“Countdown to Zero,” a VICE special report on the progress being made to prevent, treat and cure HIV, airs on HBO tonight — World AIDS Day — at 9 p.m. ET/PT. Scientists at Fred Hutchinson Cancer Research Center who are working on preventing, treating and potentially curing HIV/AIDS were among those interviewed for the documentary. In advance of tonight’s program, we talked with one of those experts, internationally renowned virologist and Fred Hutch president and director emeritus Dr. Larry Corey, who is founder and director of the HIV Vaccine Trials Network (HVTN), the world’s largest international collaboration working to develop preventive HIV vaccines.
You talked with VICE reporters about an endgame for HIV. What do you mean when you say endgame?
To me, the endgame is when we reduce the number of HIV incidence cases in the United States to less than 50, or less than 100. The only way that’s been done throughout the history of infectious diseases is with a vaccine. That has to be a 95 percent effective vaccine, like vaccines against polio or rubella or mumps.
Why do we still need a vaccine when we now have antiretroviral therapies that can stop HIV from progressing to AIDS?
Using antiretroviral drugs and putting everybody into therapy is important. But that is an approach that will never get to my endgame. With asymptomatic acquisition and asymptomatic transmission, you’re never going to get to less than 100 cases. For the last decade, the U.S. has recorded about 50,000 new cases of HIV yearly. With our current strategy to test and treat all people as soon as possible, we may reduce the transmission rate to 25,000. That would be a beautiful thing. But you’re not going to get to less than 100 cases yearly.
“Test and treat” is necessary, but it’s also costly. For many countries with a high burden of HIV, these approaches create a true Sophie’s choice. We would rob Peter to pay Paul, especially for some countries that also have issues with diabetes and obesity and child health and all this other stuff. How sustainable over time is that approach? When you look at the ultimate endgame from an economic point of view and a humanitarian point of view and a public health point of view and individual care point of view, it’s going to be incredibly important and cost-effective to make a vaccine.