Ken Mayer, M.D. (in photo below), was one of 12,500 physicians, researchers, clinicians and others who participated in the international conference on AIDS in Durban, South Africa, July 9-14. The professor of medicine and community health, based at Memorial Hospital, has studied HIV for 20 years. The George Street Journal's Scott J. Turner spoke with him recently about the conference.
Since the international meeting in Vancouver four years ago, there has been a dawning awareness that drugs can control HIV infection but that this route is inordinately expensive. To achieve maximum benefit for patients, you need a lot of health care services. At a time when this epidemic is raging worldwide, the stark reality, besides the high cost of drugs, is that the health care infrastructure is not there in many locations. Also, HIV management is much more complex. There are more than a dozen drugs to suppress the virus but none by itself is effective.
What are some of the meeting's clinical highlights?
In terms of current management regimens, several new drugs in various stages of development look promising. Several are similar to the categories of drugs still being used but are active against resistant virus; other newer drugs attack different parts of the virus' life cycle, but have not yet been extensively studied. So the therapeutic arsenal is expanding. One regimen being developed will be simpler, involving one pill twice a day. It will cost thousands of dollars but should be available in the next few months. There is also more science understanding as to how we can monitor HIV infection. We can measure HIV in the blood and viral resistance to treatment. So we can switch medications, if necessary, in a more informed way. However, these refinements in treatment add to the costs of caring for persons with HIV, increasing the gap between those with access and those who face a high likelihood of debilitating disease and death.
What was the significance of holding the meeting in South Africa?
This was the first time that a meeting was held in a location where the AIDS epidemic is so widespread. In sub-Saharan Africa, 20 million to 25 million people are infected with HIV and there is a lack of access to treatment. Ramifications of this explosive epidemic were well documented such as the growing number of orphans, falling life expectancies and how poverty affects care. All of this significantly affected the conference content.
What exactly is the scope of the worldwide AIDS epidemic?
We are a global community when it comes to AIDS. More than 50 million people are infected worldwide. More than 15 million have died. AIDS is going to kill tens of millions more people. Infectious disease epidemics don't respect borders. The virus continues to mutate and because of global travel it's only a day away.
How may AIDS eventually lead to social instability in some parts of the world?
Many of the people who are most likely to acquire the virus are more-affluent men who have the cash to pay for sex and/or travel. In resource-constrained nations, this could stall economic progress and weaken social stability. Because of so much potential illness in the ranks of productive individuals, Richard Holbrooke, U.S. ambassador to the United Nations, recently called AIDS one of the world's biggest security problems.
How is the face of HIV infection changing in the United States?
The spread of AIDS has reached a plateau but it's a pretty high plateau. There are 35,000 to 50,000 new infections per year. More and more people of color are getting AIDS. So are greater numbers of younger people and increasing numbers of women. One out of every three new infections is in women. More new infections are also showing up in smaller towns, particularly in the Southeast and between urban areas in the Northeast. Many people think that the epidemic is over. I wish that were so, but we still have a long way to go before we have relegated AIDS to the dustbin of history.