HIV is a very expensive disease to treat and since it's no longer a death sentence, a significant amount of resources go towards a lifetime supply of drug cocktails for long term HIV patients (which is all of them). Even a 10% reduction in the number of infections would free up a massive amount of resources at the NHS, CDC, and other agencies best suited to put them to use dealing with the remaining infections. Like with cancer and drug resistance, there is no single panacea but that doesn't mean we can't make big leaps that help a lot of people. Fighting a virus like HIV takes a lot of victories, big and small, that chip away at the problem until, like with smallpox or polio, there are so few cases left that each can be dealt with individually by the public health infrastructure.
With my tin foil hat on, I've always wondered that now there is a very profitable business (for the big Pharma companies) out of just providing HIV positive people with drugs for years, that there is little appetite (again, inside big pharma) to actually 'cure' the disease...?
The real problem is not pharma trying to turn things chronic but rather people who have less common or less prominent diseases.
That's not entirely true. When Hillary Clinton was running health policy in Washington, the white house threatened to impose trade sanctions on India and South Africa if they manufactured generic drugs to treat their citizens with HIV. This was before it had become an epidemic in those areas. And now that it is an epidemic, the pharma companies get tax writeoffs by working with the Clinton Foundation to provide treatment in those areas at 'reduced cost'.
I agree that insisting that third world countries who are already debtors to first world countries for aid pay huge sums for HIV drugs is problematic at best, but I am not sure why you add Clinton's name into this argument.
http://www.pbs.org/wgbh/americanexperience/features/biograph...
B) The issue you mention does not even fall under health care policy, it falls under IP and trade policy, because the point of objection is when foreign nations nullify or nationalize U.S. pharma patents. That is an ongoing fight to this day, BTW.
Multiple companies could collude to keep a cure off the market. But such cooperation would require all the collaborators to be simultaneously honorable enough to keep the agreement, and dishonorable enough to keep life-saving drugs away from people who are dying. I find that unlikely.
Meanwhile it would only take one traitor to make the deal collapse. Such a traitor could be any person who is in on the secret and also has a family member affected by the disease in question. It takes dozens of scientists, project managers, lab assistants, and random extra staff to create a new drug. I don't believe that many people can keep any kind of secret for any amount of time, let alone a secret as hot as a cure for (in this case) HIV.
This is why I don't believe in the idea that drug companies intentionally keep cures off the market. If no cure is available, it's probably because it genuinely doesn't exist yet.
That's not quite correct. The company with the cure will make more money going forward. But not necessarily overall, and the difference there is important.
Let's say you're a venture investor in biotech, and you're thinking about whether to fund the development of an HIV cure or a better HIV treatment. Both will completely replace the existing market in HIV drugs. When you do the net present value calculation for the treatment however, you'll see that you have some probability of people staying on it basically forever. That means that over time, you can extract more money from it, which means of course that you ought to be willing to invest more money in developing it.
It is through this completely rational, non-evil mechanism that treatments may receive more funding than cures. Nobody here is suppressing anything, it's just that one of them will receive more funding than the other because it has a greater potential ROI.
A market based solution might be allowing pharma companies to charge extremely exorbitant prices for their cures, sufficient to recoup the foregone profits of treatment. But i'm not sure how well that would go down.
So, it may be that sometimes that causes it to make sense to search for a cure (if there is a particularly promising pathway that someone else is likely to explore, for instance), but all else being equal, it probably makes more sense to fund treatments.
The initial cost of developing any new drug is extremely high. We're talking hundreds of millions to billions. That's just to break even. That means if you have a cure for a disease that 100k people have, you have to charge them each $10k just to break even.
That is insane. The numbers of course scale directly with the number of patients, too. If only 10k people in the world have the disease, you need to charge them each 100k, just to break even (the average cost of developing a new drug is actually 2.5 billion, but for these purposes let's say you get lucky and it's 'only' 1 billion).
If you want to actually make a profit, you'll need to charge even more than that.
Also, there does not need to be an evil twist where someone deliberately holds back a developed cure. It is much easier to cut/steer the research in ways that favor treatment/management options, ensuring that a cure would only be found be accident.
No. Stuff like this gets posted to HN all the time but that is just not how things work. In a public corporation, management has broad latitude to make decisions about how to run the company and shareholders have essentially no say in it. They can sell the stock if they don't like it.
If you don't believe me, consider that Tim Cook, CEO of one of the most valuable public companies on Earth, said almost exactly the same thing in a shareholder meeting and nobody batted an eye.
Furthermore, the cost of HIV drugs isn't even the majority of the cost of HIV treatment because the constant monitoring and long term complications are extremely expensive. A single hospital visit for HIV-related pneumonia or another opportunistic infection can cost more than several years worth of the drug cocktails and the visits become more frequent and expensive with age as the weakening immune system contributes negatively to almost every other healthcare issue. The incentives for public health and universal healthcare agencies around the world is pretty cleanly aligned with curing HIV at any cost.
[1] http://store.globaldata.com/market-reports/pharmaceuticals-a...
1. Researchers build careers based on reputation. The reputational value of "cured cancer" (even for some small subset of cancer) is probably worth more than a lifetime of developing treatments.
2. Also, some motivated researchers have lost family or friends to the diseases they're working on.
3. Also, many researchers are simply not working at for-profit companies.
All of the above can be filed under "profit is not the only motive for curing diseases (even if it's a powerful one, it's not the exclusive one)." A different tack:
4. Many lines of research have unpredictable results. Studying a virus to develop a treatment may uncover a key weakness that results in a cure. Foundational research often is too early to prioritize a use, and breakthroughs happen in unpredictable ways.
5. There are a lot of players involved in research. A big mix of for-profit companies, NGOs, and governments might have to collude to avoid developing impending cures. So if there's an reasonable next step for global research, it'd be a bad gamble for a company to avoid it, hoping that no one else would pursue it either. ie, If you can get there, assume others can too, so just claim the credit.
EDIT: OTOH if you want to run with this line of thinking, there's a great classic comedy called "The Man in the White Suit" starring Alec Guinness. He invents an unstainable suit that never needs cleaned, and the garment industry sends people to stop him.
If nothing else, many academics are motivated by ego rather than money (I'd put myself in this category). Having successfully discovered a cure for HIV would do such spectacular things for my career that the level of money that would have to be involved is pretty substantial - and would have to be spread over a large number of people.
This of course brings money and marketshare to the company that owns the cure over the company that owns the treatment patents, and it brings recognition to the scientists involved.
So you can take off that tinfoil hat, if someone would find a cure for HIV, they would absolutely not sit on it.
Of course, in practice, doing so would lead to severe media outrage, calls for regulation, state-sanctioned patent breaching all over the world, etc. So the practical price is capped. Investors know this.
wait..birth control doesn't affect STD transmission. Unless you mean people getting birth control tends to lead to mode education from the medical professionals who prescribe it to them?
We've been able to eradicate or nearly eradicate several viruses from the planet. It starts with getting them down to manageable numbers, then addressing every outbreak. (Granted, HIV is not quite an analagous in terms of spread to viruses like smallpox.)
https://en.wikipedia.org/wiki/Eradication_of_infectious_dise...
I think that reducing the spread alone still could get us to a point where we "manage this out over the long term" as you say. Say you're a person with many sexual partners that has say a 1 out of 100 chance of sleeping with someone infected with HIV on a given day. Say there's a 1 in 10 chance that encounter will lead to transmission of the virus. (These aren't like factual numbers, just examples). That's still a 1 in 1,000 chance per encounter, so it adds up over time. After 1000 encounters chances are you've contracted HIV. But say you're vaccinated against 99% of the serotypes. That reduces your chance per encounter to 1 in 100,000. Even after 1000 encounters your chance of contracting HIV is 1 in 100. Not terrible.
Of course this is not realistic. People like sex, novelty, and having sex with different partners!
Not my area of expertise either, but as I understand it, it really depends on how many strains you are infected with. If it's just one, it'd reduce the infections in the next generation of patients by 99%. If the average patient had 10 strains, randomly distributed, it'd still reduce the infection rate by 90% (because there's a 10% chance of having that one resistant strain).
Only if all HIV patience had all strains (and I'm pretty sure that's not the case) would it bring us back to where we started.
The transmission rate of HIV is not really dependant on the strain but on the behaviour of the affected host.
Since HIV infection can be asymptomatic even for the natural life of a host the transmission rate is then dependant on the environment the social interaction of that host.
A host that has unprotected sex (or any other risky activity as far as blood transmitted diseases go) and does not get tested regularly will have a considerably higher transmission rate than a host that has only protected sex and gets tested when they switch partners.
Most HIV patients are infected with multiple strains, because at this point most new infections are multi-strain ones due to the lifestyle of the hosts and due to the fact that the virus can mutate in vitro.
I'm also not clear how does this press release counts "strains", since it's 16 it's more than just by major types HIV-1 and HIV-2, but then it's the question of what and how they count sub groups.
Most people in the west will get infected by HIV-1 Group M type B, type B itself can have several variations, and there are also host specific mutations, and if you are coinfected with another subtype you can have multiple variations of both and also recombinant (a new form made out of several types of the virus due to coinfection of a single cell) variations that may or may not be unique to each host.
That said effective post infection and pre AIDS outbreak treatments can drastically reduce of new hosts that end up as transmission vectors and carriers, if HIV becomes a considerably more manageable disease that would allow most infected people to carry on with a normal lifestyle (safely have sex with a partner, and have children) once treated more people are more likely to be tested regularly.
If you can also contain the disease to specific subtypes which are regionally locked as sad as it sounds you still doing quite a bit of good since now you can focus your resources on education and containment as well as further research since the transmission rates between say interveinal drug users in Berlin are considerably higher than between a sex worker in nairobi and the same drug users.
Yes, this is something to worry about and is exactly the reason why it is so hard to find a cure for AIDS. HIV mutates inside the body into thousands of different configurations and no matter what treatment you throw at it there will generally be at least a couple of strains that will survive and take over.
> Or is the promise here that we can combine this discovery with another that solves that remaining 1%?
That would be hard. There is always a chance that the additional treatment will only treat 99% of that 1% and even a single surviving virus might be enough to restart an infection with resistant strains.
> Or, do the mutations of that last 1% make HIV less virulent or harder to transmit?
One of the other comments here, from someone that read the paper, says that the antibody found in this study binds very specifically to a part of HIV that is crucial for infection so the 1% of strains that resist the antibody (due to mutations in the binding site) are less virulent. The antibody also binds only to parts of HIV that mutate very slowly so it might mean that it would take longer for virulent resistant strains to evolve.
Another strange thing, it does not seem all that difficult (relatively) for interspecies transmission to occur: "Scientists have now documented that the SIV virus has jumped from monkeys or apes into humans at least 13 separate times!"[4]
Perhaps those transmissions are due to self-injury while cutting infected meat, etc. The vagina is tissue that expects the presence of foreign human cells, and so has defenses against them. Anal sex, injections, etc are a different story. To me it sounds like an entire cell gets transmitted.
[1] http://m.jid.oxfordjournals.org/content/191/9/1403.full
[2] http://www.ncbi.nlm.nih.gov/m/pubmed/18490657/
[3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614444/
[4] http://evolution.berkeley.edu/evolibrary/news/081101_hivorig...
EDIT: Another possibility is that the vast majority of these variants found floating free in the blood are non-functional and serve as chaff to confuse the immune system.
The various HIV strains inside the body compete with each other over infected cells. Once you kill some of the strains with a treatment it opens up space for the other strains to to fill.