December 18, 2018
David Alain Wohl, M.D. (Credit: Warren Tong)
It's the beginning of the end. Not in some apocalyptic way, but rather in how we think about the prevention and management of HIV.
A tea-leaf reader of the stories that made heads turn this past year could reasonably predict that the antiretroviral regimens of tomorrow will come in pairs, be delivered via a route other than the gastrointestinal tract, or both. The next great leap in HIV prevention will also involve novel ways of getting drugs where they need to be when they need to be there.
Until then, we remain stuck trying to get providers to prescribe pre-exposure prophylaxis (PrEP), and to get those who can benefit from PrEP to take it. All we are saying is: Give PrEP a chance.
Less mutable are racial and socioeconomic influences on HIV outcomes. Inequities in HIV care are intractable, and will remain so as long as society is stacked to shower preference and privileges on some while it thwarts and threatens others. The advocacy that is woven into the fabric of HIV care has supported great progress: The Ryan White Care Act and, in some places, the Affordable Care Act have ensured access to health care for many living with or at risk of HIV acquisition. But these efforts mitigate, and do not obviate, the inherent injustices that make the difference for staying HIV negative or undetectable.
Any recap of where we are really is a preamble to speculation about where we are going. Beyond innovations in medications, the year closed with a sour taste of things to come from a physicist in China who appears to believe he is servicing humanity by messing with it at its most basic level to fix a problem that can be solved more compassionately and ethically in other ways. That this scientist chose, among the options, to re-engineer the genes of babies to make them resistant to the HIV their father carries speaks to an ignorance and fear that no tweaking of a molecule can cure.
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David Alain Wohl, M.D., is a professor of medicine in the Division of Infectious Diseases at the University of North Carolina (UNC). He is site leader of the UNC AIDS Clinical Trials Unit at Chapel Hill, director of the North Carolina AIDS Education and Training Center (AETC), and co-director of HIV services for the North Carolina state prison system. In 2014, he became co-director of the UNC-Duke Clinical RM Ebola Response Consortium.
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