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Human immunodeficiency virus (HIV) has become a manageable chronic disease, but that is true only in rich countries that have a relatively small number of HIV cases. With the evolution of treatment, patients can expect a natural life expectancy with the available therapies. These treatments are needed globally in third-world countries where most of the cases are.
"About 33 million people have AIDS worldwide, and about 2.5 million new cases develop annually," said Dr. Lynn, a senior consultant in infectious diseases, Infection and Immunology Unit, Ealing Hospital, London. "These numbers are staggering. About 2 million deaths due to HIV occur each year."
Most of the 2.1 million deaths from AIDS that occur annually are in sub-Saharan Africa and Asia, but there are substantial numbers of cases elsewhere in the world, Dr. Lynn said, especially in Southeast Asia, eastern Europe, and central Asia. The case numbers in western Europe, North America, and Latin America have remained relatively constant over the past few years.
"Recently, there has been evidence of a small decrease in the number of new HIV infections, which might be attributable to effective education campaigns about HIV," Dr. Lynn said. "However, it might also be due to deaths in the most severely affected countries in sub-Saharan Africa."
Because of the evolution of treatment of AIDS, the disease is now manageable over the long term and patients can expect a natural life span. This is in contrast to the 10 to 12 years of life expectancy associated with the untreated natural course of the disease.
Dr. Lynn highlighted the status of the mortality rates in the UK.
"Generally, HIV-infected individuals are living longer in the United Kingdom," he said. "The . . . effect of the newer therapies-non-nucleoside agents and the protease inhibitors, and the more recent chemokine receptor blockers and the integrase inhibitors-have been phenomenal, he said.
In contrast to the 1980s, when life expectancy was months following diagnosis of AIDS, patients potentially have a natural life expectancy with good quality of life. The number of patients living with HIV is steadily increasing, and there are relatively few (7,000 to 8,000) new cases each year.
Despite the success with AIDS therapies in developed countries such as the United Kingdom, Dr. Lynn said, there is disappointment with the progress in the development of a vaccine during the same period.
"Vaccines still have not been able to prevent an HIV infection," he said. "The hopes about such a vaccine that rose 5 to 6 years ago have largely been dashed."
Costs are high
The downside to the phenomenal effect of the AIDS drugs is the associated health- care costs. They are quite high and are expected to increase five-fold by 2030 in the United Kingdom. With a projected life expectancy of 40 years with treatment, the projected health-care costs for an individual would be $385,200, which in the United Kingdom with its population of about 100,000 infected individuals would be quite substantial-£4 to £5 billion annually, according to Dr. Lynn.
"As we go forward in the 21st century, we will see development of additional AIDS drugs," Dr. Lynn said. "I am confident that with the currently available drugs, HIV can be controlled for at least 30 to 40 years.
"However, this type of treatment is only available to a small number of patients who live in developed countries," he said. "This type of therapy is needed globally in areas where most of the AIDS cases [exist]."
Dr. Lynn said he looks forward to an effective vaccine within 10 to 30 years.