After being recently awarded the King Holmes Endowed Professorship, Peter Piot discussed the future of Human Immunodeficiency Virus (HIV) on Tuesday in the William Foege building.
Piot was one of two people who discovered the Ebola virus in 1976. He also led research on HIV and Acquired Immune Deficiency Syndrome (AIDS), as well as other sexually transmitted infections (STIs).
The professorship Piot received was created after King Holmes, who, along with Piot, made the study of STIs a respectable field to be in, slowly weeding out the stigmas and creating research jobs in the field.
Piot said his lecture was to focus on the future of HIV.
Currently, HIV treatment is possible through Antiretroviral (ARV) treatments: a single pill taken at the exact same time every single day. With this pill, HIV-infected people can live without symptoms, typically as long as an uninfected person.
While ARV treatment has the money to back it, the money is plateauing at a time when “needs are going up,” Piot said.
Within the United States alone, there are at least 1.2 million people living with HIV and AIDS, and there are 50,000 new infections a year, according to the most recent Center for Disease Control and Prevention data. Those statistics are sizeable, but still relatively tiny compared to other countries.
“We’re dealing with micro-epidemics, many epidemics,” Piot said.
In particular, sub-Saharan Africa sees the most cases of HIV and subsequent deaths, yet the virus is inversely treated the least there. But, unlike the United States, treatment is more affordable thanks to Africa’s decision to use generics.
Despite treatment being available at low costs, and in part because low prices minimize manufacturer profits, Piot believes ARV shouldn’t be more affordable than it already is in places like sub-Saharan Africa.
“Some manufacturers, despite what activists think, do this because they see a business in it, not because they’re a [non-governmental organization],” Piot said.
For manufacturers creating ARVs, profit margins aren’t as large as they could be if the companies decided to create a different drug. Because of that monetary incentive, many companies are switching to making different drugs, which is creating stock-ups.
When a place is experiencing a stock-up on a product, it is running out of its supply; in this case, it is a shrinking supply of ARV. This issue is mostly affecting marginalized populations around the globe.
This means two things: Treatment has failed altogether for HIV-infected people, because even stopping and then continuing treatment for HIV increases the rate at which one dies, and stopping and restarting treatment then creates an ARV-resistant strain of HIV.
“I think we are in collective denial of antiretroviral resistance,” Piot said.
If ever there comes a time when HIV becomes resistant to ARV on a large scale, the world is back to square one without a treatment.
Despite this, Piot said, there is lots of worrisome talk of soon reaching a cure within the epidemiology and virology fields of HIV.
“We should be proud of collectively [climbing great hills], but there are many more hills to climb,” he said. “If we just look back and be satisfied with what we’ve done, all the achievements of the past will disappear.”
He contended HIV and AIDS work will not be finished by the year 2030.
“I don’t want to leave you with the impression that it’s all negative,” Piot said. “We’ve come a long way, but we’re entering a new phase. … The road ahead is going to be very, very bumpy and we should not promise what cannot be delivered.”