How early treatment has changed the death sentence of AIDS

At the 2015 International AIDS Society Conference, researchers confirmed that starting HIV patients on antiretroviral drugs early does prevent AIDS-related illness and deaths. Gwen Ifill talks to Justin Goforth of Whitman-Walker Health and U.S. Global AIDS Coordinator Dr. Deborah Birx about how far we have come in the struggle against HIV/AIDS, and the goal of ending the disease by 2030.

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    Patients, advocates and scientists are hailing new studies that show the value of getting AIDS drugs to people early and often.

    The three-decade-long fight against AIDS has seen a series of breakthroughs in recent weeks, showing momentum in the push for an HIV cure. Yesterday, at the 2015 International AIDS Society Conference in Vancouver, researchers detailed some dramatic findings. They confirmed that, for people with HIV, starting treatments with antiretroviral drugs early did prevent AIDS-related illness and deaths.

    Until now, there had been concern that starting such therapy too early might increase patients' risk of cardiovascular and renal disease. That news came on top of another surprising development, as doctors at the conference described the case of a French teenager. The so-far unidentified girl was born with HIV, and received antiretroviral treatment until she was 6. Twelve years later, she's still free of the virus. It appears to be the first confirmed long-term remission in a child infected from birth.

  • MICHEL SIDIBE, Executive Director, UNAIDS:

    People were saying that we were foolish dreamers, that we were even naive.


    And that followed word last week that the U.N. reached its 2015 goal of providing access to HIV treatment for 15 million people worldwide, nine months ahead of schedule.


    And they said it was too costly. But we have been able to demonstrate that they were wrong. And they were saying that the costs will never go down.


    The report also said that a once inconceivable goal, ending the AIDS epidemic, is in sight by the year 2030.

    So let's look closer at the growth of treatment, the push to dramatically expand it to unheard-of levels and what these drugs have meant to people coping with the still-incurable disease.

    Deborah Birx is the point person for the government as the U.S. global AIDS coordinator. She joins us from Vancouver, where the conference is still under way. And Justin Goforth is a nurse and director of outreach for the Whitman-Walker Health care clinic here in Washington. He was diagnosed with HIV back in 1992.

    Dr. Birx let's talk about these numbers, which are quite stunning. We're talking about a 48 percent decrease in HIV infections in children just since 2009. That's in 21 priority countries. What is the significance of this?

  • DR. DEBORAH BIRX, U.S. Global AIDS Coordinator:

    It really shows that when we focus and work together, we can achieve amazing goals.

    So, under the global plan that was launched by PEPFAR and UNAIDS just a few short years ago, it really mobilized governments and communities to really move forward in an organized and focused way to have this dramatic change in the number of new infections in pediatrics.


    Justin Goforth, you were hands-on every single day dealing with this for some years. How has it played out in a health clinic like yours, which serves so many people in a highly affected community?

  • JUSTIN GOFORTH, Whitman-Walker Health:

    It's been quite an evolution of course with the technology and science around HIV.

    We really needed to get to a point that we didn't just have effective treatments, but that we had treatments that could actually be managed within a daily life of the people we take care of. And that's where we're at.

    And that's why things are changing so quickly and it's so important to pay attention to the issue, because if you can get in care and stay in care on treatment, it is a manageable chronic illness.


    And that's what's happened with you?


    That's correct. It's been since 1992.

    In, I think, '96, I was taking at least 40 pills a day. That was five times a day, three times a day, had to be exactly eight hours apart with a full meal. Nobody eats like that. Two times a day had been to be with a completely empty stomach.

    They were effective, but they were toxic and not really manageable in people's lives. And that's not where we are. Where we are today is the majority of the people we take care of take one pill a day and manage their illness very effectively and plan on living full lives.


    Dr. Birx, many of the findings that you have been talking about in Vancouver have to do with children worldwide, where there has been great impact over the years, especially among the youngest.

    Tell me about the significance of how soon you begin to act and provide this medication for children.


    Well, both children and adults, so it's been incredibly exciting to be back in Vancouver.

    As you heard there from Justin, we had 19 years ago in this very city the announcement of highly effective treatment. And for myself and many clinicians, that was when we were actually able to keep our patients alive. So the patients that made to it 1996, if you were in the developed world, you were able to actually live effectively. And that was so extraordinary.

    To be back here 19 years later and here now, through the really groundbreaking trial that was done around the world, the START trial, it says, if we start people early, they can live full and productive lives, no matter where they are. So that theme of that conference, which was one hope, one world, can finally be realized with this new trial results.

    And we are so excited to translate that science immediately into programs through PEPFAR.


    You also were — part of your role, also, Dr. Birx, was to provide antiretrovirals for 15 million people by the year 2015, and you got there early. How did that happen?


    You know, that is so extraordinary, because when UNAIDS said that we were going to get to 15 — by 15 in 2011, everyone was incredibly doubtful.

    And those of us who could really see the vision were really excited about translating that vision into practice. And I think, through the funding of the Global Fund and the funding through PEPFAR, and it's really — it's new collaborations and partnerships with host governments and civil society allowed us all to really sprint in a way we didn't know we were capable of doing.

    And so to say now that we have the last piece of the puzzle and the last tool that will really allow us to move and move back into this sprint mode to really reach people as quickly as we can, not only with effective therapy, which, as — but as what Justin said, not only effective, but a therapy that can be utilized as a community so that people can stay on treatment and thrive. And so this really is a unique opportunity.


    Justin Goforth, in order to treat, in order provide this therapy, this wonderful technology, people have to be willing to take an early diagnosis as well. Has that changed over time? The numbers are not so positive here in Washington, D.C.


    If you look over time, our numbers actually are getting tremendously better.

    I believe we had about 500 new infections last year, according to the new data that was out, and five to 10 years ago, that was easily 1,000 to 1,500 or for new infections. So, we have changed the number of new infections dramatically. That's really a lot about getting a lot of people tested, those folks that HIV-positive into care.

    We have lots of data to suggest that it's really difficult to change people's behaviors.




    But getting them into care and on treatment actually doesn't just keep that person healthy and well for a life span; it also prevents them from infecting other individuals.

    That's an historic marriage of two — public health prevention and treatment all coming together at the same time. And having a manageable treatment was necessary to get to the point that we could use this as prevention.

    And so that's what, I think, is really see — we're seeing a turnaround in the numbers in all of our urban centers in the United States, but particularly here in D.C., where we used to be seen as the worst of the worst. That's not the case actually more with our new numbers.


    Dr. Birx, 2030, you're talking about getting to zero. What is the possibility of that and how do you get there?


    Well, we're talking about ending AIDS as a public health threat, so we certainly want all of our HIV positives, the 37 million people living with HIV right now, to know their status and to thrive and to be on medication so they can thrive.

    To get there to the end is that we're going to require us to bring all our prevention tools to the table and expand them in an appropriate way in absolute partnership with the community, and I think we have been using the Whitman-Walker example. You can see what that clinic and its community outreach has been able to do.

    We want to translate what the Whitman-Walker clinic and others have been able to do in Washington, D.C., to every city, every village and every community around the globe. And you can see from what we just heard from Justin, it's possible.


    Dr. Deborah Birx, U.S. global AIDS coordinator, and Justin Goforth, the director of outreach at the Whitman-Walker Clinic here in Washington, thank you both very much.


    My pleasure.


    Thank you, Gwen.

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