By Anthony S. Fauci
Anthony S. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
In the summer of 1981, the world became aware of a mysterious new disease that was seen initially among a relatively small group of gay men in the United States and was soon shown to be caused by the human immunodeficiency virus. Fast- forward more than 30 years, and the entire world is struggling with one of the most devastating pandemics in history. More than 70 million infections have occurred, predominantly among heterosexuals in the developing world, resulting in more than 30 million deaths. Despite these horrendous statistics, advances in HIV treatment and prevention have transformed the lives of those HIV-infected people who have access to health care, and have provided us with highly effective methods of preventing HIV infection.
So why does this global pandemic continue to rage? It is not that we lack the medical advances and interventions to end the pandemic. It is that our proven tools have not been implemented adequately or uniformly.
Combination anti-HIV therapy became available in the mid-1990s, and although the drug regimens were highly effective in suppressing the virus to below detectable levels and allowed patients to live relatively healthy lives, some questioned whether the cumulative toxicities of long-term drug therapy would negate the beneficial effects over time. Controlled clinical trials have since put that concern to rest by showing that the mostly manageable toxicities of anti-HIV therapy are much less harmful than continued HIV replication in the absence of therapy.
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