Today marks World AIDS Day — a commemoration that the World Health Organization began 27 years ago to raise awareness of a rising epidemic of HIV/AIDS.
At last count, an estimated 36.9 million people worldwide had HIV/AIDS, according to the WHO.
With 60,000 infections, the Los Angeles County area has one of the highest infected populations in the nation, according to the county’s Department of Public Health.
USC researchers have had a hand in reducing infections, finding new treatments, and addressing social and political issues associated with disease.
From epidemic to chronic disease
Helen Land, associate professor for the USC School of Social Work, has focused her research on ways in which culture and gender factors, stress, coping and spirituality affect physical and mental well-being in vulnerable populations, particularly those struggling with immigration, poverty, violence, HIV/AIDS and family caregiving. Through her work, she has seen the disease’s social impact shift over the course of more than 30 years.
HIV/AIDS has increasingly become a disease of the poor living with multiple primary medical conditions.
“In the early 1980s, HIV/AIDS was first noted in gay communities in New York and California,” Land said. “Increasingly over the past 20 years, HIV/AIDS has affected communities and families on a global level. While we continue to see new infections in the United States among all major groups — gay men and women, African-Americans, Latinos, homeless youth, sex workers, IV drug users, polysubstance users and others — HIV/AIDS has increasingly become a disease of the poor living with multiple primary medical conditions.”
The disease now is more prevalent among the poorest populations of the world.
“Globally, HIV/AIDS has struck developing countries the hardest — in Africa, India and parts of Asia — where children and the aged are often caregivers for the infected,” Land said. “Among industrialized nations where health care is most accessible, HIV has become more and more a chronic disease to be managed on a long-term basis for those who can afford treatment.”
HIV/AIDS diagnosis and treatment is the core mission of the Maternal Child and Adolescent/Adult Center for Infectious Diseases and Virology at the LAC+USC Medical Center, located in the Health Research Association building on Marengo Street.
Andrea Kovacs, professor of pediatrics at the Keck School of Medicine of USC, directs the clinic and leads the medical center’s Division of Infectious Diseases in the Department of Pediatrics. She noted the clinic has had significant success in reducing mother-to-child transmissions, but encountered new challenges when a new second wave hit.
“When we started out in the late ’80s and early ’90s, we were seeing that about 30 percent of babies born to mothers were infected. We used antiretrovirals pretty aggressively at our clinic and so most of these babies are still alive and are now adolescents or young adults in our clinic having children of their own,” Kovacs said. “By 1995, we were part of a large clinical trial, and we decreased mother-to-child transmission by two-thirds. Since then we have been able to prevent almost all transmissions. As time went on, though, we started seeing a second wave had begun among adolescents.”
Although HIV has become a chronic disease that can be managed with appropriate care and treatment, it remains a threat.
People are still dying. Early treatment is critical.
“People are still dying,” Kovacs said. “Early treatment is critical. Many of those that are getting infected are very poor and don’t access health care. An estimated 60,000 people in the Los Angeles County area are infected, and 10,000 of these don’t even know they are infected.”
Scientists are focusing on biomedical interventions, said Michele Kipke, a professor of pediatrics and preventive medicine at the Keck School of Medicine, who also is vice chair of research in the Department of Pediatrics at Children’s Hospital Los Angeles.
“We also have new technologies to help improve adherence to treatment for those who have been infected,” said Kipke, who also directs the Community, Health Outcomes and Intervention Research Program of The Saban Research Institute at CHLA. “Our ‘Healthy Young Men’s Study’ provides a unique opportunity to leverage advances in science and medicine to help end the HIV epidemic in the United States.”
Scientists also are learning more about the genetic makeup of the disease, which could guide development of new drug therapies and interventions to disrupt the virus.
“Our laboratory has identified several microRNA-like sequences embedded in various protein-coding regions of HIV genomes,” said Suraiya Rasheed, professor of pathology at Keck Medicine of USC. “These viruses have evolved specific mechanisms to evade innate immune responses and disrupt normal cellular processes.
“Perhaps the new-generation drugs may be helpful in disabling HIV-sequences associated with human genomes,” added Rasheed, who is also the director of Laboratory of Viral Oncology and AIDS Research.
Social, economic benefits of treatment
The USC Schaeffer Center for Health Policy and Economics has examined the economic implications of treatment and patient access through various lenses.
A team of researchers including Neeraj Sood, director of research for the Schaeffer Center and vice dean for research at the USC Price School of Public Policy, found U.S. funding for treatment and prevention of HIV/AIDS in sub-Saharan Africa is tied to employment gains.
With implementation of the Affordable Care Act, some policymakers have questioned the need for continuing support for funding services through the Ryan White HIV/AIDS program and Medicaid.
Sood, also an associate professor at the USC School of Pharmacy, led research published in the journal Health Affairs two years ago that found such support services are critical for case management. The research team found that in the post-ACA era, the Ryan White program may need to shift focus to medical and nonmedical case management, but providers believe it remains “critical in facilitating high-quality care for people living with HIV/AIDS.”
Sood said he and other Schaeffer Center researchers also found early diagnosis and treatment are critical for improving and extending the lives of patients who are infected, and preventing further infection.
In effect, HIV/AIDS patient treatment saves lives and ultimately, with a reduction in infection rates and disease prevalence, health care costs.
“With continued success, we will soon celebrate World AIDS-Free Day,” Sood said.