How close are we to eradicating HIV Philip A. Chan
The world is getting closer
to achieving one of the most important
public health goals of our time:
eradicating HIV.
And to do this, we won’t even have
to cure the disease.
We simply have to stop HIV from
being transmitted
until eventually it fizzles out.
Once, this goal would have
seemed impossible.
HIV has caused millions of deaths
and is one of the most devastating
diseases that humanity has ever known.
But we’re now at a point where new
advances
such as one-pill, once-a-day medications
are helping us tackle HIV
in effective ways.
HIV is a retrovirus–
meaning it integrates copies of itself
into an infected cell’s DNA,
allowing it to replicate and
infect other cells.
HIV has evolved numerous ways to evade
the human immune system,
which makes it difficult to cure.
But by developing ways to
block HIV replication,
we can stop the spread of HIV itself.
That’s where antiretrovirals–
a.k.a. ARVs– come in.
ARVs are a group of drugs which work
in different ways to combat HIV.
Some block HIV’s access into immune cells,
and others work by stopping the
virus itself from replicating.
ARVs also work preventatively in people
who don’t have HIV.
This type of approach is called
pre-exposure prophylaxis, or PrEP.
PrEP works by accumulating in a
person’s body
and preventing HIV from
establishing itself.
That means an HIV-negative person who may
be at risk of contracting the disease
can take certain ARVs
to protect themselves,
before they become exposed.
Here’s where it gets
especially interesting:
In people with HIV, ARVs can also
dramatically reduce HIV transmission.
This is called “Treatment as Prevention.”
On a global scale, this has the potential
to end the HIV epidemic.
It’s based on the idea that someone with
HIV who takes ARV’s
can lower the virus level in their bodies
until it becomes undetectable.
That doesn’t mean the virus is gone;
it could still be lurking within cells,
ready to reactivate if treatment stops.
But so long as it’s kept
dormant with drugs,
HIV remains undetectable.
And when HIV is undetectable,
it’s untransmittable, too.
In theory this means that by testing
everyone who’s at risk of HIV
and treating those who test positive,
we could stop transmission and
eventually eradicate HIV.
In the real world, however,
things are more complex.
Many at-risk HIV negative people across
the world
do not have access to PrEP or ARVs,
and those who are HIV positive may
experience challenges to taking ARVs.
These problems are often greatest in
countries
where the burden of HIV is highest.
Getting these medications depends on
access to a functioning healthcare system–
and this isn’t something everyone has.
That’s part of the reason why stopping
the spread of HIV for good
will require a significant investment of
resources to improve those systems.
One study carried out by the UNAIDS
estimated that between 20-30 billion
dollars per year
would be needed to achieve
a nearly 90% reduction
in new HIV infections by 2030.
This investment would ensure more people
would get tested in the first place,
and more would be able to access and
maintain treatment.
Achieving this goal and improving
healthcare in general
is in everyone’s best interest,
from individual people to
society as a whole.
We have roadmaps that could allow us
to bring the HIV epidemic to an
end in the near future,
with the possibility of eradicating the
disease altogether
several generations in the future.
In the period from 1996 to 2017
we almost halved the number
of new HIV infections,
and for the millions of people who still
live with the virus,
ARV treatments enable most to lead long
and healthy lives.
With continued and increased investments,
we can get transmission rates low enough
to end HIV once and for all.
A world without HIV is no longer
inconceivable:
it’s closer than ever.