Question-and-Answer: The Future of HIV

Dr. Mike McCune, MD, PhD


Last week, the Foundation hosted a presentation on the history and future of HIV/AIDS, “The AIDS Epidemic at Year 30: Is There an End in Sight?” Led by Dr. Mike McCune of San Francisco General Hospital, the presentation provided an overview of the HIV/AIDS epidemic, and where we are on the path to a cure. After his presentation, Dr. McCune talked with us about why some people living with HIV aren’t taking antiretrovirals, what challenges we face in creating an HIV vaccine, and the role of preventative medicines in HIV treatment.

What are some of the reasons people living with HIV may be receiving care-and-treatment, but not antiretrovirals (ARVs)?

(Some) possible reasons include:
1. They choose not to take ARVs.
2. They are not offered ARVs.
3. They cannot afford ARVs if offered.
4. ARVs are found to be hard to take, e.g., because of side effects.
5. They are receiving care and treatment from those who do not encourage the use of ARVs.

What are some of the current barriers or challenges to developing an HIV vaccine, beyond the science?

Some barriers include a lack of understanding of how the immune system correlates to viral control, limitations of current (means of analysis) to measure potential protective effects, inadequate architecture of collaboration, uncertainty regarding how to measure efficacy and the sample sizes that will be required. In addition, vaccine clinical trials, in the context of all the other successful prevention measures needing to be offered, will be extremely large and expensive. Limited resources are also a potential challenge.

In some areas of the United States, people at high risk of HIV (sex workers, men who have sex with men (MSM)) are taking part in trials of a pill that uses HIV treatment to prevent infection.  But this has not come without some criticism. What are your thoughts on the development of this pill, and what role could it play in future prophylaxis efforts?

Prophylaxis such as this will play a role, but only for those that have access to it AND who remember to use it.

To eliminate HIV, do we have to have a vaccine (like other infectious diseases – polio, for instance)?

Reducing rates of transmission (e.g., by eradicating HIV in those who are infected) could go a long way in limiting the spread of the epidemic.  But yes, a vaccine would be a necessary tool in the fight against HIV.  A combination of all of our efforts, including all measures of prevention and treatment, will likely be required. These include: condoms, male circumcision, microbicides, Pre-Exposure Prophylaxis (PrEP), a vaccine, and curing those who are infected.

Jane Coaston is Media Relations Coordinator for the Foundation, based in Washington, D.C.