AIDS, COVID-19 similarities ‘profound’
Officials at virtual conference say strategies in the past can help battle current pandemic
Even as the deadly virus spread, the federal response stalled. Tests were short. So were treatments. A vaccine was imminent, experts promised. The hardest hit? The sick, the poor and people of color.
That pathogen was HIV, not COVID-19. The year was 1990, not 2020. The event: The International
AIDS Conference, held in San Francisco, which is again sponsoring the mega-event, virtually, this week.
“These are the same challenges we’re facing now,” said Ernest Hopkins, senior strategist and adviser to The San Francisco AIDS Foundation. “The similarities are profound.”
The twin pandemics are the theme of this week’s conference, with research contributed from around the globe. COVID-19 has upended the original plans. The estimated 20,000 people who were expected to pour into San Francisco and Oakland are staying home, watching online. The final day of the AIDS conference will be devoted exclusively to the new respiratory virus.
One gives hope to the other, scientists say.
In the three decades since the first San Francisco AIDS conference, research has made great
strides in defeating a complex and wily culprit that once seemed unbeatable.
“There has been incredible progress, with HIV turning into a quiet disease instead of a death sentence,” said Dr. Monica Gandhi, conference co-chair, a UC San Francisco professor of medicine and Medical Director of the city hospital’s Ward 86, exclusively serving HIV-infected patients.
Thirty years ago, drowned out by jeers, whistles and air horn blasts from hundreds of angry protestors, a federal official stood at the lectern of San Francisco’s Sixth International Conference on AIDS to give a speech that no one could hear — and said little. Activists raced to the front of the room shouting and unfurling a pink banner that read, “He talks, we die.”
At this week’s AIDS conference, there is progress, not pandemonium; activism but not anger. Rather than zealotry, there’s just Zoom.
Three decades of experience with AIDS has helped transform prevention and treatment of many diseases, including COVID-19, experts said.
Legal restrictions and educational outreach reduced risk. At the 1990 conference, when gay bathhouses were long gone and the gay community was well-informed, the infection rate was already falling. Since then, the number of annual HIV infections in the U.S. has been reduced by a more than half. There were 84,200 new diagnoses then; there are 36,400 today, according to the Centers for Disease Control and Prevention.
Frustrated by the government’s inability to quickly test and approve drugs, AIDS patients were angry, impatient and strategic. They demanded more research, more money and quicker approval for drug treatment.
These reforms are reflected in speed of today’s COVID-19 drug trials, with agents fast-tracked and distributed through a program called Emergency Use Access. Journal articles are published much more quickly.
HIV protection has improved, suggesting new avenues for COVID-19 research. In the beginning, condoms were the only way to block HIV infection. Now a daily pill, known as “preexposure prophylaxis” or PrEP, is taken daily to prevent infection. On Tuesday, UC Los Angeles scientists announced an even simpler strategy: an injection called cabotegravir, required once every two months.
We’ve learned a lot about how to control infections, once they happen. Thirty years ago, AIDS could only be treated with the antiviral drug AZT. Now there are daily pills — Biktarvy, Complera, Genvoya and others — that combine several drugs. They’re more convenient, and cause fewer sideeffects.
On Tuesday, scientists announced that a 36-yearold man in Brazil seems to have cleared an HIV infection using a super-aggressive combination of drugs. While it’s too soon to be considered a cure, this “São Paulo patient” went off all HIV treatment in March 2019 and the virus has not reappeared.
But in both diseases, efforts still fall short.
Much as President Trump has assured the delivery of a “vaccine solution” to the COVID-19 pandemic “long before the end of the year,” in 1990, NIH’s Dr. Wayne C. Koff told the conference: “I think in the next two or three years we will knock it down.”
The most promising HIV vaccine was abandoned last February because it did not work.
“We are really not there yet at all,” said Gandhi. “It was very disappointing. We haven’t given up, but we really do need to go back to the beginning.”
There is concern that COVID-19 treatments, like AIDS treatments, will not be globally available and affordable. In both diseases, social and geographic factors play enormous roles.
There has been a shift in who gets sick. In white, educated and affluent communities, fewer people are contracting HIV or COVID-19. But it is taking a disproportionate toll in homeless, black and Latino communities.
These populations are three times as likely to become infected by COVID-19 virus as white Americans, and are nearly twice as likely to die from it.
To conquer both pandemics, there must be a greater effort to find, test and treat these hidden and high-risk populations, say experts.
“The HIV community knows what it’s like to battle a pandemic for a period of time,” Hopkins said.
“But we’re deeply frustrated,” he added. “We see all the same kinds of gaps and deficiencies and inequities now that existed then. And that is tragic.”