The progress in treating HIV since it first entered the popular psyche has been significant. It is no longer a death sentence in the developed world, and those infected with HIV - who get treatment and adhere to that treatment - can live long and relatively normal lives.
The real problem is in the developing world, and amongst populations in the developed world that cannot or will not seek/adhere to treatment. Treatment is sufficiently advanced that, while further developments of a vaccine are unbelievably exciting, they are not necessarily a game-changer in terms of worldwide infection. We have a long way to go in terms of beating this virus. Theoretically, we could follow the same route as with [edit: smallpox], unifying and mobilizing the world to isolate and then eradicate pockets of the disease, but this is a much larger effort than the one taking place in the lab, and is a question of government & administration, rather than medicine.
Edit: Bringing it up from a comment I made below, here is a relevant TED Talk on stopping pandemics: http://www.ted.com/talks/larry_brilliant_wants_to_stop_pande...
I'm further confused by your polio reference, because that sort of effort would only be possible with a vaccine.
I should have been more specific - I meant that if we did develop a vaccine, then it makes following the [smallpox] example theoretically possible, but this is still extremely challenging due to the reasons given.
Although you and I might have the vaccine, not everyone has it - not by a long shot - because not everyone is born in a modern westernized hospital. These people are protected by virtue of an extreme mobilization to literally isolate every single instance of the virus. It (hopefully) only exists in the lab at this point.
Polio is unfortunately still "in the wild" in certain areas (Afghanistan/Pakistan/India, Sub-Saharan Africa), and had a bit of a resurgence lately. The Gates Foundation is putting a lot of effort into finishing up polio eradication.
Relevant TED talk: http://www.ted.com/talks/bruce_aylward_how_we_ll_stop_polio....
One of the main issues is that the polio vaccine requires a cold chain (presently; I think they have a new shelf-stable one); the smallpox vaccine, at least one of them, does not.
But a 50% decrease in new HIV infections is huge!
My understanding is that many (all?) of these studies have been conducted in sub-Saharan africa. The environment in which AIDS spreads may be very different in developed countries. The presence of secondary infections, unhygienic conditions, and other social norms may play a big role in the spread of aids and greatly amplify the protection that circumcision provides. The evidence does look compelling.
Now, if the infection rate is already low, secondary STDs are rare, hygiene is at a very high standard, and transmission vectors are different, then the effects might be much less pronounced. I suspect it would be hard to create a controlled study of this in Europe, since you'd have to convince a large number of men who are probably in a very low risk group to be circumcised.
One question, that I don't think has been answered sufficiently is that the controlled trials and published studies have been criticized for possibly overstating the effectiveness of treatment. (The trials were stopped early on ethical grounds which can overestimate the effects being tested.) Wikipedia has a fairly comprehensive roundup: http://en.wikipedia.org/wiki/Circumcision_and_HIV#Randomised...
I think my bigger point, though, is that it's easy to look at data and say, "Aha! This one thing is the solution" without stepping back and looking at all the different pieces that make up the big picture. It's going to take some combination of education, prevention, vaccination, and health policy to tackle this disease.
Except there have been dozens of randomized, controlled studies that show circumcision significantly reduces risk of infection.
If that were the case here it would make vaccination much harder, though still possible of course.
The adherence part is the most interest bit of the story. The adherence to HIV medications is ~93%, much greater than the adherence to almost every other drug or behavioral treatment. If diabetes patients or cardiac patients had adherence rates anywhere near that high then the life expectancy of the average American would be dramatically higher.
- expected or actual efficacy
- regimen complexity
- knowledge, commitment, and ability
- doctor-patient relationship
My understanding is that with HIV a lot of money has been spent on actually implementing the adherence research in order to reduce the spread of the disease, whereas for most other diseases no one really cares. I think getting diagnosed with HIV also encourages some people to grow up a little bit in a way that getting diagnosed with high blood pressure or whatever doesn't, though maybe less so now that infection vectors are changing.
Diabetes (type 2) and cardiac disease are scenarios where people can still kid themselves to a certain extent.
India would probably just violate the patent, claiming national security reasons, and sell it for ~production cost throughout the world. The USA might enforce a patent domestically, and it would be a rational economic choice for insurers to pay for it for many patients instead of long-term treatment if someone contracts AIDS otherwise -- if you have a 0.1% risk of contracting AIDS in a lifetime, and lifetime treatment costs $1mm, it's worthwhile to pay $100-$1000 for it.
A charity (or government) might pay for full rights to the vaccine globally, and then distribute it for the good of humanity (and to burnish their reputation), but the really out of the box thing would be for a consumer product company to distribute the vaccine cheaply, purely as a form of PR. Imagine: "Coca-Cola, the drink that is good for you. Remember, we cured AIDS."
I think his point is that much of the problem of preventing the spread of HIV has less to do with the science of killing the virus, and more to do with the difficulty of actually getting it in the hands of people who need it. There are already very cheap, readily-available ways of preventing HIV transmission (condom use comes to mind), but people aren't using those. The reasons are varied, but some cite misinformation, cultural misconceptions, government ineptitude, and so on. Even if there were a 99% effective HIV vaccine that were as cheap as water, it still wouldn't make it into the hands of every person in the developing world. Proof of that is the fact that we can't even get water to all of these people.
Not sure how good an analogy this is. I suspect it would be moderately expensive (i.e. on the order of a few billion dollars), but possible to deliver a liter of clean water to nearly everyone in the developing world. The problem is, that solves their water problem for about 12 hours, if you're being generous. Solving their problem long term is the hard part. With vaccines, you only need to visit the people a finite number of times, and then you're done. Given that HIV is sexually transmitted (and assuming that the vaccine can be given relatively young), you wouldn't even need especially frequent visits to immunize the next generation of people.
Here's a relevant TED Talk about pandemics: http://www.ted.com/talks/larry_brilliant_wants_to_stop_pande...
"Herd immunity" protects the others -- basically, the disease itself can't spread if a sufficient number of people are vaccinated, so it dies out in a few generations (of the disease, not of humans).
The problem is the standard models of herd immunity depend on some simplifying assumptions which may be true in livestock, but are not true in humans -- specifically, that it's a homogenous population with equal chance of giving any other individual the disease, and that vaccines will be distributed fairly randomly as well.
If you have backwater villages which never get vaccinated, and are highly interconnected, you can end up with persistent reservoirs of disease, even if it's only 1% of your overall population. Then, you can have periodic epidemics when an individual from that area travels to an unvaccinated area elsewhere (because compliance rates on vaccination go down once the disease is "cured" in a population).
(I know about this from drinking with some of the UN/WHO vaccination people in Afghanistan)
I think things should work out well in the end, but it might take a while.
There are places where the official government-endorsed treatment for HIV was sex with a virgin. There are religious notions that declare use of birth control sinful. There are moral police that call education about safe sex (instead of abstinence) wrong, despite its proven efficacy.
Except the side effects (as with any drug therapy) can be severe. And the effects of long term use is anybody guess. Many patients who lived, just now reaching their 50's; are experiencing everything from diabetes to chronic kidney and liver disease to macula edema.
Course the trade off is death. So maybe it is a good deal.
Phase 1 is generally a small trial that is primarily designed to test the safety of the drug, not its efficacy.
I like hearing about scientific progress like this, but worry that it will be another "promising advancement" that we never hear about again, like a new cure for cancer or tax cuts for the middle class.
As far as I know there is no herpes vaccine and herpes stays with you for life resulting in recurring problems. Doesn't quite sound like a very flattering comparison to an effective vaccine solution.
There are cases of herpes causing death. For example, in an infant infected by his mohel, and a laboratory researcher killed after exposure to monkey feces. (http://www.cdc.gov/mmwr/preview/mmwrhtml/00056008.htm)
The reason medical professionals recommend parents let their children catch chickenpox is because it the symptoms get worse the older you are. In your later years it can even be life-threatening. Never underestimate the chickenpox!
This test was done on healthy volunteers, not ones with HIV. Although it's promising that 90% of the patients showed an immune response, we don't know how well that immune response translates into therapeutic benefit until it's trialled on HIV-positive patients.
EDIT: thanks guys, but I have enough upvotes. My comment didn't add much to HN. Wasn't actually trying to prove him wrong -- I thought I'd missed something and was asking for clarification.
I don't know myself, I know next to nothing about medicine.
1. http://www.cienciatk.csic.es/Videos/PRESENTACION+DE+LOS+RESU... (Spanish)
Once that is done, how well it works is the Phase 2. See here: http://en.wikipedia.org/wiki/Clinical_trial#Phases
1. Phase 1 is for safety
2. 30 is a small number
But the big issue here is the reason HIV and even the common cold is hard to treat -- high turnover and high rates of mutation.
So, even if you have Ab's and/or helper T cells (cell that remember an infection) against one or more strains of HIV, the presentation of the strain that an individual may pick up later on in life may be different and thus might not mount an immune response. Also of interest -- Helper T-cell sare the primary target of HIV.
In order to really determine if or not this vaccine is effective, we will have to observe the responses in people who have been given the vaccine and then contracted HIV later in life. While this is promising and will add another barrier against HIV, its unlikely to eradicate the virus.
Before you say these things lightly, think about it for a few minutes.
i) Here is a recent analysis of existing evidence: http://hivskeptic.wordpress.com/2008/01/15/hiv-has-never-bee....
ii) A prize of $100.000 "was officially offered to anybody who would demonstrate HIV particles in the blood of allegedly high viral load patients". It has not been claimed yet.
So far, there is ground for a reasonable scientific doubt regarding claiming that HIV causes AIDS. The accumulated evidence is not conclusive unfortunately.
Kind of funny that people with AIDS tend to, you know, live, when HIV-targeting drugs are administered.
Just one of those weird coincidences, I guess.
"What you're saying, though, is a stance that's literally killing millions of people in Africa. Before you say these things lightly, think about it for a few minutes."
"This claim is made by a discredited minority."
I don't think there is anything wrong with not believing, but rather questioning and examining a scientific assumption. Also when it is held by the majority.
And to attack people directly, making them look stupid, evil or irresponsible is certainly no going to convince them.
I found this text  which encourages to question orthodoxy, but also shows very clearly why in the case of AIDS/HIV there is overwhelming evidence for causation. It makes clear note that there is not a proof.
First I've ever heard of anything like this.
However, the article was withdrawn by Medical Hypotheses later
Of all the pseudoscience and conspiracy theories in the world, I think this one bugs me the most, primarily because it has a real cost in human lives  (unlike moon landing or JFK conspiracies). Hopefully if/when a reliable vaccine is found, HIV can be wiped out for good and this will no longer be an issue.
It's a fair statement to say that no credible scientist in the field honestly believes this.
Are these the same scientists who don't believe in global warming?
Then again, Michelle Bachmann can speak in a public forum and decry an HPV vaccine as "slut juice" and the next day cite revoked not-even-psuedo science as vaccines causing mental retardation, so I think there's something to be said for some scientific opinions or observations being more sound than others.
(ie: the ones that actually employ the scientific method with some genuine modicum of effort.