"Given that 2003 saw four new antiretroviral drug approvals -- more than any year to date -- do you feel that real progress is being made toward a cure for HIV disease?"
"No, not toward a cure. That doesn't mean that we as a global community should give up looking or that something may not show up around the corner. There have been small but incredible advances in our understanding of how this retrovirus operates. But I think that it is easier for the pharmaceutical industry as a business to maintain a cache of nongenerics with enhanced delivery systems rather than actual 'improved' pharmaceuticals. Yes, research and development is difficult, and incremental leaps in medical knowledge are nearly impossible to predict. However, we need to continue pushing for these advances and at pricing levels that benefit all people."
Derrick Mapp is a community advisor for several HIV prevention and treatment research groups. He lives in San Francisco.
"Last year we increased our arsenal of really good treatment options, especially for people who have access to medications and don't have any viral resistance to worry about. Unfortunately, even a simple, tolerable, and nontoxic treatment is not a cure. HIV has proven to be a formidable opponent of the best minds, and there are still some basic hurdles to clear before a cure is visible on the horizon. Even so, I fear it will be a continuing lack of political will and financial commitment, not brain power, that will prevent us from winning this war. On my most cynical days, I don't think we'll have a cure until the people and families and communities we lose to AIDS are worth as much as the dollars needed to end the epidemic."
Heidi Nass is an HIV-positive community advocate based in Madison, Wisconsin.
"I wouldn't say the distance has changed. We have better drugs and we're moving to once-a-day regimens, but a real cure remains as far away as it was last year, and the year before. Progress toward a vaccine is facing ups and downs, and some have already started questioning whether having a vaccine -- which is not as mouthwatering as a new blockbuster drug -- will ever be possible. Still, the 1996 HAART revolution was real, and those with access to antiretrovirals are privileged enough to deal with quality of life and new emergencies such as cardiovascular risk, coinfections, and even aging. Yet these privileges aren't available to millions of people whose only mistake is to live in the wrong part of the world. Their leaders are visionary enough to demand that the wealthy nations -- we and our leaders -- give everybody the same right to benefit from the progress of science. Their efforts to give the world a wake-up call deserve all our support and respect."
Mauro Guarinieri is chair of the European AIDS Treatment Group. He lives in Bologna.
"What a depressing question! No, last year's crop of new anti-HIV drugs clearly demonstrated the shortcomings of a profit-based approach to clinical research and development. The three 'me-too' drugs responded to the demand of the HIV market with lower pill burden and easier dosing, but provided no significant clinical improvements such as addressing the issues of cross resistance and side effects. While T-20 [enfuvirtide, Fuzeon] does employ a new site of inhibition, it is beset by the difficulty in administration and its high cost of production, limiting its usefulness. Meaningful basic science research that is likely to find a cure is primarily done by academic and small biotech firms due to the high investment risks. Big drug companies that are profiting handsomely under the current approach of lifelong maintenance therapy have no profit incentive to change that."
Lei Chou manages the Access Project of the AIDS Treatment Data Network in New York City.
"I do feel that real progress is being made in the realm of combination therapy, especially in reducing pill burden, minimizing side effects, and simplifying regimens. Looking at the state of treatment even five years ago when I began therapy, I appreciate the quantum leap in treatment efficacy and tolerability. But, sorry to say, none of the advances of the past year seem to have put us any closer to a cure -- a treatment that can either eradicate the virus from the system or put it into remission for a long time without daily dosing. Though we can, in many cases, keep HIV in check, we still cannot get free of it; it remains a constant companion, a time bomb that has stopped ticking for the moment. There are a few experimental 'eradication protocols' in clinical trials, but these are still shots in the dark. Where is the cure?"
Gabe Lamazares is a treatment educator and counselor at the Alliance of AIDS Services -- Carolina in Raleigh.
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