There will be no final battle in the war against HIV and AIDS. Acquired Immunodeficiency Syndrome is caused by the Human Immunodeficiency Virus and viruses are both difficult to treat and able to evolve quickly. Antiretroviral drugs are expensive and not available to victims in poor countries. Only relatively rich people can afford the treatments. The problem is that the drugs never kill all the viruses. The ones that survive are relatively resistant to the drugs and they pass this resistance on to the next generation of viruses. This is the process of natural selection and leads to increasing drug resistance, which means that new drugs must constantly be found.
It was once believed that the final battle against mosquitoes and malaria would be won by DDT. Instead the mosquitoes developed resistance to DDT, while numerous other animals were indiscriminately killed. There was no final battle and the war continues to this day, with malaria killing millions world-wide each year. Unfortunately, the same story is likely to be true of HIV. Drugs that work now will be useless in a few years time. In poor countries the situation is made worse by the lack of inexpensive drugs. What happens is that poor people, desperate for treatment, buy small quantities of the drugs, or out of date drugs or even fakes. These drugs may help the symptoms temporarily but they don’t cure anybody. In fact they eventually make things worse by exposing the virus to just enough of the drug to develop an immunity to it.
We have seen this with many bacterial diseases and antibiotics. If the full course of antibiotics is taken, a cure can occur. But many people stop taking the antibiotics when they feel better and this allows some of the bacteria to survive and reproduce. We are now seeing many drug-resistant forms of bacteria so that diseases we thought were defeated are making a comeback. Golden staph and penicillin-resistant syphilis are just two examples. Will HIV be any different? Bitter experience says no.
Recently there was a breakthrough in HIV treatment. A patient was treated with stem cells and is now believed to be disease free. Wouldn’t it be nice if all AIDS victims could receive this treatment? Will they? Not likely. It’s too expensive and too untested. It will be years before it is available even in relatively rich countries. Meanwhile the virus continues to spread in poor countries, where lack of information about the disease and the practice of unprotected sex is still the norm. Millions will still be infected and will die without effective treatment. Millions more will receive inadequate treatment which will allow the development of more drug-resistant strains.
Of all the diseases that affect humans, we have been able to wipe out only one: small pox. This disease was defeated because it only occurred in humans, was really obvious when infection occurred and it could be isolated and wiped out case by case with an extreme effort. The causative agent of small pox was not able to evolve quickly enough to survive. Very few other disease organisms meet these criteria and so for them, with current technology, there will be no final battle. HIV does not meet these criteria and it will continue to plague humanity for the foreseeable future. Eventually gene therapy may provide an answer, but not yet.
