...And Will We Ever Cure AIDS?

By Dr. David Ho

Predicting the future is risky business for a scientist. It is safe to say, however, that the global AIDS epidemic will get much worse before it gets any better. Sadly, this modern plague will be with us for several generations, despite major scientific advances.

By January 2000, the AIDS epidemic will have claimed 15 million lives and left 40 million people living with a viral infection that slowly but relentlessly erodes the immune system. Accounting for more than 3 million deaths in the past year alone, the AIDS virus has become the deadliest microbe in the world, more lethal than even TB and malaria. There are 34 developing countries where the prevalence of this infection is 2% or greater. In Africa nearly a dozen countries have a rate higher than 10%, including four southern nations in which a quarter of the people are infected. And the situation continues to worsen; more than 6 million new infections appeared in 1999. This is akin to sentencing 16,000 people each day to a slow and miserable death.

Fortunately, the AIDS story has not been all gloom and doom. Less than two years after AIDS was recognized, the guilty agent--human immunodeficiency virus, or HIV--was identified. We now know more about HIV than about any other virus, and 14 AIDS drugs have been developed and licensed in the U.S. and Western Europe.

The epidemic continues to rage, however, in South America, Eastern Europe and sub-Saharan Africa. By the year 2025, AIDS will be by far the major killer of young Africans, decreasing life expectancy to as low as 40 years in some countries and singlehandedly erasing the public health gains of the past five decades.

It is Asia, with its huge population at risk, that will have the biggest impact on the global spread of AIDS. The magnitude of the pandemic could range from 100 million to 1 billion, depending largely on what happens in India and China. Four million people have already become HIV-positive in India, and infection is likely to reach several percent in a population of 1 billion. Half a million Chinese are now infected; the trajectory of China's epidemic, however, is less certain.

An explosive AIDS epidemic in the U.S. is unlikely. Instead, HIV infection will continue to fester in about 0.5% of the population. But the complexion of the epidemic will change. New HIV infections will occur predominantly in the underclass, with rates 10 times as high in minority groups. Nevertheless, American patients will live quality lives for decades, thanks to advances in medical research. Dozens of powerful and well-tolerated AIDS drugs will be developed, as will novel means to restore the immune system.

A cure for AIDS by the year 2025 is not inconceivable. But constrained by economic reality, these therapeutic advances will have only limited benefit outside the U.S. and Western Europe.

A vaccine is our only real hope to avert a disaster unparalleled in medical history. A concerted research effort was launched three years ago in the U.S., and hints of promising strategies are emerging from experiments in monkeys. But even if an AIDS vaccine is developed before 2025, it will require an extraordinary effort of political will among our leaders to get it to the people who need it most.

Dr. David Ho, director of the Aaron Diamond AIDS Research Center, was TIME's 1996 Man of the Year

Number of AIDS Rate of Growth THE SPREAD OF HIV cases in thousands* 1996 to 1998

1. North America 890 18.7% 2. Latin America 1,400 7.7% 3. Caribbean 330 22.2% 4. Sub-Saharan Africa 22,500 60.7% 5. North Africa and Middle East 210 5.0% 6. Western Europe 500 -2.0% 7. Eastern Europe and Central Asia 270 440.0% 8. South and Southeast Asia 6,700 28.8% 9. East Asia and Pacific 560 460.0% 10. Australia and New Zealand 12 -7.7%

34 countries contain 85% of all AIDS cases

* As of Dec. 1998 Source: UNAIDS