Time to fast-track the fight against HIV

There are considerable challenges to address if global HIV/AIDS aspirations are to be accelerated.

Achieving a new set of ambitious targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) could bring an end to the AIDS epidemic by 2030.

In the report ‘Fast-Track: ending the AIDS epidemic by 2030’, UNAIDS advocates that 90% of people infected with the virus are made aware of their status, 90% of those people receive antiretroviral treatment and 90% of those have undetectable viral loads by 2020 before raising targets to 95% by 2030.

Great strides have been made in many countries to tackle the HIV epidemic and reduce the discrimination that stymies control of HIV. The risks of mother-to-child transmission of HIV can be reduced to below 1% by the appropriate use of HIV treatment during pregnancy and delivery. Meanwhile, the total number of people living with HIV continues to rise owing to improved survival, and the rate of new HIV infections has decreased.

But the scale of the challenge in meeting these ambitious new targets is massive. A report by UNAIDS published in July 2014 revealed that more than half of people living with HIV do not know they are infected — meaning some 19 million of the estimated 35 million people with HIV worldwide will need to be identified. And two-thirds of adults with HIV, and three-quarters of the children, are not receiving treatment.

The notion of a world in which HIV is under control is a tantalising prospect

An effective antiretroviral treatment programme requires a healthcare system capable of helping each patient stick to the therapy and achieve a suppressed viral load. This involves viral load testing and the ability to detect drug resistance, but this technology is out of reach for many living in the developing world. Newer drugs must be made affordable too; the virus becoming resistant to standard first-line antiretrovirals is an ever present threat that might yet hamper UNAIDS’s ambition.

The notion of a world in which HIV is under control is a tantalising prospect. More must be done to reach groups at high risk of HIV transmission, including men who have sex with men, sex workers and injecting drug users, especially in countries where a diagnosis is still highly stigmatised.

UNAIDS makes it clear that if the efforts are not ramped-up now, the epidemic could rebound out of control. All this will not come cheap. But with each dollar spent on aiming for these new targets estimated to pay back fifteen-fold, this fast-track is an opportunity too good to be missed.

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Citation
The Pharmaceutical Journal, PJ, 6/13 December 2014, Vol 293, No 7839/40;293(7839/40):DOI:10.1211/PJ.2014.20067301