El fin del vih

T he

N EW ENGLA ND JOURNAL

of

M EDICINE

Perspective
august 23, 2012

The Beginning of the End of AIDS?
Diane Havlir, M.D., and Chris Beyrer, M.D., M.P.H.

W

e are at a moment ofextraordinary optimism
in the response to the human immunodeficiency virus (HIV). A series of scientific breakthroughs,
including several trials showing the partial efficacy

of oral and topicalchemoprophylaxis1,2 and the first evidence of
efficacy for an HIV vaccine candidate,3 have the potential to markedly expand the available preventive tools. There is evidence of the
first cure of anHIV-infected person. And most important, the
finding that early initiation of antiretroviral therapy can both improve individual patient outcomes
and reduce the risk of HIV transmission to sexualpartners by
96%4 has led many to assert what
had so long seemed impossible:
that control of the HIV pandemic
may be achievable.
What will it take to achieve
what U.S. Secretary of State HillaryRodham Clinton called, in a

2011 address, an “AIDS-free generation”? Expanded access to and
coverage of high-quality prevention and treatment services tailored to affected populations are
criticalto keeping people living
with HIV healthy and to dramatically reducing the number of new
HIV infections.5 This goal requires
an ambitious implementationscience agenda that improves efficiency andeffectiveness and
incorporates strategies for overcoming the stigma and discrimination that continue to limit the
uptake and utilization of services.
Research efforts on HIV vaccines
will alsoprobably be key, and the
field has been reinvigorated, after
a series of unsuccessful trials, by

n engl j med 367;8

nejm.org

the findings of the RV144 trial
involving Thai adults, which
showedthat the vaccine provided
modest protection against HIV acquisition in selected populations.3
Research focused on curing HIV
disease is yielding fascinating insights into how HIV persists in the...