Perspectives on HIV/AIDS and “getting to zero” – via Global Health, Epidemiology and Genomics

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HIV/AIDS is a global killer that affects an estimated 37 million people worldwide.(1) Despite success in reducing the burden of HIV, we are now facing treatment challenges due to resistance and are still without a cure or a vaccine for HIV. These issues must be addressed if we are to realise the goal of “getting to zero” HIV cases and deaths.(2)

Sub-Saharan Africa (SSA) has the highest global burden of HIV, with an estimated 25.8 million adults and children living with the condition. Asia, the Pacific region, Eastern Europe and Central Asia also have a considerable burden of HIV. Of the 1.2 million global AIDS-related deaths in 2014, 790,000 occurred in the SSA region and 240,000 occurred in the Asia and the Pacific region.(1) Thus HIV remains a major cause of ill-health and premature death globally, disproportionately affecting low- and middle-income countries.

Access to antiretroviral therapy (ART) has rapidly increased over the past decade, which has led to a notable decline in HIV associated morbidity and death in SSA. It is also believed that overall HIV incidence has been reduced. However, this is not the case for some high risk groups, such as men who have sex with men, where incidence is thought to be on the rise.(3) Thus, it is important to galvanise education and prevention strategies, particularly targeted to these high risk groups to reduce the number of new HIV cases.

There are currently more than 30 antiretroviral drugs approved for use in the majority of developed countries.(4) The latest therapies have improved efficacy, fewer side effects and are easier to administer. However, despite these improvements, there remain issues surrounding drug-specific side effects and interactions with other drugs. We are still without a cure or a vaccine for HIV and treatment of HIV is further hindered by the emergence of drug-resistant pathogens. The development of novel drugs is therefore central to the continued success of HIV therapy, globally. Several drug strategies have been developed or proposed, including antibody therapies and newer classes of antiretrovirals. A better understanding of biological processes underlying HIV disease progression would facilitate efforts to develop novel HIV treatment strategies. It is clear that combinations of current and novel drugs will be required for effective long-term HIV control.

Surveillance will be instrumental in the identification of new and existing cases of HIV to enable the targeting of treatment and control interventions. Fortunately, we have the tools to rapidly detect cases of HIV at the point of care. HIV rapid diagnostic tests (RDTs) are non-invasive and provide results in less than 30 minutes. Scaling-up the use of RDTs will help to identify new cases of HIV and will be particularly valuable in the detection of hotspots of epidemic infection. However, more sensitive and specific tests are still needed, particularly to detect cases of acute infection.

In order to achieve the target of “getting to zero”,(2) integration of surveillance, case detection and diagnosis, treatment and case management will be essential. In light of ART resistance, it will be evermore crucial to incentivise vaccine development initiatives to prevent establishment of infection in the first instance. New treatment strategies, novel HIV therapeutics and the scaling-up of HIV prevention strategies will also be essential if we are to reduce HIV infections and deaths to zero.

Key references:
1. Joint United Nations Programme on HIV and AIDS (UNAIDS). 14 July 2015.
2. Joint United Nations Programme on HIV/AIDS (UNAIDS). Getting to Zero 2011-2015 Strategy. Geneva, Switzerland, 2010.
3. World Health Organization. Global Update on the Health Sector Response to HIV, 2014. Geneva, Switzerland, 2014.
4. FDA. 2014. Antiretroviral Drugs Used in the Treatment of HIV Infection. (Accessed 22 August 2015)


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