It’s now 40 years, almost to the day, since the first case of HIV/AIDS was reported in the U.S. The following year, the first Canadian case was diagnosed.
Although the virus had made the jump from monkeys to humans several decades earlier, it was only in 1981 that public health agencies in North America took notice.
In that year, there was a sudden increase in Kaposi’s sarcoma, a rare type of tumour. At first, it was thought the disease must be an immune deficiency disorder, given the unusual symptoms it gave rise to.
Then, in 1982, French researchers isolated what they believed, correctly, was the virus that causes HIV.
It’s thought that 37 million people are infected around the world today, roughly a quarter of whom may be unaware they carry the disease. In Canada, 75,000 are living with the virus, another quarter of whom don’t know it. To date, more than 20,000 Canadians have died of HIV.
At the outset, this was nearly always a fatal disease. Though huge steps forward have been made, at its peak in 2005, nearly two million people died worldwide of HIV/AIDS, many in sub-Saharan Africa. Globally, there are still one million HIV-related deaths a year.
So where are we at in the treatment and prevention of this disease?
The good news is that we now have triple-drug therapies that give people infected with the virus the same life expectancy as individuals free of the malady.
This is a remarkable accomplishment for medical science. A disease that was, only four decades ago, the equivalent of a death sentence has now been reduced to a chronic condition that can be managed successfully.
Indeed, so great is the progress that the state of California has cancelled legislation that made it a criminal offence to knowingly infect a sexual partner with HIV. It’s now a mere misdemeanour.
I confess this seems a bridge too far. Yes, we can now manage the disease, but it remains a lifelong condition that can still kill patients who go off their medication for any length of time.
In 2019, the Public Health Agency of Canada noted that the number of new HIV cases had jumped 25 per cent over the previous four years, from 2,040 in 2014 to 2,561 in 2018. That leaves Canada well behind other G7 countries in reducing new infections.
Some of this may be due to complacency among at-risk populations. But some of it is also due to funding cuts by the public health agency.
So clearly, the battle with HIV is not yet won.
The proof of victory would be an effective vaccine. Unfortunately, this is easier said than done. Several large-scale trials have been carried out over the past 15 years. All failed.
Part of the problem is that HIV, like the flu virus, mutates rapidly. But it’s also partly because of the reluctance of people infected with HIV to come forward. There remains a stigma associated with the disease that has yet to be overcome.
There is also the reality that, to a considerable extent, HIV has become a third-world pandemic. Distributing a vaccine in those countries would be a huge challenge, even if one existed.
Nevertheless, smallpox was eradicated by exactly this means — developing a vaccine and distributing it to every corner of the globe.
In the same way, researchers believe HIV could be eliminated once a vaccine is found.
The WHO has set 2030 as the target date to halt the spread of HIV. While that now seems unlikely, enormous steps forward have been made in the science of developing vaccines.
COVID-19 vaccines were produced in less than a year, an unheard-of achievement.
If the same technologies can be used to combat the HIV virus, eradication of this scourge may be closer than we think.
