AIDS: The Drug Companies are Winning the Image Game

"Going the Distance" reads the advertisement, which shows four mountain climbers bursting with health, and promotes an anti-AIDS drug manufactured by Merck . What's wrong with that? Plenty, according to the Food and Drug Administration, which recently ordered that the Merck ad, as well as those of other companies featuring robust young men heaving javelins, riding bikes and crewing on sailboats, be pulled. Such portrayals, said the F.D.A., were "not generally representative of H.I.V. patients and do not adequately convey that these drugs neither cure H.I.V. infection nor reduce its transmission."...

     Disinformation has been spread by the advertising used to promote anti-AIDS drugs, said Natasha Jenkins, an infectious disease market analyst in London for Datamonitor Healthcare, which does research for drug company advertising campaigns. Since 1997, when the F.D.A. first allowed drug companies to market directly to consumers, "They have made it seem like there is a cure and a lot of people have stopped taking the same precautions because they feel that AIDS is being controlled by drugs," said Ms. Jenkins.

    "There is obviously a tradeoff in wanting and letting people know that there are treatments for H.I.V. infection," Dr. Validiserri, of the C.D.C., added. "But we also don't want to go so far that we minimize what is still a lifelong, incurable disease."...

    "The numbers make it seem as if we had found a cure, but it is really just that the drug companies are winning the image game," Ms. Sinnock said. "Whether it is the America Responds to AIDS campaign or the more recent ads by the drug companies, we have a history of creating misconceptions that have made this disease more difficult to fight on the ground level."                        DRF 2001

And when is a "cure" a cure? 

In clinical medicine, one either "cures" a disease, or "manages" it. Those diseases that are "managed" are, at the time, described as "incurable." Schizophrenia, Cancer and AIDS are often in this category. Despite the uncomfortable side-effects of treatment, AIDS can be managed with what was marketed as "highly active anti- retroviral therapy"  (HAART). This has since been toned down to "ART".  But, never at a loss, the marketers have now defined management as a cure!

     It turns out that there are two kinds of cure - a "sterilizing cure" that eliminates all HIV from the patient's body, and a "functional cure," which describes the management of the disease (Dieffenbach & Fauci 2011). Indeed, Buchholz & Hauber (2013) declare that “Clearly, a functional cure may be easier to achieve, but a sterilizing cure is considered to the holy grail of HIV therapy.” But many readers will interpret this as meaning that a “sterilizing cure” is technically difficult, so that is why a “functional cure” may be easier to achieve. Actually, this is far from clear.

     Those of us who in the 1980s proposed approaches for achieving a "sterilizing cure," simply had our grant applications rejected. The all-eggs-in-a-few-baskets philosophy led to research funds going either to the functional cure researchers, or to those who had successfully marketed the bizarre idea that HIV was like other pathogens, so success in making a vaccine would just require a little tinkering.

     Had those who, from the outset, saw how to achieve a “sterilizing cure,” been given their heads, the entire story might be very different today. We simply do not know whether a sterilizing cure would have been difficult to achieve, since only in the last decade or so has a trickle of funds been grudgingly advanced for this purpose.

D. R. Forsdyke February 2013

Buchholz F & Hauber J (2013) Engineering DNA modifying enzymes: components of a future strategy to cure HIV/AIDS. Antiviral Research 97, 211-17.

Dieffenbach CW, Fauci AS (2011) Thirty years of HIV and AIDS: future challenges and opportunities. Annals of Internal Medicine 154, 766-71.