It's going better, but it is not won. "For the first time, the fight against AIDS experts take a relatively optimistic speech. "In developed countries, the life expectancy of HIV is now close to that of the rest of the population", provides Pierre-Marie Girard, head of the infection and tropical of the hospital Saint-Antoine in Paris. In France, the disease continues to advance at 7,000 to 8,000 new cases per year. Is majority supported by insurance - disease and an integrated health network in 68 hospitals. "Today we have sick 120,000 of which 30 are of African origin." Approximately 82 of them receive anti-retroviral treatments effective and accessible. "This largely explains the decrease in the evolution of the disease", says Jean-François Delfraissy, Director of the National Agency for research on AIDS (ANRS).
With triple, more than half of patients treated in France have become undetectable viral loads (1). But the virus is not eradicated so far. HIV is a pathogen incredibly vicious. When it is threatened, he sought refuge in "sanctuaries" where it goes into sleep. It becomes inaccessible to available antiretroviral drugs (ARVS) and the immune system can no longer detect it. But as soon as the pressure of drug fades, it resurfaced and resumed its infernal cycle of replication with a frightening productivity. "Replication rate can reach 10 billion virus produced per day with a very high number of mutations and genetic recombination," says Vincent Calvez, head of Virology at the Pitié-Salpêtrière in Paris hospital.
Many research focuses on the identification of the "shrines" and how to permanently serve the body of these ultimate enemies. "The Elimination of these viral reservoirs is one of the most important challenges of the research," judge Jean-François Delfraissy. This residual viral load and these phenomena of release of "new" virus in the body cause a terrible consequence for the sick: they must take medication for life. "We must now take into account this factor and ask ourselves how our patients are getting older with HIV," notes Pierre-Marie Girard.
In the northern hemisphere, AIDS is now deemed to be a chronic and some patients will be followed for decades. "This is why we need new molecules." This allows us to compose various medical plans. "The patients will receive treatment individualized at different times of their lives," says Christine Katlama, head of Department of infectious and tropical diseases at Pitié-Salpêtrière in Paris hospital. The financial cost of this transformation of chronic disease AIDS was evaluated by North American experts. "In developed countries, the cost of a triple therapy is of the order of 250,000 dollars for a lifetime", says Julio Montaner, researcher at the University of British Columbia to the Canada.
Despite these undeniable advances and the wealth of available therapeutic arsenal (2), between 6 and 7 of patients have become resistant to all drug combinations. "But this figure seems now stabilized", said Jean-François Delfraissy. The arrival this year of a new class of drugs, the entry inhibitors, finally brings hope to these populations "in therapeutic escape." Maraviroc is a small molecule that blocks the virus in its initial phase, at the time where he landed the first lymphocyte he has chosen to target. It condemns somehow HIV entry doors. "In fact, the virus can no longer cling on the membrane CCR5 receptors", says Professor Jacques Reynes Gui de Chauliac hospital in Montpellier. Reserved as a first step to a certain class of patients receiving this molecule developed by Pfizer, newcomer in the field of AIDS, American seduced researchers. "It could also boost the immune system and we will begin a clinical trial in 2009," reveals Christine Katlama.
Prevention and screening
In this context relatively satisfactory, the two main objectives are prevention and screening. In developed countries, there is a recovery in the increase in new infections. This is the case in the United States where the incidence of disease (number of new infections) grew in 2007 after a long stabilization. These data seem to confirm an increase in "lines at risk" of the younger generations entering the sexual life. Some of these young people mistakenly believe that AIDS has become a curable disease. The other issue is also strategic: the screening. "There is in France close to 36,000 people who are unaware of their HIV status or that do not follow." "Far too many patients are diagnosed late", indicates the pattern of the ANRS. "About 40 deaths are the cause of these late diagnoses," adds Dominique Costagliola, researcher at Inserm.
While the disease is virtually under control in the countries of the North, it is far from the account in developing countries. In sub-Saharan Africa which is home to about 22 million people infected with HIV, of which 10 million should receive ARVS, the situation remains precarious despite real progress in the management. In Kenya, about 80 of patients do not know their status. In Tanzania, adult 300,000 receive free drugs, then only a million should benefit, according to the standards in force in developed countries (3). But the greatest concern is the maintenance of international financing which could be questioned as early as the year next by the economic crisis. "I hope that it will not affect to the holdings of major programmes such as the Global Fund." "Public opinion would not be to inject hundreds of billions of dollars to rescue banks and deletes billions of dollars to treat people", said Robert Sebbag, in charge of access to drugs in Aventis.