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My journey into the world of HIV/AIDS research and treatment didn’t begin in a laboratory or a conference room—it started in high school. Through a unique connection, during the mid 1980's, I had the opportunity to conduct a series of long-form interviews with Dr. Robert Gallo, one of the co-discoverers of HIV and a towering figure in the field of virology.
At the time, my father, Wayne Pines, was assisting Dr. Gallo with some public relations and communications challenges, and I—then a student journalist at the Maret School in Washington, D.C.—was granted access to a scientific story that was still unfolding in real time.
I remember vividly how Dr. Gallo described the way HIV hijacked the CD4 cell, sketching out the emerging blueprint of the HIV replication cycle on a lined yellow note pad. I didn’t fully grasp then how much this virus would shape not only my professional life, but the future of medicine itself.
After graduating from Haverford College, I began consulting for several of the companies on the front lines of the HIV battle, including Merck, Agouron, Roche, and DuPont Pharma. Over time, my focus shifted from pure science to the equally complex world of commercialization and patient insights. But the throughline remained constant: a commitment to understanding and addressing HIV.
This article is both a retrospective and a celebration. It's an appreciation of how far we’ve come in the fight against HIV, and a call to ensure we don’t lose sight of what it takes to sustain that progress. It is also a reflection on the role that marketing insights—often operating behind the scenes—have played in shaping one of the most sustained innovation arcs in pharmaceutical history.
In 1987, when AZT (zidovudine) became the first FDA-approved treatment for HIV, it offered the first glimmer of hope in what had been an unimaginably dark and devastating chapter in medical and social history.
The 1980s were a time of profound fear and loss, especially for gay men, people of color, and others in marginalized communities who were hit hardest by the epidemic. The virus was spreading rapidly, yet public acknowledgment and government response—particularly under the Reagan administration—were chillingly absent. Stigma was as deadly as the virus itself, silencing conversations, isolating the sick, and slowing action. In the absence of leadership, advocacy groups and caregivers stepped in, fighting for dignity, visibility, and treatment. The AIDS Memorial Quilt began to grow, panel by panel, each one stitched with grief and love—each one a human life lost to a disease the world seemed determined to ignore. Against this backdrop, AZT’s approval didn’t just represent a medical breakthrough—it was a signal, however faint, that science might begin to push back against despair.
AZT was far from perfect—it had a narrow therapeutic window, considerable toxicity, and limited efficacy when used alone—but it marked the beginning of something transformative: the idea that HIV could be treated pharmacologically. It was also the moment when innovation in antiretroviral therapy (ART) truly began. And unlike many other therapeutic categories, that innovation has never stopped.
As an insights consultant during the mid and late 1990s, I was dispatched by clients to the epicenters of the epidemic: New York, San Francisco, Los Angeles, and Miami. There, I sat down with some of the most important voices in the HIV space—Dr. Joe Sonnabend, one of the earliest physicians treating AIDS patients with compassion and science; Dr. Michael Gottlieb, the author of the original MMWR piece that announced the emergence of the virus; leaders at advocacy groups like GMHC and the People With AIDS Coalition.
These interviews were not simply marketing research exercises—they were acts of bearing witness. The clients I was working on behalf of at the time understood that deeply. These weren’t just companies looking to position a product or capture market share. They were mission-driven organizations, staffed by individuals who saw themselves as part of a larger fight—to stop a virus that was tearing through the very communities they lived in, worked in, and loved.
What we were doing in those conference rooms, clinics, and community centers wasn’t traditional market research—it was something far more urgent. We were listening, learning, and trying to understand what people living with HIV needed not just to survive, but to live with dignity.
I vividly remember one set of interviews conducted with participants in an early access program for a promising new fusion inhibitor. These were patients who had exhausted nearly every other option. One man, gaunt from AIDS wasting but still smiling, told us plainly: “This drug is the reason I’m still alive.” That moment landed with force. It wasn’t just humbling—it was clarifying. It reminded us that our work wasn’t about branding or messaging. It was about being part of a monumental, life-and-death effort to change the trajectory of an epidemic. It affirmed that insights, when done with care and purpose, could inform decisions that literally extended lives.
Through these interactions, we began to gather insights that went far beyond traditional marketing. What we were learning shaped not only how products would eventually be positioned, but also how they would be developed. Patients and providers alike were telling us—sometimes in words, sometimes just in tone or expression—that viral suppression alone wasn’t enough. They needed regimens that were sustainable, tolerable, and that fit the rhythms of real life. Our work helped translate these deeply human needs into strategic imperatives: simpler dosing, fewer side effects, and better long-term safety profiles. It became clear that true innovation in HIV treatment wasn’t just about potency—it was about partnership with the people these medications were meant to serve.
By the mid-1990s, highly active antiretroviral therapy (HAART) arrived, combining multiple drugs to suppress the virus more effectively. Suddenly, a diagnosis of HIV was no longer a death sentence—it became a chronic condition. Mortality dropped. People returned to work. Communities stabilized.
From a commercialization standpoint, this was a pivotal moment. I worked with companies developing some of these foundational therapies—Agouron with nelfinavir and DuPont with efavirenz. Each of these breakthroughs moved us closer to durable viral suppression and a higher quality of life for patients.
Yet as we celebrated these gains, we also learned—through marketing research—that pill burden and toxicity were becoming new barriers. Patients were living longer but were burdened with regimens that were hard to tolerate and harder still to adhere to. The insights were clear: the next wave of innovation needed to make life easier, not just longer.
The launch of Atripla in 2006 marked a paradigm shift. The first durably effective once-daily, single-tablet regimen (STR), Atripla represented a fusion of three potent ARVs into one convenient pill. For many people living with HIV, it meant the end of complicated dosing schedules, reduced stigma (no more carrying around a lunchbox of pills), and improved adherence.
During this time, our insights research revealed growing patient satisfaction and relief. We heard stories of regained independence, of people traveling without fear, of morning routines that didn’t begin with a handful of pills. Stribild and other STRs followed, each improving on the last in terms of tolerability and simplicity.
These advances weren’t just technical—they were deeply human. And they were propelled, in no small part, by the industry’s growing ability to truly listen. Patient insights made it clear: fewer side effects, lower toxicity, and simpler dosing were not luxuries—they were essential. These factors directly influenced adherence, which in turn made sustained viral suppression possible. New mechanisms of action were important, of course—but just as critical was developing medications that people could take consistently, tolerate well, and trust to be safe over the course of a lifetime.
The next major evolution wasn’t just in treatment—it was in prevention. With the approval of Truvada for pre-exposure prophylaxis (PrEP) in 2012, the industry delivered a new promise: that people at high risk for HIV could protect themselves before exposure.
PrEP represents more than a pharmaceutical innovation—it’s a social one. It challenged the narrative of risk and inevitability, and offered a new kind of agency. It also demanded a new kind of outreach, particularly among communities that had historically been underserved or stigmatized by the healthcare system.
Today, with long-acting injectables like cabotegravir (Apretude), we’re seeing a new frontier—prevention that doesn’t require a daily pill. These innovations are critical for populations where adherence is challenging or stigma remains high.
HIV represents one of the few therapeutic categories where innovation has never stood still. What makes the antiretroviral category unique—arguably unparalleled—is the continuous wave of meaningful innovation. Over nearly four decades, we’ve seen:
In an industry where some therapeutic areas stagnate after initial success, HIV remains a model of what’s possible when science, purpose-driven commercial strategy, and public health align. This sustained innovation has had a remarkable "side effect": in the U.S., the use of generics remains limited, not because of market control, but because branded products continue to earn their place by improving outcomes.
This should be instructive to the broader biopharmaceutical industry. When we center the patient, and when we let insights guide us, we don’t just create better drugs—we build sustainable, resilient franchises.
It’s worth pausing to remember just how dark the early days of the HIV epidemic were. The stigma, the funerals, the silence. The indifference of those in power. And the refusal of some hospitals to even admit patients suffering from AIDS-related complications.
The AIDS Quilt, now comprising more than 50,000 panels, stands as one of the most moving and monumental works of public mourning in American history. Each square is a name, a face, a life that could have been saved had treatment arrived sooner—or stigma fallen faster.
Today, we live in a world where people with HIV can live normal life spans. Where new infections can be prevented. Where treatment can be simplified and tailored. This is not just scientific success—it is a moral achievement.
Yet we cannot take these gains for granted. There are disturbing signals that funding for both domestic and global HIV programs is under threat. Lifesaving initiatives like PEPFAR, which have prevented millions of deaths globally, face potential cutbacks. In the U.S., community programs that provide access, education, and support are often the first to see budgets slashed.
This is a critical moment. We are on the cusp of what could be the final chapters in the HIV epidemic—but only if we remain committed. We must continue investing in both treatment and prevention. We must continue listening to the patient voice. We must continue innovating, not for market share, but for impact.
The history of antiretroviral therapy is one of the most profound and enduring stories in modern medicine. It is a testament to what science, public health, advocacy, and commercial insight can achieve when they work in harmony. It is also a reminder that progress, no matter how monumental, is always fragile.
As professionals in the biopharmaceutical industry, let us learn from HIV—not just the science, but the empathy, the urgency, and the relentless drive to do better.
Innovation brought us this far. Let’s ensure it carries us the rest of the way.
