R&D and innovation: From death sentence to lifetime treatment for patients
The HIV/AIDS crisis triggered a level of global solidarity that had not been seen before. We must garner the same support for non-communicable diseases.
Advances in R&D have transformed HIV from an untreatable and almost uniformly fatal virus into a manageable, chronic condition. These innovations have extended the lives of millions of people living with HIV.
A major breakthrough was the development of ARV therapy, which works by preventing HIV from multiplying, the first generation of which was developed in the mid 1980s. Since then, research has improved understanding of the disease and medicines have improved in tolerability, efficacy, and convenience for patients.
In 1996, the adoption of HAART (highly active antiretroviral therapy) inaugurated a new era in HIV treatment. This combines drugs in different sequences, far more effective than any single drug treatment and has since become the default therapeutic approach.
Innovations help prevent transmission from mother to child: it is now known that HIV positive mothers adhering to ARV before birth can eliminate the risk of transmission to the baby through pregnancy, birth, and breastfeeding.
The development of less costly care regimens allowed the extension of effective treatment to resource-scarce communities, including many of the geographies worst affected by the virus.
Partnerships address the full lifecycle of HIV/AIDS, delivering care to those who need it most
Research collaboration: Partnerships have supported R&D advances, bringing together academia, governments, and industry. For example, The AIDS Clinical Trial Group supports clinical trials and laboratory studies in order to set standards of care for HIV infection.
Treatment for vulnerable groups: Collaborations focus on reducing HIV rates amongst vulnerable people including children, mothers, and intravenous drug users (IDU). These include the Pediatric HIV treatment Initiative which aids the development of pediatric ARV formulations. Saving Mothers Giving Life – a public-private partnership between USAID, MSD, and others – makes investments to reduce deaths of mothers with HIV. Harm reduction strategies target IDU by focusing on education, needle syringe programs, drug treatment and community development.
The number of children acquiring HIV infection declined from 360,000 in 2009 to 160,000 in 2016.
Partnering for delivery: Providing access to diagnosis and treatment is crucial. Currently, only 60% of people with HIV know their status. AmpliCare, a public-private partnership between Roche, the Clinton Foundation, USAID and UNICEF addresses barriers that prevent early diagnosis of infants with a focus on sub-Saharan Africa. UNAIDS, WHO, Boehringer Ingelheim, BMS, Roche, GSK and MSD partnered in the Accelerating Access initiative which applied preferential pricing to ARVs, opening the door to improving access in developing countries. Another mechanism to improve access is voluntary licensing agreements whereby a patent holder grants a license over product patents in certain countries to generic manufacturers, enabling development of generic versions in resource-limited settings.
By 2006, 28% of those in need in sub-Saharan Africa received treatment, compared to just two percent in 2003; 2007 saw a 54% increase in the number of people in LMICs receiving ARV therapy, but there is a need for continued progress.
Strengthening health systems: Caring for those living with HIV/AIDS extends beyond provision of treatment. Bristol Myers Squibb Foundation’s ‘Secure the Future’ initiative partners with governments and NGOs to invest in sub-Saharan African communities to support outreach, home based care, and psycho-social support, with a focus on women and children . Education promotes awareness of how to protect from AIDS, encourages people to get tested and reduces discrimination against HIV-positive people. GSK and ViiV Healthcare’s Positive Action programs tackle societal barriers such as stigma and discrimination, gaps in education and sexual health services.
Botswana is an example where partnerships have strengthened the health system of a country with one of the highest adult prevalence rates in the world. The African Comprehensive HIV/AIDS Partnership, a collaboration between MSD, BMGF and the government of Botswana, developed a holistic approach to increase prevention, treatment, and care for those infected. Botswana was among the first countries in sub-Saharan Africa to reach universal access to treatment for HIV.
2030: The end of the AIDS epidemic?
Despite the array of effective HIV prevention tools, 1.8 million people became newly infected with HIV in 2016.
The search for a cure: Researchers have successfully lowered levels of the virus to undetectable levels in certain children for a period of time, though there has not yet been a confirmed case of an infant totally cured. Several R&D eradication techniques are in development which focus on ‘flushing’ the HIV virus out of latently infected cells, ‘waking up’ inactive cells, forcing them to produce new virus particles that are susceptible to current antiretroviral drugs.
Vaccine development: Researchers are optimistic that a vaccine will be found in our lifetime. For example, Johnson & Johnson is working to develop a mosaic-based vaccine is yielding encouraging results from clinical studies and is progressing to the next phase of clinical development.
Closing the funding gap: Despite improvements in access to ARV therapy, it is estimated that just 12 million of the 25 million living with HIV/AIDS in Africa receive ARV therapy. UNAIDS suggests a USD 26 billion funding gap for HIV in LMICs over the 2015 to 2020 period. Individual R&D-based pharmaceutical manufacturers – through licensing, pricing initiatives and partnerships – seek to improve access, alongside prevention, diagnosis and broader health system strengthening. Only a holistic approach will ensure critical treatments are available to all people in need.