This World AIDS Day, some 30 years after the epidemic began, we should recognize how the hard work of thousands of dedicated scientists transformed the most dreaded disease of the late 20th century into a chronic, manageable condition.
AIDS has been tamed in the Western world — perhaps the greatest triumph of the pharmaceutical industry.
Back in 1994, the disease had reached an awful nadir. The number of US deaths from AIDS reached 41,699 that year, a new high. With no vaccines or effective drugs available, the death rate was 100 percent.
Just two years later, the cover of Newsweek asked if we were seeing “The End of AIDS?” The number of deaths that year was below 20,000 and falling. This number has stabilized and is now about 18,000 a year.
And it was largely due to the much-maligned drug companies, waging a campaign that is arguably among the most impressive in medical history in its scope, scientific sophistication and outcome.
Behind the scenes, pharmacologists worked feverishly to uncover the secrets of HIV and look for potentially helpful therapies. Using state-of-the-art technologies in drug design, virology and biotechnology, the industry delivered a revolutionary series of novel therapies that not only halted the disease, but also actually reversed it.
In 1987, we had only one specific AIDS therapy — AZT, an old drug that was marginally effective at best. But in 1995, Hoffman-La Roche (now Roche) received FDA approval for a drug called saquinavir, the first member of a new class of drugs called protease inhibitors (PIs). The PIs attacked HIV by a completely different mechanism than AZT — making possible the use of “AIDS cocktails,” in which two or more drugs are given together. Within 10 years, nine more PIs were approved, as well as eight other new AIDS drugs.
These drugs were the end-result of painstaking research. The industry average is to get just one new, marketed drug out of every 5,000 to 10,000 new chemical compounds. A good chemist will synthesize only about 50 such compounds a year.
These figures only hint at the degree of difficulty involved in discovering a new drug and the number of people required to do the research. The extent of the manpower devoted to AIDS research during the first two decades of the disease was mind-boggling.
Yet we now have 22 different AIDS drugs in seven distinct classes, with each class using a different mode of action against HIV. Some are meant to replace older, more toxic drugs; some just work better and some function to “salvage” patients for whom conventional therapy has failed.
Among the most dramatic developments is the decreased pill burden. Fifteen years ago, AIDS patients had to take 30 to 40 pills a day. But in 2006 collaboration between Gilead and Bristol-Meyers Squibb yielded a single, life-saving pill called Atripla, which is taken just once a day.
Drug companies are often portrayed as “evil” or “greedy,” but they actually make very little money on AIDS drugs, as do the scientists who work for them. The big payoff was for the patients: Hospitalization for AIDS is drastically decreased, and the projected life span of patients receiving modern AIDS treatments now ranges from 63 (in the United States) to 77.7 years in Germany (compared to 78.1 years for those not infected). This kind of life expectancy would have been considered science fiction a decade ago.
Although universities and government made significant contributions, the campaign against HIV was waged primarily by the pharmaceutical industry — the only one with the knowledge and resources to develop new drugs.
Never before has a virulent, fatal disease been so rapidly brought to heel. Instead of the usual drug-company bashing, today calls for at least a quiet “Thanks.”
Josh Bloom worked in the pharmaceutical industry for more than two decades before joining the American Council on Science and Health in September as the group’s di rector of public health.