Map of life expectancy at birth from Global Education Project.

Wednesday, August 06, 2008

The Big Guns

Now we hear from Anthony Fauci, head of the National Insitute for Allergy and Infectious Diseases (NIAID) -- and by the way Tony, thanks for the dough, he's never heard of me but he's paying for this trip -- and Peter Piot, head of UNAIDS. For those of you who aren't AIDSologists, these are the big guys. Fauci sets the agenda for biomedical research on HIV, and Piot is probably the single most influential individual when it comes to the organized social and political response, or at least he sits at the hub of the international response.

Their mission was to lay out the projected course for the next 25 years. Piot is retiring this year, so all he had to offer was his thinking, but Fauci's talk was the hard stuff. He actually does control the money, and he was telling us how he intends to spend it. And by the way, what he says is for real because it's at least 100 to 1 President Obama will leave him right where he is.

I could say a great deal about the presentations of each of them, but I'll just take a bit sized chunk for now. Fauci does not intend to fund any vaccine trials in the foreseeable future. He has decided that research needs to get back to basic biology that can support development of a vaccine, but even so, he does not foresee any vaccine that will offer full protection or a cure. Indeed, the most he's hoping for is a vaccine that offers partial protection to people who happen to have a favorable genetic inheritance. He didn't say so, but it's not clear to me that such a vaccine would have any practical use whatsoever.

He also doesn't see any hope for a cure, at least not in a meaningful sense. He believes it's possible that if intervention could start within a few days of infection, a cure might be possible, but he doesn't point out that hardly anybody will be aware that they have been infected within such a short interval and this is again, a meaningless concept of "cure."

Weirdly, he described his outlook as "optimistic." He has some other, serious blind spots, which I will discuss in an upcoming post. But, bottom line, HIV will be with us, and probably as a growing problem, for the rest of my life and probably considerably longer. Get used to it.

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