Julie Davids Comments On the Future of HIV/AIDS Research
Julie Davids: Director of the Critical Path AIDS Project, member of ACT UP Philadelphia, co-founder of Project TEACH, and member of the Health GAP Coalition, which fights for global HIV treatment access
With mounting toxicities and treatment fatigue in the US and Europe, we may be in the hangover phase of antiviral cocktails, but many still depend on the hair of the dog that bit them to stay healthy until we have a better answer.
The growing movement for global treatment access is also searching for safer, lower cost HAART options. The needs of people with HIV around the world overlap when it comes to treatment strategies that do not mandate lifelong chemotherapy.
At the 2001 Retrovirus Conference, NIAID presented data on a handful of people who alternated seven days on, seven days off their combo for almost a year -- without viral breakthrough or resistance. This study design represents an acknowledgement that people can't take pills day in, day out for a lifetime -- and that treatment interruptions, even without boosting immune response, could make life more livable and treatment more affordable if they can be done without viral rebound. Half the cost of drugs! Half the time on treatment! Current plans are to expand the study to include more people, and try different lengths of treatment and breaks.
Research advocates and access activists must join together to get answers on who can delay HAART, and whether those who need treatment can safely use less drugs, less of the time, less times a day and/or with less pills. To do so, we must confront drug company threats that seek to divide us. An increasingly common trope is that the fight for global drug access will undercut drug company efforts to find better therapies and The Cure. If we continue to challenge industry to lower prices or allow generic competition in hard-hit and cash-strapped nations, industry threatens to "leave AIDS" in search of the next hard-on pill.
Some people point to the trickling drug development pipeline as validation of this threat, with few truly novel approaches winding their way towards market. It's a pretty scary situation for those running out of treatment options. But this is a troubling phenomenon we've been tracking for years. The pipeline was showing signs of serious dehydration at least four years ago, two years before the all-too-real and decades-long AIDS horror in Africa and elsewhere hit the front page of The New York Times.
If we look at the cold hard economics, the greatest potential impact on the bottom line of AIDS Pharma right now is the change in the US treatment guidelines, which finally recognize the lack of data -- and plethora of toxicities and side effects -- for starting treatment early in folks without symptoms or low CD4 counts. Clearly, this represents a drastically reduced market in the cash cow regions -- and don't even talk about treatment interruptions.
People with AIDS and other activists fought for research on AIDS medications. And we may need to fight to keep the research going, rather then letting the focus drift to more profitable areas. It is the solidarity of people worldwide that will keep the heat on for the cure.
The industry has no reason to disclose that they may be disinvesting from AIDS due to more sensible, data-based guidelines, when they can instead pit activists against activists and blame the fight for global drug access -- just as they have blamed women and their advocates for the past 15 years. We have heard similar arguments against prioritizing research in women with HIV. We have been told that the development of drugs for all is dependent on refusing to direct resources to crucial questions about side effects, toxicities, markers and drug levels in women. Yet many answers could come from small Phase I trials, new models of statistical analysis and data collection, or lab analysis of stored samples. "It costs too much to study women," insists the industry that has raised US drug prices 10% a year for the past two years.
We help ourselves and our loved ones in the United States when we act in solidarity with the tens of millions across the world without access to treatment. It is the promise of medication that has finally driven home that the world must deal with AIDS and spotlighted the absolute necessity of vaccine development.
The pressing need for drastically simplified -- but equally effective -- treatment across the world has stimulated interest to find strategies that could help make life easier here at home.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication CRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.