Dr. Fauci Isn’t Going Anywhere Until There's a Cure for HIV

Last week, the media picked up on a story that President Joe Biden's Chief Medical Advisor -- and America's doctor (at least to me) -- was toying with the idea of retirement. Appearing on ABC's This Week with George Stephanopoulos, Dr. Anthony Fauci reassured George and the rest of us that he will stay on his job until the COVID-19 fight is over.

When I spoke to him this week, and knowing his love for baseball, I asked Fauci if the Washington Nationals called and offered him the job of general manager, would that prompt him to leave the National Institutes of Health where he's been for over 40 years?

He laughed, and said, "I gotta tell you, in another life, I would definitely want to be more tightly connected to sports, particularly my favorite sport, baseball. But I'm staying where I am because of the unfinished fight we have with COVID, and also because of the unfinished fight we have with HIV and AIDS."

While there has been so much focus on COVID-19 during the last two years, Dr. Fauci wanted me to be sure to emphasize, in the strongest terms possible, that he has "not pulled back one bit, and not in the least, on his enthusiasm, passion, and efforts toward HIV/AIDS."

"This is very personal to me," he explained.

Fauci is heartened by the fact that as of today there are better treatments, preventions, and hopes for a vaccine, and for these reasons, he's not taking his foot off the gas pedal. "Look how far we've come, and though we have more work to do, we now have an injection available that some HIV-positive folks can get every seven months that will keep them undetectable, and long-acting PrEP injectable that works better than Truvada."

I asked Fauci if injectables are the future. "Absolutely. We've gone from a cocktail of pills to one or two pills taken twice a day, to one pill a day, and so yes, things are progressing whenever you get injectable. We know we can do it in two months, so there's no reason to believe we can't do it every six months. It's not a prediction but based on all of the science and research."

Part of that research coincidentally comes from what's been gleaned from developing the COVID-19 vaccines. "Obviously it's a different vaccine but using the mRNA platform and successfully transforming all of that, and having it applied to vaccine research for HIV -- and using the structure, the approaches, and discipline for HIV vaccinology."

Along with the science, Fauci said that satisfying public health needs is also crucial to the fight. "We need to address disparities of treatment in society and make sure we're testing and treating in poorly served areas, which are usually the minority populations," he said. "You have 13 percent of our population being African-American, yet well over 40 percent of HIV cases are African-Americans, and that needs to change with better access to treatment and prevention."

Then there's the question of an HIV vaccine, and how soon we can expect one.

"As you know from our previous conversation, there's been difficulty making a truly and highly safe vaccine. It's been problematic," Fauci explained. "I don't want to say failures, because every notable non-success we've had, we have also learned something from each trial. Once we do have a vaccine that has a high degree of efficacy and other methodologies, we will end the HIV pandemic as we know it."

I wondered about all of the strains we're seeing with COVID and if there would ever be an opportunity for an outbreak of a new, more virulent strain of HIV that is resistant to treatment?

"The HIV strains are completely different from the SARS COVID-2 which replicates in society so rapidly. With HIV, we have been dealing with the same strain for over 40 years, so you don't see that rapid change, like COVID, with HIV. With COVID, we've had the original, Delta, and, Omicron and more to come, most likely. We just don't see these multiple strains with HIV."

I asked Fauci what he thinks of the younger generation being sort of blase about HIV since they've lived with various prevention and treatment methods. "It's very dangerous," he warned. "This generation is very fortunate to have highly effective therapies and very lucky to have very good medicine for pre-exposure prophylaxis. While it's still a very serious disease, there are very effective interventions."

Fauci added that it's unfortunate that some are lulled into complacency: "This generation hasn't seen all the wasting away and dying that scared the hell out of all of us years ago. And most people in this generation don't know anyone who has died from the disease. People who are 25-35 don't have a clue what happened when people were dying all around us and the fear and terror of an HIV diagnosis."

"Yes, it's no longer as bad as it once was, yet we still have over 36,000 new HIV transmissions annually here in the U.S. and it's still a major disease globally, and people are still dying from it. And the science and the disease don't get as much publicity as they used to," he said.

"We still have challenges ahead, and we have not -- or will not -- give up, and I am going to remain 100 percent involved, fighting for more support for research, and continuing the fight to find a cure."

John Casey is editor at large for The Advocate.