HIV完治療法が求められるのはなぜか エイズ30周年IAS理事長見解

(解説) エイズの流行30周年に際し、国際エイズ学会(IAS)のエリ・カタビラ理事長が見解をプレスレリースのかたちでIAS公式サイトに発表しました。抗レトロウイルス治療のアクセス拡大の重要性や治療の普及が予防にもたらす効果に一定の期待を示しつつも、それではHIV/エイズの流行を終息に導くには不十分として、完治療法開発のための研究の必要性を強調しています。そのプレスレリースの日本語仮訳です。


【2011年6月3日】 30年前の今月、米国の保健機関が、のちにエイズの最初の公式症例となる不思議な病気のモニタリングを始めた。その1年後には、ウガンダの保健センターで働いていた若い医師が、ビクトリア湖岸のラカイ地区で、ウガンダ初のエイズ症例を確認し、保健省に報告した。




いかなる状況においても、地球規模の治療、予防、ケアのプログラムから直接、資金を削って、「完治」の研究に回すようなことはすべきではない。IAS は今後も、それぞれの柱に対する資金の増額を求めていく。ただし、IASは同時に、資金拠出機関や各国政府、エイズコミュニティがHIVの完治の研究に対し、必要な資金の投資をいますぐに行うことが不可欠であるとも確信している。

世界のHIV陽性者数は現在、3330万人と推定されている。抗レトロ ウイルス治療へのアクセスの拡大に向けて大きな進歩があったとはいえ、新規感染が増加している地域もあること、対策に向けられる資金が減っていること、WHOの新たなガイドラインのもとで HIV陽性者はこれまでよりも早く治療を開始することが推奨されていることは、ユニバーサルアクセスの目標は実現にほど遠いことを意味している。資金に限りある現状では、新規感染のペースは2対1の割合で治療の普及のペースを上回っており、ギャップは広がるばかりである。


HIV陽性者に大きな負担となるARVの生涯にわたる服薬にかわり、HIV感染のFunctional cure実質的な完治(注1)もしくはSterilizing cure感染の完全解消(注2)を実現するため、その研究資金を確保することは、陽性者の健康や人権の面で重要なだけでなく、社会の経済的利益にもかなうものである。




(注1) 実質的な完治 HIVの遺伝子素材は幾分、体内に残るが、患者の免疫機能によりウイルスが作られることのないよう完全に制御された状態。患者は抗レトロウイルス治療を続けなくてよくなる。
(注2) 感染の完全解消 HIV遺伝子素材が完全に消え、体内からHIVが根絶された状態

Thirty Years On: Why We Need a Cure for HIV Now More Than Ever Before
Opinion Piece by Elly Katabira, IAS President

June 03, 2011 - Thirty years ago this month, health agencies in the US began monitoring unusual clusters of diseases that would later be identified as the first cases of AIDS. A year later, a young medical officer working at a Health Center documented and reported to the Ministry of Health the first cases of AIDS in Uganda found on the shores of Lake Victoria in the Rakai district.

Over the past three decades, I have worked extensively in the field of care and support for people living with HIV, watching the story of AIDS unfold in my own country and around the world. I have witnessed some of the devastating consequences of silence and stigma, as well as the incredible results that translating scientific evidence into action can produce.

Today, HIV experts are in agreement that “prevention”, “treatment” and “care” are the three pillars to successfully responding to the HIV epidemic. Lessons learnt, and in particular the compelling new evidence that HIV treatment is also HIV prevention and that expanding antiretroviral therapy (ART) coverage has preventative benefits for the entire community, also show us that these three pillars must not be approached separately, but as three interconnected efforts.

Here at the International AIDS Society (IAS) however, we are convinced that the three pillar approach to ending the HIV epidemic is incomplete and, to mark this historic month, the IAS is calling for the addition of a fourth pillar -- “cure” -- to the international response to the HIV epidemic.

Under no circumstances should the inclusion of “cure” into the global response direct funding away from treatment, prevention and care programmes. The IAS will continue to advocate for increased funding across each of these pillars. The IAS does believe however, that it is imperative that donors, governments and the AIDS community make a viable economic investment in HIV cure research, and right now.

Globally, there are currently 33.3 million people living with HIV. Although significant progress has been made towards scaling up access to antiretroviral treatment, the increase in new infections in certain regions, a decrease in funding, and the fact that under new WHO guidelines HIV patients should be starting their treatment regimens much earlier, means that universal access targets are way off track. As new infections continue to outstrip numbers on treatment by 2 to 1 in resource-limited settings, the scale of unmet need can only increase.

Furthermore, while ART has greatly improved the quality of life of people living with HIV and reduced AIDS-related mortality rates, the virus remains persistent in certain cells even in patients being successfully treated. In turn, patients have no option but to undertake life-long treatment to keep the virus under control. Life-long adherence to these drugs remains both costly and tiring for the patient, while side-effects associated with ART usage can be severe. Lastly, resistance to treatment can occur for a number of reasons.

Funding research to develop a functional1 or sterilizing2 cure for HIV which could offer people living with the virus an alternative to the burden of a difficult life-long ARV regimen is therefore not only important for the health and human rights of people living with HIV, it is in our collective economic interest.

Professor Françoise Barré-Sinoussi, co-discoverer of HIV, Nobel Laureate and IAS President-elect, is currently guiding the development of a global scientific strategy, Towards an HIV Cure. This strategy aims at building a global consensus on the state of the art research in the field of HIV reservoirs and defining scientific priorities that must be addressed to tackle HIV persistence in patients undergoing treatment, the key hurdle impeding any alternative to long-term therapy.

Thirty years after the first cases of AIDS, if we are ever to envisage the remission of the disease in infected individuals, or even the eradication of the virus, then we must invest in and aggressively pursue an HIV cure.

Dr Elly Katabira is President of the International AIDS Society, the world's leading independent association of HIV professionals.

1 Functional cure some HIV genetic material remains in the body, but the patient’s immune defense fully controls any viral rebound, allowing patients to be free of antiretroviral treatment
2 Sterilizing cure no HIV genetic material can be found in the body, HIV infection is

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