To mark the 25th anniversary of The American Journal of Managed Care¨ (AJMC¨), we spoke with Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID). Fauci has been at NIAID for 36 years, and he gave a keynote address at the first International AIDS Conference in San Francisco in 1990. Here he speaks on progress that has been made in the fight against HIV and AIDS, from AZT to Truvada to undetectable viral loads; why there is no cure just yet; and how the first tumultuous years of the AIDS crisis shaped research for decades to come.
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So, if you look at what’s happened since that meeting, we have therapies now that can bring a person’s viral load to below detectable in a sustained way. An offshoot of that is not only saving the lives of countless individuals, but the concept that was never spoken of back in 1990, what’s part of our lexicon right now, is the issue of treatment as prevention, or “U equals U” [undetectable = untransmittable]. Namely, if you are undetectable and your viral load is beyond or beneath the level of detection by classical assays, that makes it essentially impossible to transmit the virus to another individual.
So if you look at all those things that we didn’t have when I was giving that plenary address in San Francisco and Peter Staley was giving his plenary address, and then-secretary of HHS Louis Sullivan was up there getting condoms thrown at him from the audience-that took place in 1992-we didn’t have therapy that was effective. We didn‘t have treatment as prevention and “U equals U.” We didn’t have exquisitely effective preexposure prophylaxis, and we didn’t have a vaccine. Of all of that, the things that we don’t have still are a vaccine and a cure. And we’re trying for a cure, but a cure is going to be problematic.