NL
DE
While most people might think of acquired immunodeficiency syndrome (AIDS) as a disease of the past, there are still roughly 40 million people living with human immunodeficiency virus (HIV). More strikingly, 23% of these people do not have access to proper treatment. As a consequence, globally, every minute in 2024 someone died of HIV-related causes. All the more reason to stop and think about this disease on the 1st of December, World AIDS Day. For this occasion, we sat down with David Burger, professor of Clinical Pharmacy at the Department of Pharmacy at Radboud university medical center.
What is HIV/AIDS?
To understand why HIV/AIDS is such a challenging disease, it helps to revisit the basics. HIV infects and destroys immune cells, such as CD4 cells, thereby gradually weakening the body’s ability to defend itself. AIDS is diagnosed when the patient suffers from a so-called AIDS defining illness such as Pneumocystis Jerovicii Pneumonia (PJP) or the number of CD4 cells drops from 500-1500 to below 200 cells per mm³, a threshold at which even a simple cold can become life-threatening. The most common HIV transmission routes are unprotected sexual intercourse and intravenous drug use. Nowadays, there are effective treatments (antiretroviral therapy: ART) and preventive agents (pre-exposure prophylaxis: PrEP) available, but finding a vaccine or cure remains extremely difficult, due to the way HIV can ‘hide’ in different cells and compartments of the body.
A career spanning the ups and downs of HIV/AIDS
David’s interest in HIV/AIDS began in 1990 during an internship for his Pharmacy degree, less than a decade after the first cases were reported. At this point, the first treatment for HIV/AIDS, azidothymidine (AZT, also known as zidovudine), had been approved, but getting infected with HIV was still a death sentence. The research on interactions between AZT and other medications sparked his interest in HIV/AIDS so much, that he ended up starting a PhD trajectory in this field. After defending his thesis in 1994, he moved to Radboud university medical center to become a hospital pharmacist, but kept doing research on HIV/AIDS on the side.
When discussing some memorable moments in his career, one moment stood out among the rest. David attended the XI International AIDS Conference in Vancouver in 1996, where results of combination therapy suddenly showed HIV infection was no longer an absolute terminal disease. In his own words: ‘You have to imagine, there was no social media during that time, so we all saw the data for the very first time at that conference. Suddenly, we were shown that it is possible to truly suppress the virus and provide an effective therapy’. Within a week after this conference, over 75,000 patients began using this effective antiretroviral regimen, truly marking a turning point in the fight against HIV.
Despite enormous progress, David stressed that the fight is far from over. The research questions just shift to new challenges. One of these challenges was the stark divide in access to medications between the Global North and the Global South. He quotes the late professor Joep Lange, who famously said: ‘If we can get Coca-Cola to every remote corner of Africa, why can't we do the same with HIV drugs?’ Luckily, Joep’s activism was followed by lifting the patent on HIV medications in the Global South in order to make these drugs available there. This led to an interesting contrast: ‘Nowadays, treating an HIV patient is actually cheaper in Africa than in the Netherlands’, according to David. However, the prices in the Netherlands are expected to drop soon, as patents on many drugs will expire in the coming years.
Therapy compliance is another challenge for people living with HIV. Many of the available treatments need to be taken every day for life. This is already quite a challenge in itself, but the everlasting stigma on HIV makes it even harder. Many people living with HIV are not open to family and friends about their diagnosis, which could also negatively impact the medication adherence. David illustrates: ‘Imagine having to open your suitcase at the airport and being asked what your medication is for. This is still a barrier for many people’.
The future of HIV/AIDS
Looking ahead, David sees both concerns and hope. On the one hand, he worries about the US announcing cuts in international development assistance. ‘Scrapping these programs with one stroke of a pen will have an immense impact.’ At the same time, there are some promising developments. ‘Within two years, we will get the most effective combination therapy in generic form, which will drop the costs of HIV treatment dramatically’, he said. Additionally, the transition to more long-lasting antiretrovirals has already started with lenacapavir, the first PrEP agent that prevented nearly all HIV infections with a mere twice-yearly injection. While this PrEP will primarily be rolled out in the Global South, it would also benefit a lot of young people here.
Reflecting on his 35-year career, David has witnessed extraordinary change. ‘In the 80s, HIV/AIDS was a leading cause of death among young adults, but this has dropped dramatically due to treatment availability’. Such a dramatic rise and fall in cases and disease severity is something you rarely witness in one career, highlighting that HIV/AIDS is an extremely dynamic field of research. So, while the 1st of December should primarily be a day to reflect on ways to finally end AIDS as a public health threat, we should also celebrate how far the field has come.
-
A blog by Kim van den Nobelen & Robbin Kramer (PhD candidates @ Dep. Medical BioSciences)
Jr. editors for Radboudumc Research Institute for Medical Innovation
