There's still no cure for HIV and AIDS, but researchers hope an upcoming restructuring of clinical trials will help focus resources on the most current and relevant avenues of research.
In 2013, the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health, will restructure its six networks that deal with various types of clinical trials surrounding HIV and AIDS.
NIAID is also seeking input from individuals outside the organization, such as scientists, researchers and people living with HIV.
The networks will be reorganized to emphasize diseases that often coexist with HIV and AIDS, such as tuberculosis and viral hepatitis, prevention, finding a cure and maternal/pediatric health, according to Dr. Ann Collier, Professor of Medicine at the University of Washington and Director of the Aids Clinical Trials Unit (ACTU) at UW.
Understand TB, treat HIV
"Tuberculosis is the most common infectious disease in the world. Much of the TB epidemic has been fueled by people with HIV and tuberculosis. If someone wants to treat HIV, especially on a global scale, then it's important to understand the relationship between HIV and TB," Collier said.
The same can be said for the overlap between viral hepatitis and HIV/AIDS, she added.
As far as prevention research goes, the NIAID wants to look primarily at vaccines and social behavioral prevention.
Aging with HIV/AIDS
The restructuring will also emphasize finding a cure for HIV/AIDS and the problem of aging with HIV. As Collier explains, HIV-positive people in the United States are more likely to receive good treatment earlier, and thus live longer. This long-term exposure to medication presents a whole different collection of issues.
"Some of these complications are wrapped up with the American lifestyle, and when you add the long-term effects of HIV treatment, there's a double set of complications," Collier said.
As for the potential downsides of this reorganization, Collier said some trial sites might be discontinued or downsized.
"One thing that ACTG (Aids Clinical Trials Group, one of the six networks) has done extremely well is to help define the optimal treatment for HIV. Those studies have been fairly large, and have provided access to treatment for many individuals. Those kinds of studies are going to go away. In that sense, I think, our trials will be somewhat smaller," Collier said.
The prospect of smaller trials has some advocates on edge.
Stephanie Deyo, a representative with the Community Advisory Board for the group IMPAACT (International Maternal and Pediatric Adolescent Aids Clinical Trials), worries that crucial funding might be taken from pediatric and maternal HIV clinical trials as more emphasis is placed on other areas.
"We've been doing a lot of lobbying to make sure they do include pediatrics, and I know that they'll still focus on maternal and pediatric health, I just don't know to what extent," Deyo said.
Treatment as prevention
Collier hopes that this round of reorganization will be politics-free and fairly quick. It also may also make greater use of the link between treatment and prevention.
"One of the exciting new things is the coalescence of treatment and prevention. People once thought they were completely different areas, but now we see that effective treatment can draw people into learning about prevention, and can encourage people to get tested.
"Treatment might really be a way to decrease HIV transmission," Collier said.