.
Highly-active antiretroviral therapies (HAART) had transformed the management of the disease and its prognosis. However, antiviral resistance remained problematic and access to treatment in developing countries was still difficult. Other concerns included the potential for continuing mutations in the viral genome, and the failure to develop effective vaccines. Research on vaccines had been forced “back to the drawing board”.
Sex inequity and stigma were still massive impediments to approaching the epidemic. “As the virus encroaches inexorably on communities and populations that are marginalised, and on women and (increasingly) girls who are powerless to control their sexual vulnerability, the dismal shadow of HIV/AIDS will continue to spread across the global landscape,” it stated.
The editorial recounted the history of the HIV/AIDS epidemic, and the fear that it initially evoked. “The caregivers who stepped up to help the first desperately ill patients with AIDS were truly heroic as they faced the unknown, but even after the facts evolved about how to protect oneself, many recoiled....It was almost unbelievable that a democratic, altruistic society could turn so nasty and hostile to individuals with a lethal disease.”
One result of the epidemic was an unprecedented interaction between a broad range of scientists, from social, behavioural and biomedical disciplines, and their close cooperation with activist communities battling the disease on their own terms.
Reference
Osborn, J. 2008, ‘The past, present, and future of AIDS.’ JAMA vol. 300, pp. 581-583.
Abstract