Mark Wainberg
Contributed to The Globe and Mail

Mark WainbergThe HIV-AIDS epidemic is unprecedented for a number of reasons.

First, who can remember another disease that arose as quickly as HIV did in the early 1980s to infect millions of people around the world, almost all of whom succumbed to their illnesses at a time when antiretroviral drugs were non-available?

Second, the development of safe and well-tolerated ARVs over the past 25 years has now resulted in a situation in which almost all of these people can aspire to live for many years, as HIV has been transformed into a chronic, manageable condition. Of course, many problems remain, not the least of which is that HIV continues to spread to millions more people each year. In addition, people who live in developing countries are often treated with inferior drugs and so are less likely to fully benefit from these treatment advances.

All this notwithstanding, there is now a widespread consensus that the only truly effective way to deal with the HIV epidemic over the long term will be to find a cure. Although global programs to provide ARVs to people in developing countries (who could not otherwise afford them) have been successful, they may well be unsustainable over the long term. Simply put, the total costs may well exceed hundreds of billions of dollars over the next decade, and many health-care economists have sounded the alarm that the West may not be able to provide this assistance unless the global economy improves. Anyway, it is no panacea for anyone to have to take drugs every day for a lifetime.

So far, at least, the quest for an effective HIV vaccine has fallen flat, despite valiant and insightful efforts by scientists around the world. But there is palpable optimism about potential curative strategies.

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November 30, 2013