01 December 2016

World AIDS Day is held on the 1st of December of each year and is an opportunity for people worldwide to unite in the fight against HIV. Around 100,000 are currently living with HIV in the UK and an estimated 35 million people suffer from HIV globally.

Ever since AIDS was first recognized in the United States in 1981, the autoimmune disease has grown on an unprecedented scale. To halt its progression, the United Nations (UN) endorsed the sustainable development goals to bring the AIDS epidemic to an end by 2030 (figure 1)

Figure 1. WHO goal to end AIDS epidemic by 2030, getting to Zero 1.

Figure 1. WHO goal to end AIDS epidemic by 2030, getting to Zero 1.

 

This initiative follows the footsteps of the millennium development goals set in 2000 which has been hailed as a major triumph revealing an annual HIV infection incidence drop by 38%, from 3.4 million in 2001 to 2.1 million in 2013. Correspondingly, AIDS-related deaths have also declined by 35% between 2005 and 2013 (2).

Yet and despite this laudable progress, HIV/AIDS remains a major public health threat. In 2015 alone, there were still an estimated 2.1 million new HIV infections worldwide, with current figures indicating 34.9 million people living with HIV, including more than 2.6 million children.

 

Figure 2. HIV/AIDS worldwide infections and death rates (3).

Figure 2. HIV/AIDS worldwide infections and death rates (3).

 

The African continent is the only region to have recorded a consistent drop in new HIV infections since 2010. Last year Matshidiso Moeti, WHO regional director for Africa, said the continent had continued to make remarkable strides in ending the AIDS pandemic – with the latest statistics showing that new infections had been reduced by 42% between 2000 and 2014  (3).

 

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More promisingly and on the eve of World AIDS day, a large clinical study is set to begin in South Africa involving the new version of the only HIV vaccine candidate know to provide some sort of protection against the virus  (4).

HIV transmission

HIV transmission predominantly occurs through three mechanisms: sexual transmission, exposure to infected blood or blood products, or perinatal transmission. Worldwide, sexual intercourse is the predominant mode of transmission, accounting for approximately 80 % of infections (4).

Many of the clinical features of HIV/AIDS can be ascribed to the profound immune deficiency which develops in infected patients. The destruction of the immune system by the virus results in opportunistic infections as well as an increased risk of autoimmune disease and malignancy.

Treatment measures

Antiretroviral treatment (ART) fundamentally changed the course of the epidemic by substantially reducing mortality from HIV infection and as part of HIV control strategies. The scale up of ART thus has been one of the major public health success stories, with 17 million people accessing ART by the end of 2015 – 2 million more than the 15 million target set by the UN General Assembly in 2011.

 

Jean Francoi Tolno and Hawa Madi, part of Team Nine of the WHO Ebola vaccine trial staff at work in Katongourou, Guinea. Here they check the blood pressure and other indicators of a trial participant for half an hour after receiving the vaccine. The World Health Organisation is running phase III clinical trials for Ebola virus disease vaccine in Guinea. The technique being used is "ring vaccination" which was used in the 1970s to eradicate smallpox.

 

One key gap in current treatment scale-up efforts however is the failure to reach marginalized populations including migrants, prisoners, and many more. In addition to focused outreach, it is also essential to remove punitive laws and practices that violate human rights, increase people’s vulnerability to the risk of acquiring HIV, and impede utilization of healthcare services.

Bright horizons

The roadmap for ending the AIDS epidemic is clear. Combined with a stronger focus on HIV prevention, reaching the 90–90–90 target – by 2020, 90% of all people living with HIV know their HIV status, 90% of people with diagnosed HIV receive ART and 90% of all people on HIV treatment achieve viral suppression – will enable to lay the groundwork to end the AIDS epidemic by 2030 (5).

Scaled-up ART is a pillar of effective HIV prevention, as experience in different parts of the world has demonstrated that expanding the use of ART is directly correlated with declines in new HIV infections. This is especially so, given that several promising Antiretroviral products that are well advanced in the pipeline have the potential, when manufactured as generic products, to save as much as US$ 3 billion on HIV treatment costs over 10 years (6).

Show your support

World AIDS Day is a great opportunity to raise money for NAT (National AIDS Trust) and show support for people living with HIV. If you wish to donate or simply hold an event to raise awareness, click on the following link – NAT.

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