Since it emerged three decades ago, Aids has killed nearly 30 million people worldwide, including 20,000 in Britain. Another 33 million, of whom 100,000 are in the UK, are currently living with Aids or the HIV virus that causes it. Much has been achieved in the treatment of HIV and, caught early and treated correctly, the condition is no longer a death sentence. So fewer people are dying, but more are still being infected.
“Aids was a profound societal and medical shock,” says Sir Nick Partridge, chief executive of the Terrence Higgins Trust. “All of a sudden, 30 years ago, this new fatal, transmissible disease appeared which shook everybody. “The speed at which young people got sick and died, and the rate of increase of people being newly diagnosed each year was truly terrifying.
There was a very real sense of fear that we would not be able to control this.”But remarkable research and drug development resulted in a treatment breakthrough in 1996, with the introduction of protease inhibitors, when people living with HIV were given an unexpected lifeline. In just 18 months, the number of deaths in the UK from Aids related illnesses dropped by a staggering 70 per cent.
Science was able to stop the virus replicating and damaging the immune system to such an extent that nowadays life expectancy is restored. If someone is infected with HIV, tests promptly after infection and goes into treatment at the optimum moment, they are likely to need to take only one or two pills a day with minimum side effects. Of course, access to HIV drug therapy around the world is uneven.
At the centre of the Aids epidemic, in sub-Saharan Africa, the chances of getting effective treatment are currently far less than in the UK. But the success of new drug treatments available in developed countries like the UK has resulted in an increase in the number of people living with HIV.
In just 18 months, the number of deaths in the UK from Aids-related illnesses dropped by 70 per cent
However, there is no sign of a slowdown in the rate of infection as HIV has become far less visible and more still needs to be done to strengthen prevention strategies.“It felt that, after the trauma and fear of the 1980s and early-1990s, HIV had almost gone away,” says Sir Nick. “But the reality is that we still have around 7,000 people in the UK being newly diagnosed with HIV each year, so the number of people with HIV grows by about 6 or 7 per cent each year.“We need to understand that HIV has not gone away, that it has changed, but it’s a virus that we should all try, as best we can, to avoid. While daily drug treatment is easier to take, if you have HIV it still damages your life chances dramatically.
“So it means that, while you live probably as long as an HIV-negative peer, you are going to have much more significant mental health issues to deal with and HIV is likely to harm your overall employment career.”
The stigma and discrimination that attaches to HIV, not least because of its transmissibility, largely remains. “If our societal approach to HIV had changed as dramatically as drug treatment over the past 30 years, we would be in an even better place,” he says.
Building on the scientific success of recent years, researchers at Madrid’s National Biotech Centre are developing a new vaccine which they believe could reduce HIV to a relatively minor illness.The Spanish researchers found that 22 of 24 healthy people (92 per cent) developed an immune response to HIV after being injected with a MVA-B vaccine. MVA-B is based on a smallpox vaccine laced with genetic material from HIV. The idea is that it primes the body to recognise HIV and mount a rapid immune response. It could be used to treat people who have already been infected or to prevent infection.
Professor Mariano Esteban says: “If this genetic cocktail passes phase-two and phase-three clinical trials, and makes it into production, in future HIV could be compared to the herpes virus nowadays.” HIV could become a “minor chronic infection” that only resulted in disease when the immune system was otherwise compromised, he says.
