The recent commemoration of World AIDS Day is a reminder of the impressive progress we are making in the fight against HIV/AIDS. The United Nations AIDS agency, UNAIDS, announced that if the international community can meet certain HIV testing and treatment targets over the next five years, we may be able to control the AIDS pandemic by 2030.[i] But the agency also warned against complacency at this critical juncture, citing the many challenges we must still address if we are to conquer this disease.
I wholeheartedly agree with this warning, and in fact, it is my job as an HIV researcher to come up with solutions to the challenges we continue to face when it comes to successfully treating those living with the disease.
The first step in taking on this daunting mission is deceptively simple: Listening to people with HIV. In the world of pharmaceutical companies, this approach is called “patient-centricity,” and in recent years, it has become a bit of a buzzword in the industry. However, people living with HIV are actually the ones who founded and led this pioneering movement.
In the early years of AIDS, it was people with HIV who led the way in motivating pharmaceutical companies, academic researchers, and the U.S. Food and Drug Association (FDA) to prioritize the development of the first HIV medicines. The work of advocacy organizations such as Gay Men’s Health Crisis (now GMHC), Act Up, and the Treatment Action Group – to name only a few – led to groundbreaking reforms in the ways that HIV clinical studies were designed and how the FDA “fast tracked” the review of drugs to treat HIV. These patient advocates also played a central role in getting the first life-saving “AIDS cocktails” into the hands of patients once the medications were approved.
Thirty years later, with more than 30 approved anti-HIV medicines in the United States[ii], it can be tempting to conclude that HIV is now a controllable disease. It’s true that we’ve made great strides in treating HIV, but it’s also true that we still have a lot of work to do. The U.S. Centers for Disease Control and Prevention estimate that more than 15,000 Americans still die of AIDS every year.[iii]
From my work with people with HIV and their advocates, it’s clear that there are three types of HIV patients who continue to have urgent unmet needs but are often neglected in the current public discourse on HIV. They are individuals who have developed drug-resistant HIV, older patients who require more tolerable and safer medicines, and people who are still struggling to take complex, multi-dose regimens.
People with highly drug-resistant HIV may simply run out of treatment options. Often, they have been on treatment for many years, have cycled through many different treatment regimens, and their HIV has mutated into a form that is resistant to most if not all of the available HIV medicines. These individuals desperately need entirely new types of HIV medicines that have the potency to get their infection under control again. Developing new classes of antiretrovirals must be one of our primary goals and it is one of my key priorities at Bristol-Myers Squibb.
We also need to develop safer and gentler HIV medicines that are easier for older patients to tolerate. This is a significant issue as we head into 2015, when it is projected that for the first time more than 50 percent of people living with HIV in the U.S. will be more than 50 years of age.[iv] Older people with HIV need therapies that are not going to worsen any other age-related health challenges they may be experiencing, and that are less likely to interact with other medicines they’re taking.
And we need to help those patients who still endure a daily struggle to take multiple pills and doses of their HIV medicines. You’ve probably heard about the advent of single pill regimens for HIV over the past decade. Bristol-Myers Squibb played a central role in helping to bring about this form of simplified therapy, which is often appropriate for recently diagnosed patients who are starting treatment for the first time. But we can’t rest until all patients benefit from simplified therapy, because it can help to extend life expectancy by making treatment easier to take consistently over the long term.
These are the people with HIV who urgently need our help before we can begin to talk about the end of HIV/AIDS. At Bristol-Myers Squibb, these are the patients we have at the forefront of our minds as we identify new anti-HIV compounds, as we design new clinical trials, and as we consult with patient advocates about our efforts to address this disease.
Clearly, “patient-centricity” continues to have a profound and positive impact in the fight against HIV, and will be one of the keys to beating this disease globally. Looking beyond HIV, we are beginning to see tangible signs of the patient-first approach taking root across a host of other health areas, as the FDA holds a series of grassroots consultations to boost patient-focused drug development for conditions including lung cancer, sickle cell anemia and fibromyalgia.v
In my view, this trend is a good thing, as long as it continues in a meaningful way, where patients are getting the treatments they need for their condition and there is a real impact on the pharmaceutical industry’s R&D plans. If it does, patient-centricity may not just be the key to conquering AIDS, but the key to optimizing medicine for us all.
George Hanna is Vice President of HIV Development within Virology Global Development and Clinical Research at Bristol-Myers Squibb.