From her start in 1987 as an intern at Melbourne’s Alfred Hospital, Professor Sharon Lewin is now one the world’s foremost infectious diseases experts, and is also at the forefront of finding strategies to eventually cure HIV.
A member of the International AIDS Society (IAS), Lewin is the co-chair for the 20th international AIDS 2014 Conference to take place at Melbourne’s Convention and Exhibition Centre next July. Expected to be the largest health conference to ever take place in Australia, it is estimated that about 15,000-20,000 will be present for the week-long event that will unite some of the world’s leading public health experts, scientists and advocates for people living with HIV.
This week, Lewin talked to the Star Observer about the state of HIV in Australia, the continuing search for a cure and her hopes for the AIDS 2014 Conference.
The latest official figures from the Kirby Institute show a 10 per cent national increase in new HIV infections in 2012 in Australia, the highest increase in 12 months in about 20 years. There was also a significant rise in the 2011 figures. What efforts or programs need to be looked at by the community and governments to help curb rates in the near future in Australia?
This data is very disappointing – especially at a time when many other countries across the world are aiming to reduce new infections by 50 per cent and meeting those targets. We need to strengthen our approaches in Australia to reduce new infections which needs to include targeted education on HIV prevention in high risk groups, making it easy to get tested regularly and improving access to and uptake of antiviral treatment.
What are the benefits of current antiretroviral drugs on the market and why is it important for people to start treatment early if infected? Are scientists also working on improvements to these drugs, and in what way?
Antiretrovirals save lives and reduce HIV transmission. If started at the right time, life expectancy for someone living with HIV is now the same as for someone without HIV. But the key thing is to know you are infected and to be in regular care so the antivirals are started when needed. We now know that earlier treatment means less long term damage to the immune system. The drugs that we currently use are excellent and often only requires taking one tablet a day with very few and often no side effects. It gets more complicated if people start treatment late.
What would a ‘HIV cure’ conceivably consist of?
Scientists are aiming for two possible types of cure. One would be a complete cure meaning HIV is no longer detectable. This might be difficult to achieve and so far we only have one case of a complete or “sterilising” cure – the ‘Berlin Patient’.
What might be more achievable is putting HIV in remission or what we call a “functional” cure. In this case, people might take antiretrovirals for a few years and then stop treatment and the virus stays under control. It’s still there but at very low levels. Functional cure has been reported in several people now and may be more common than we think – especially in people who start antiretrovirals very early following infection. But we still need to find new ways to allow people to safely stop their antiretrovirals and stay in remission.
What are the main differences or challenges for experts when faced with high rates of HIV infection in less developed areas or countries when compared to places such as Australia?
I don’t know the answer to this but I suspect there are real differences. We are likely to need very different strategies to reduce new infections in generalised epidemics and in countries like Australia where HIV affects certain key populations.
HIV was only discovered 30 years ago, do you believe HIV will continue to be a major issue for humans in another 30 years time? Will it soon become more a question of politics than science when it comes to how the virus will be ‘eradicated’?
For the last 30 years we have needed both – science and advocacy – together with community engagement and leadership. I suspect we still need all four for the next 30 years and in the search for a cure. There are still many scientific barriers we need to overcome before we can seriously envision a world without HIV.
Is the IAS hoping for some core commitments to be made or formed at the AIDS 2014 in Melbourne next July? What else can we expect at the conference which is expected to be the largest ever health conference in Australia?
We want a long lasting legacy from AIDS 2014 internationally and within Australia. My personal vision is that the conference will generate a global commitment to see the end of AIDS through universal access to antiretrovirals globally, eliminating stigma and discrimination and accelerating the scientific discovery to find an effective cure and vaccine. Australia can and hopefully will play a major role in leading this legacy.
Lewin a director of the Infectious Diseases Unit at The Alfred Hospital; a Professor of Medicine at Monash University and the Co-Head of the Centre for Biomedical Research at Melbourne’s Burnet Institute.