While the world is reducing new HIV infections and AIDS-related deaths, substantial challenges remain.
Almost 21 million of the 36.7 million people worldwide living with HIV had access to antiretroviral therapy (ART) in 2017 — a huge jump from the 685,000 individuals undergoing treatment in 2000.
In another sign of progress, deaths related to AIDS fell to 1 million in 2016 from 1.9 million in 2005, according to UNAIDS, the Joint United Nations Program on HIV/AIDS. If not treated, HIV can lead to AIDS.
“The scales have tipped,’’ Michel Sidibé, executive director, UNAIDS, told MD Magazine in advance of today’s World AIDS Day.
“More than half of all people living with HIV (20.9 million) now have access to HIV treatment and AIDS-related deaths have almost halved since 2005,’’ Sidibé said. “Provided that scale-up continues, this progress puts the world on track to reach the global target of 30 million people on treatment by 2020.’’
UNAIDS data show substantial progress has been made toward reaching the “90-90-90’’ targets designed to help wipe out AIDS by 2030. The goals call for 90% of people living with HIV to know their HIV status by 2020; 90% of those diagnosed to receive sustained ART; and 90% of individuals on ART to achieve viral suppression.
“More than two-thirds of all people living with HIV globally knew their HIV status in 2016,’’ Sidibé noted. “Among those who knew their HIV status, 77% were accessing antiretroviral therapy and 82% of people on treatment had suppressed viral loads.’’
The availability of affordable, generic antiretroviral medicines has made HIV treatment accessible, he said.
New first-line antiretrovirals, such as dolutegravir (Tivicay/GlaxoSmithKline PLC) cause fewer side-effects and suppress viral loads more quickly. Such medicines will help South Africa and other nations save money and treat more people, South African Health Minister Aaron Motsoaledi has said.
Research shows that HIV-positive individuals who adhere to ART are up to 97% less likely to transmit the virus, reducing new infections — which is already happening.
The 1.8 million people who were newly infected in 2016 represent a 39% drop from the 3 million who became infected at the peak of the epidemic in the late 1990s, according to UNAIDS.
While taking a drug every day for the rest of one’s life can be tough, the rewards are clear, UNAIDS Science Adviser Celeste Sandoval told MD Magazine.
“People on ART certainly need good support mechanisms to encourage them,’’ Sandoval said. “But the exciting proof that taking effective ART every day means that not only do people living with HIV lead full and productive lives themselves, but also that they are not able to pass the infection onto their loved ones and sexual partners.’’
Nonetheless, as more people take ART, there will be pressure on the virus to become resistant to treatment. “We need additional research to develop the next generation of antiretrovirals, including long acting treatments that could last for months at a time,’’ Sandoval said.
Healthcare systems, in the meantime, face the challenge of handling increased demand for treatment. Some countries are investigating ways to tailor care. People receiving treatment and are stable often can be managed by professional health care workers and trained "lay providers" at peripheral centers, Sandoval said.
“Those who are just starting treatment or who present to the health system late need more intensive support,’’ she added.
Despite encouraging signs, substantial challenges remain.
Worldwide, only 43% of children who are living with HIV have access to antiretroviral therapy. For adults, the number is 54%.
“As many as two-thirds of children under 2 years old are diagnosed late and start treatment with advanced immunodeficiency, resulting in a high mortality rate for children of this age group,’’ Sidibé said.
Youth aged 15—24 are lagging behind on HIV knowledge, testing, treatment and prevention. Some 610, 000 new HIV infections occurred in this group, 59% of them among women.
More than half of young men don’t know how to protect themselves from HIV while less than half of HIV-positive men are accessing ART. Many start therapy only when they fall ill, making them much more likely to die of AIDS-related illnesses than women.
UNAIDS is launching a report called Blindspot today, on World AIDS Day, highlighting the importance of reaching boys and men.
While the world is reducing new HIV infections and AIDS-related deaths, Eastern Europe/Central Asia is an exception. It’s the only region where new infections and deaths due to AIDS are both rising. People who inject drugs accounted for 42% of the new HIV cases.
“Even though access to HIV treatment in Eastern Europe and Central Asia has more than doubled in the past 6 years, still only 28% of people living with HIV have access to antiretroviral therapy, despite 2 out of 3 people living with HIV knowing their HIV status,’’ Sidibé said.
In contrast, new HIV infections in sub-Saharan Africa have fallen by 48% since 2000.
“Today, South Africa has the biggest life-saving treatment program in the world, with more than 4 million people on treatment,” Sidibé noted. “This is the kind of acceleration we need to encourage, sustain and replicate.”
Funding remains a hurdle in the global effort to eradicate HIV/AIDS. About $19 billion was available in low- and middle-income countries at the end of 2016 and domestic resources accounted for 57% of that. However, he estimates that $26 billion is required to meet the 2020 goals.
“We are still $7 billion short,’’ he said. ‘’With more international assistance, increased domestic funding, innovative financing and effective programming we can end the AIDS epidemic by 2030.’’
Asked about his greatest fear in the mission to wipe out HIV/AIDS, Sidibé replied: “Our quest to end AIDS has only just begun. We live in fragile times, where gains can be easily reversed. The biggest challenge to moving forward is complacency.’’