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 Interview with
Dr. Anthony Fauci
Head of the National Institute of Allergy and Infectious Diseases at the N.I.H.
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CBS CARES: Why are infection rates in the U.S. not going down?
DR. FAUCI: I think it's probably because of the pervasive perception in society that HIV is a problem that we now have under control. And it's unfortunate that over the last ten-plus years, even more, we've had a steady annual rate of about 40,000 new infections.
The demography shifts. You know, it doesn't necessarily mean in the same populations. Right now, for example, in inner city minorities, we have young women who are getting infected from partners they don't realize are infected and these women, themselves, are monogamous.
We also have young gay men who don't have the experience of seeing so many of their friends and colleagues dying of a bad disease because they weren't around in the early '80s, so there's a lot of misperception about risk. And, unfortunately, that misperception is leading to a sustained and unacceptably high level of infection in this country.
CBS CARES: Why is the goal of successful antiretroviral therapy to suppress HIV viral load in plasma to less than 50 copies per cubic milliliter? Why was this threshold of 50 chosen?
DR. FAUCI: You want the viral load to be undetectable. Fifty is an arbitrary cut-off, which is the range of detection of the viral load tests in question.
CBS CARES: Why not a goal to reduce viral load to zero? Wouldn't the less than 50 viral copies that remain be the most drug resistant because they have survived the onslaught of the drugs and could they cause problems at a later point?
DR. FAUCI: The reason it isn't zero is because you can't measure zero. That's the point. The tests are not that sensitive, so that's the reason why they say less than 50. I mean, you would like to get it to be zero, but given the current, readily available viral load tests, you can't get down that low.
There's also no evidence that people who are being followed with less than 50 viral copies for years and years do develop resistance. In fact, there's some evidence to indicate that if you keep them below that threshold of 50, they do just fine. And they don't spontaneously develop resistance unless the virus percolates up to levels that are much higher than that.
CBS CARES: The FDA requires that HIV-1, Group M antibody tests--so called "ELISA tests"--be tested against the major Group M subtypes, not against all its subtypes. Do you think the diagnostic tests in the United States have kept pace with the constant genetic mutations of HIV and increases in infections by genetically divergent subtypes such as the "Non B's"?
DR. FAUCI: Well, they're two different things. The genetic mutation of the B subtype is going to be picked up by the ELISA test. The genetic mutation has more to do with resistance than our ability to detect it with a diagnostic test. There doesn't seem to be a significant amount of other subtypes slipping through the cracks.
The FDA is continually monitoring whether antibodies to different genetic subtypes could slip through. And if it turns out that we do have an influx of cases that get beyond our ability to diagnose them, for example in screening blood, then I am certain that they will then institute the appropriate tests to fill those gaps.
CBS CARES: How far back can the first human blood sample with HIV be traced?
DR. FAUCI: That's debatable. People say the late-'50s, early-'60s, but that's something that is continually on and off the table. It certainly is earlier than the first recognition in the late-'70s and early-'80s.
CBS CARES: Have we learned any lessons from the fact that HIV was around for decades, spreading and infecting humans, but remaining unknown and undiagnosable? For example, are any steps now being taken to ensure that the next HIV is detected and intercepted before it spreads widely and becomes an epidemic?
DR. FAUCI: Well, if you look now at the capabilities of the World Health Organization that partners with countries, including the Centers for Disease Control in the United States, surveillance for diseases now is considerably better than it was 20 years ago. There's no question about that. The surveillance of emerging and unexplained diseases worldwide is much keener than it was years ago.
CBS CARES: Wangari Maathai, the Kenyan woman who recently won the Nobel Peace Prize has said that HIV did not jump from chimpanzees and monkeys to humans. She says that HIV was created by scientists as a biological weapon to perpetrate genocide. What is your response to that?
DR. FAUCI: I think it's unfortunate that she made that statement because, obviously, that's not true. I think she somehow dampens the impact of many good things she's done by making an uninformed statement like that.
CBS CARES: Is it fair to say that this a good time for infectious diseases, because there are relatively few antiviral drugs in medicine, antibiotics have become less effective due to misuse and there are constantly new and challenging viral and bacterial infections with which the human immune system struggles to cope?
DR. FAUCI: Well, I wouldn't word it that way. I would say that it's important to have infectious disease experts because infectious diseases continue to be an extraordinary challenge to global health.
CBS CARES: What makes you most optimistic and what worries you the most today about the HIV pandemic?
DR. FAUCI: Well, what makes me optimistic is the continued excellent science that's developing new drugs and the pipelines as well as our better understanding about the immune system and its relationship to what we can do vis-à-vis the development of a vaccine. Even though, as I mentioned, this is quite a difficult problem.
I feel good about the fact that we're finally getting drugs to the people in developing nations who need them through a variety of programs--the Global Fund, the President's Emergency Plan for AIDS Relief, a variety of bilateral programs. So we are finally, after so many years, getting treatment and care to the people who need it the most. That's what I feel good about.
What I feel badly about is that we still have major threats to our global civilization. The situation in Asia is a time bomb. I would hope that we don't have the explosion of cases in Asia, particularly China and India and other Asian countries, that we've had in sub-Saharan Africa. So we really need to try as much as we can as a global community to prevent that from happening.
CBS CARES: Why did you decide to specialize in infectious diseases?
DR. FAUCI: I've been excited about infectious disease from the time I was a medical student because, well, first of all, they are very serious diseases. They have global impact. They're diseases that are eminently preventable and treatable, unlike some diseases.
So, the application of good science to development of important countermeasures for prevention and treatment gives you an extraordinary amount of opportunity to have a very important positive impact on the health of the world because of the large burden of infectious diseases. Infectious diseases, even today with all our vaccines and therapies, are the second leading cause of death worldwide and the first leading cause of death among young people.
And they are the largest cause of disability years, associated with disease burden. So the importance of infectious diseases is undisputable. And as scientists and clinicians, we have an extraordinary opportunity to do something that will have an important global impact, worldwide. I came to the NIH and got involved in a very good infectious disease program after my training as a medical intern and resident and I have been enthralled with the sub-specialty ever since.
CBS CARES: Thank you so much for giving us all this time. The last question is: is there any question we didn't ask, but which you think we should have?
DR. FAUCI: No, I think we covered the subject very extensively.
CBS CARES: Well, many thanks again.
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