AIDS Experts Optimistic about Turning the Tide on Disease
NAM: It appears as though for the first time scientists are focusing their attention on finding a cure for HIV, a cure that would relieve patients from having to take the expensive antiretroviral therapy all their lives to keep the virus at bay. Is there more optimism at this conference than there has been at previous international meets?
Horberg: Yes, we are reinvigorated now, especially because we have a road map now of how to make it happen. There’s more energy now.
One of the causes for the optimism stems from the results [announced late last year] that found that when infected patients begin taking antiretroviral medicines when their immune systems were relatively healthy rather than after the disease has advanced, they are 96 percent less likely to transmit the virus. Researchers concluded that antiretroviral drugs can therefore not only treat HIV but also prevent its transmission.
NAM: The story of Timothy Brown, known to the medical world as the “Berlin Patient,” has given scientists a reason to be even more optimistic. [In treating him for his leukemia with two bone marrow transplants in 2007, doctors in Germany unintentionally also cured him of HIV by replacing his HIV-susceptible immune system with one that could ward off the disease. He has been HIV-free since.]
Horberg: A bone marrow transplant worked for Brown, but it’s not for all because it carries a high risk of death and toxicity. More importantly, it was an event that occurred in one person only and that's not enough of a scientific experience to be a recommended therapy.
NAM: At Kaiser Permanente you have a vibrant HIV-AIDS treatment program that reportedly has had good clinical outcomes. You say you have been able to successfully reduce disparities among your current HIV population of more than 20,000 people. How did that happen?
Horberg: Yes, ours is a successful program in that there has been no disparities in outcome among black and Latino HIV positive patients for both mortality and medication rates. Those two groups have a 15 percent higher rate for mortality nationally than we have at Kaiser Permanente.
When HIV-infected patients come to us we hook them up to care right away -- with doctors, social workers. We don’t wait for the disease to progress before we offer them care.
We have shown that when people are given equal access to care and in a timely manner, there is no biological reason for different clinical outcomes.
NAM: Can the health care reform law help in any way to check the spread of HIV in the United States?
Horberg: It can. Because of the expansion in Medicaid – called Medi-Cal in California – insurers will no longer be able to deny or charge more for coverage to HIV-infected people, or impose dollar limits on their coverage. Additionally, with the expansion of Medicaid, low-income, childless Americans with HIV can be enrolled in the federal/state-funded program.
And with the coverage of the so-called donut hole in Medicare’s prescription drug program, seniors will not have to worry about running out of money for their medications.
NAM: While all that sounds great, how can those antiretroviral medications be made more available to HIV-infected people in the United States given they can run up to thousands of dollars each month. To make matters worse, there have been so many cuts in federal funding for HIV treatment programs that states offer.
Horberg: For those drugs to be more accessible to more people, there has to be far greater partnerships between the public and private sectors. Everyone has to work together, and there has to be political will to realize this wonderful vision of an AIDS-free world. Scientists are looking at that now.