World AIDS Day 2014: Transforming the Trajectory of Disease

Today is World AIDS Day, and we’re examining the tremendous progress we’ve made turning what was once considered a virtual death sentence into a chronic condition. The fact that the death rate for HIV/AIDS patients has decreased nearly 85 percent since its peak in the mid-1990s is a testament to the dedicated researchers who worked tirelessly to develop new medicines like those that make up highly active antiretroviral therapy (HAART) that transformed how we treated the disease.

To celebrate this progress, we asked Truven, under the direction of Dr. George Hanna — well-known HIV/AIDS researcher and one of this year’s winners of PhRMA’s Research and Hope Awards — to not only examine the value HAART brought to patients and society, but also develop a statistical model showing what the world would look like had HAART and the innovations that followed never come into existence. Here is a conversation with Dr. Hanna about the project and progress against HIV/AIDS.

Please describe the impact HAART had on the lives of HIV patients and the health care system as a whole.

As many may recall, during the early HIV/AIDS epidemic that started in the 1980s, young and previously healthy people were getting sick and dying of unusual infections and cancers, despite the best medical care available at the time. Even in the early 1990s, HIV/AIDS-related deaths increased by 59 percent between 1990 and 1995 in the United States. Those treating AIDS patients had very few tools to change the course of the infection or slow the disease. Thanks in large part to the development of HAART by the mid 1990s, the death rate has decreased dramatically. Patients can now live with HIV as a chronic disease they can manage by adhering to their prescribed medicines.

Without these medicines and the innovations that followed we would have been on a very different trajectory and would be living in a far different world than we do today. To put it in more concrete terms, as a result of HAART and all the important innovations that followed, it is estimated that we were able to avoid over 862,000 premature deaths and gain over 27 million life-years and $615 billion in economic value over the cost of treatment in the United States alone. 

Following the dramatic changes in the 1990s, why have death rates continued to drop over the last decade?

What is remarkable about the progress we’ve made is that it has continued throughout the last 2 decades. Innovation didn’t stop with the initial development of HAART. In fact, we’ve continued to build on that initial research, which has resulted in additional treatments that control the HIV virus better, have fewer side effects, and have a reduced pill burden. We also gained more knowledge about how best to use the treatments we have.  We’ve learned more about the importance of adherence and early treatment, and which combinations of medicines are most successful. In some cases we have seen where we are able to reduce transmission to prevent new cases of the disease.

As someone who has worked for many years to advance medicines for HIV/AIDS, what has it meant to you personally to watch this revolution in treatment?

I grew up in an era when AIDS and HIV infection were first recognized, when there were no treatments for the infection, and when we saw so many people, often young and in the prime of their lives, die with this infection. This had a profound impact on me, and caused me, like so many of my colleagues in HIV medicine, to focus my career on trying to find treatments for AIDS. Looking back at our tremendous progress since the 1980’s, I’m incredibly gratified to be a part of this historic transformation that was only possible because of the commitment and collaboration of so many people dedicated to basic science, clinical research, medical care, public health, and patient advocacy in HIV.

What do you see in the future for HIV treatment?

The future is bright. We’ve seen unprecedented advances over the years to address this devastating disease, and today, we’re already seeing patients with access to medicines living close to normal life spans.

As we move forward, we’ll look for ways to make it easier for people with HIV to take their medications, both those who are starting medications for the first time and those who have had to change their medication because it stopped working or has caused side effects. For those who have HIV that’s become resistant to many of the available drugs, we’ll look for drugs that work in a different way and that can be an additional safe and effective option for them. We will also shift our focus to finding more ways to prevent people from getting the disease or even finding a cure.

While there is still a lot of work to be done, I’m very optimistic about the future and hope that one day we will really have an AIDS free generation.

Conversations and healthy debate about issues facing our industry and the health care system are critical to addressing some of today’s challenges and opportunities. The Catalyst welcomes guest contributors including patients, stakeholders, innovators and others to share their perspectives and point of view. Like in our Conversations series, views represented here may not be those of PhRMA, though they are no less key to a healthy dialogue on issues in health care today. 

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