Can we end the HIV pandemic?
- December 15,2020
- 5 Min Read
It has been nearly 4 decades since the first few cases of a mysterious immunodeficiency disease were identified. Over the last 40 years, dramatic advances have been made in our understanding of HIV/AIDS in terms of pathogenesis, treatment and prevention. The question remains.
Understanding the importance of viral loads and CD4 counts and their interrelationships with disease progression was pivotal in laying out prognosis and proved to be key when clinical trials on antiretroviral drugs were initiated. By unraveling different aspects of the life cycle of the virus in the cell, drugs were developed targeting the reverse transcriptase, protease and integrase inhibitors and entry inhibitors. Over 20 drugs and combination products are now available for the treatment of HIV/AIDS which can lead to a near normal life span and a good quality of life. More recently, therapeutic antibodies have been approved for the treatment of multiclass drug resistant HIV.
While the number of new infections has been decreasing and the number of HIV.AIDS patients who are alive continues to increase, the discovery that use of the drugs viz. a combination of tenofovir and emtricitabine by healthy persons could prevent the acquisition of HIV is a critical step towards possibly ending the HIV epidemic. Further developments in this include the development of long acting drugs e.g. an injection taken every 2 months and implants which could release drugs gradually over 1 year could prove to be truly transformational.
However, the bid challenge remains implementing all the advances to the population level. In 2018 nearly 17 lakhs new infections occurred globally and about 7 lakh people died. Of late, the COVID-19 pandemic has raised concerns that advances made in the fight against diseases such as AIDS, malaria, and TB could be derailed, setting us back by several years.
There is a real opportunity to ‘end’ the HIV/AIDS pandemic as a result of all the advances, but challenges remain. A vaccine has eluded scientists and the industry.
As Dr. Anthony Fauci in a recent editorial pointed out ‘4 decades of HIV/AIDS, much accomplished, much to do’.
Dr. Jaideep A Gogtay, MD
Global Chief Medical Officer, Cipla Ltd, Mumbai
- Fauci AS, Lane HC. Four Decades of HIV/AIDS — Much Accomplished, Much to Do. N Engl J Med. 2020 Jul 2;383(1):1–4.
- Global HIV & AIDS statistics — 2020 fact sheet [Internet]. [cited 2020 Nov 30]. Available from: https://www.unaids.org/en/resources/fact-sheet
- Saag MS, Gandhi RT, Hoy JF, Landovitz RJ, Thompson MA, Sax PE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society–USA Panel. JAMA. 2020 Oct 27;324(16):1651