Survival Comes at a Cost
Survival comes at a cost, however, both physically and economically. The drug combination can cost $15,000 per year, and the treatment regimen requires taking a number of different medications at varying times in the day. The drugs also have toxic side effects that include nausea, loss of bone mass, liver damage and an increased risk for diabetes, depression and elevated cholesterol. Those taking AIDS medications often lose weight in the face and limbs but develop a bulging stomach and rounded back.

Many scientists initially believed that the early survival rates seen after the drugs were first introduced would fade and that the drugs would lose their effectiveness over time. This has not happened to date, and many persons with HIV continue to live in relatively good health, despite their ongoing struggle with unwanted side effects. The drugs don’t cure AIDS but they do keep HIV under control and buy time for patients to wait for less toxic treatments.

The redefinition of AIDS as a chronic but treatable disease has a downside in terms of prevention. For about 10 years the new infection rate in the United States hovered around 40,000 annually. Initially the number of deaths roughly equaled new cases each year. Now the death rate has dropped to about 15,000 per year and the number of Americans surviving with AIDS is soon expected to reach one million.
But recent statistics have revealed a disquieting trend. For the first time in a number of years the number of new infections has begun to rise. Preliminary figures show an 8 percent increase for 2001 over 2000, with over 42,000 new cases reported. Some states showed dramatic increases: Kentucky increased 59 percent, North Carolina 41 percent. New York City, already one of the hardest hit cities in the country with 17 percent of all AIDS cases, saw an increase of 47 percent in 2001.

There is a concern that these increases can be partly attributed to a new generation of young adults who see AIDS as a treatable disease and, as a result, are more likely to engage in unprotected sex or needle exchange.

HIV infection has grown rapidly in recent years among African Americans and Hispanics as well as among women, adolescents and older Americans. In short, no one is exempt. Each individual must take personal responsibility for protecting himself or herself against HIV infection.

A Global Crisis
Although under relative control in the United States and some of the developed nations, AIDS has become a crisis in numerous undeveloped and emerging nations. The world’s poorest countries account for 95 percent of new HIV infections, most as a result of heterosexual transmission.

More than 20 million people have died worldwide as a result of AIDS, leaving millions of children orphaned and cities and countries depleted of young-adult workers. Another 40 million are infected, and without help most will die. The drug therapies that have changed the face of AIDS in developed countries are largely unavailable to the vast majority of those infected.

A number of countries have shown that programs to promote the use of condoms and to encourage sexually responsible behavior can help control the spread of HIV, but in order to work these programs require adequate resources and a high level of government commitment.

The only real hope for much of the world is the development of an AIDS vaccine, a goal that has so far proved unattainable. Merck and Aventis Pasteur have committed enormous resources to vaccine development in recent years, and both have potential vaccines that are ready to enter the human testing phase.

The AIDS virus has proven an extremely elusive foe, and many early attempts at vaccine development have been foiled by the ability of the virus to mutate, creating an ever-changing target. In response, rather than making an anti-body based vaccine, Merck researchers have focused on a vaccine that would protect and boost the power of the body’s killer cells.

Merck has also begun early trials of AIDS vaccines aimed at treating those already infected. If successful, such an approach would offer a vastly cheaper and more efficient treatment for the millions infected in undeveloped areas.

Aventis Pasteur, a company with support from the U.S. military, the National Institutes of Health and the French government, is ready to begin efficacy trials of a vaccine that incorporates HIV genes into a harmless bird virus called canarypox.

Three million people died of AIDS last year. At least that many will die again this year. And each year that the epidemic continues unchecked many millions more will fall victim to this modern plague. New infection rates are estimated at around 5 million annually worldwide.
On a global level the colors of despair depict the ravages AIDS has inflicted in a short 20 years. The knowledge that treatment can suppress this deadly disease gives hope for simpler, less expensive therapies in the future. The real hope for the millions of AIDS patients and the millions at risk in the future lies with an effective vaccine that can offer a one-time, inexpensive protection against this 21st century plague.