Fifty Years of AIDS Treatment: 1981–2031
By Bob Huff
A speculative history of HIV treatment presented at the PATH aids2031 meeting “Discovery and Innovation for HIV/AIDS ” held in Seattle, November 18, 2008.
First reports of disease later known as AIDS; 100% fatality feared.
HIV identified as cause of AIDS; first treatment attempts fail.
AIDS vaccine said likely within two years.
AZT, first anti-HIV drug, approved.
AIDS activists surround FDA headquarters in Rockville, Maryland, demanding faster drug development.
Triple combination treatment “cocktail” with new protease inhibitors dramatically reduces HIV in blood.
Death rate from AIDS plummets in United States and Europe.
Body fat abnormalities, toxicities appear in people taking HIV drugs. Experts expect AIDS vaccine within 5–8 years.
Treatment Action Campaign (TAC) marches at International AIDS Conference in South Africa to demand HIV drugs for developing world. U.S. guidelines call for HIV treatment when CD4 cell counts reach 250 cells/mm3; stavudine widely used in United States.
Prices of Indian-made generic HIV drugs drop; treatment in developing world becomes feasible. Developing world guidelines call for HIV treatment when CD4 cell counts reach 200 cells/mm3. Primary HIV drug regimen in the developingworld contains stavudine, lamivudine, and nevirapine.
Stavudine linked to body fat problems; dropped from U.S. guidelines. Tenofovir now preferred in the developed world; cost is prohibitive elsewhere.
Goal of universal access to HIV treatment by 2015 voiced by international community. HIV vaccine predicted within 5 to 8 years.
Prolific period of HIV drug development ends with approval of first integrase inhibitor and first CCR5 antagonist; 26 HIV drugs approved for use in the United States. Highly effective and safe first-line and salvage HIV regimens available to most patients in the developed world. U.S. guidelines call for starting HIV treatment when CD4 cell counts reach 350 cells/mm3. Developing world continues to use stavudine and start treatment at 200 CD4 cells/mm3.
Financial markets shocked; Barak Obama elected U.S. president.
Depression. Worldwide economic collapse hits emerging economies and developing countries especially hard. Trade virtually stops in Africa; people leave cities to seek food. Three generic drug makers exit the HIV treatment field. Western governments struggle to spend on foreign aid. U.S. president Obama spearheads global health safety net funded by 2% of world GDP. Funding for Global Fund and PEPFAR HIV drugs continues but treatment rarely delivered outside of cities. Progress toward universal HIV drug access halts. Treatment money stable but absorbed by switch to tenofovir as fewer patients are treated.
HIV prevalence in Africa drops as transmission declines due to restricted trade and mobility and as AIDS deaths increase. AIDS activists march in world capitals demanding new drive to universal HIV treatment access.
HIV drug development continues slowly in developed world. Next-generation drugs in existing classes approved featuring low doses, long half-lives, and virtually no toxicity.
U.S. guidelines recommend new 50mg, oncedaily, fixed-dose-regimen tablet of integrase inhibitor plus a protease inhibitor. The compact combination is licensed widely to generic makers; low-cost regimen quickly adopted in developing world; treatment access improves. New guidelines recommend treating HIV infection without regard for CD4 count: treat when diagnosed. Novel U.S. government campaign pays people to take HIV test; 250,000 newly diagnosed go on treatment; transmission rates drop. Experts predict HIV vaccine within 5 to 8 years.
Once-monthly HIV drug regimen in subcutaneous formulation approved; widely adopted in prisons and for nonadherent patients.
Revolutionary, monthly combination anti-HIV transdermal patch introduced. Developed by three Indian generic companies holding new patch technologies; best ideas combined into one product with intellectual property rights assigned to “patent pool.” Breakthrough technology attracts drug patent holders to participate. New HIV patch costs $25/year; safe; sold over the counter. Artists create colorful and trendy patch designs. Patch and drugs biodegradable. Human and economic health improving worldwide as economies surge.
Chinese company develops broad spectrum microbicide based on natural product; safe for vaginal and anal mucosa. Product tastes great; successfully marketed as soft drink; no stigma when used as microbicide. Wide market distribution achieved at low cost.
Worldwide HIV prevalence dropping as treatment rates increase; on track to become “like polio” by 2056. “Cure Pak” studied in large clinical trials; regimen delivered as blister pack containing 60 days of anti-HIV drugs, 7 days of drugs to activate latent immune cells, and then another 60 days of HIV drugs. One-year, drug-free remission achieved in 40% of participants.
U.S. president Michelle Obama announces breakthrough antiaging technology derived from HIV pathogenesis research. First HIV vif protein inhibitors enter human trials.
Nonpathogenic HIV strain found integrated into germline of extended family in Central Africa.
First experimental nanomachines “walk” DNA in yeast to locate and edit out HIV sequences. Implantable nanoarray sensors projected to provide real-time telemetry of gene and protein expression in human immune tissue in vivo; hopes increase that correlates of immune protection can be found. Experts predict HIV vaccine within 5 to 8 years.