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In the 1980’s, when the first cases of AIDs (Acquired Immune Deficiency Syndrome) were being identified, contracting HIV (Human immunodeficiency virus) was considered an almost certain death sentence, as there were no effective treatments available. Fast forward to 2017 and the picture is thankfully very different. The HIV/AIDs medical field is one of the major medical success stories, as this area has seen an exponential growth in effective therapeutics and treatment strategies.

HIV is a retrovirus that attacks the immune system. If the HIV infection progresses, a person can develop AIDs, which is when the body has lost its ability to fight off life threatening infections. HIV is contracted through bodily fluids; however the majority of infections are due to sexual contact. In 2013, 95% of new HIV infections in the UK were due to sexual activity [NHS].

The development of Highly Active Antiretroviral Therapy (HAART), which is a combination of different drug classes, means that many HIV patients will never go on to develop AIDs, and now have a life expectancy similar to the general population.  HAART therapy reduces the viral load in the plasma, so that viral RNA is largely undetectable. This not only inhibits the infection progressing but it may also reduce the transmission of HIV.

The focus on reducing HIV transmission and infection rates started in earnest when President Obama initiated the National HIV/AIDS Strategy (NHAS) in 2010 [1]. One of the primary targets of the NHAS was for a 25% reduction in HIV incidence and a 30% reduction in transmission rate.

A recent study conducted by investigators at Brigham and Women’s Hospital and Johns Hopkins Bloomberg School of Public Health, used surveillance data from the Centers for Disease Control and Prevention for 2010 to 2013, to model HIV incidence, prevalence and mortality. The work is published in the American Journal of Preventive Medicine [2].

The investigators set objectives to decrease new infections to 21,000 by 2020 and 12,000 by 2025. This would mean a 46% reduction in HIV incidence by 2020 and nearly 70% reduction in HIV incidence by 2025. The authors demonstrated that these targets could be achieved by 2020 by using the 90/90/90 HIV program framework and by 2025 by using the 95/95/95 framework. This framework is consistent with the goals of the NHAS and the United Nations HIV targets for 2020.

The 90/90/90 framework states that by 2020:

  • 90% of people living with HIV know their status
  • 90% of diagnosed people receiving quality healthcare
  • 90% people with HIV on antiretroviral treatment (ART) with fully suppressed viral load

The authors also commented that if these goals were achieved, it would be the beginning of the end of the HIV epidemic in the US. While this is certainly positive news, the authors highlighted that there was still a disproportionate amount of black, Hispanic, gay, transgender Americans and people living in the Southern American States, affected by HIV. Furthermore, the authors warned that the disparity in resources between these groups compared to the rest of the American population, needs to be rectified in order to achieve the NHAS goals.

So the future of the HIV/AIDs epidemic in the US looks optimistic however, lets hope that the new administration under Donald Trump holds the same values and commitment to reducing HIV/AIDs as Barack Obama once did.

References:

  1. The White House Office of National AIDS Policy. National HIV/AIDS Strategy (NHAS) for the United States. 2010; https://obamawhitehouse.archives.gov/administration/eop/onap/nhas
  2. Robert A. Bonacci, David R. Holtgrave. U.S. HIV Incidence and Transmission Goals, 2020 and 2025. American Journal of Preventive Medicine, 2017; DOI: 10.1016/j.amepre.2017.03.012