Imagine this… No new HIV diagnoses (& it’s happening right now in Denmark)!

Eradicating HIV is within our grasp, using the ‘treatment as prevention’ approach, experts have suggested.  The World Health Organization and the Joint United Nations Programme on HIV said they plan to use the ‘treatment as prevention’ technique to eliminate the global pandemic.

Article via Daily Mail (Video’s sourced via YouTube).

The point will have been achieved, WHO experts say, when only one person in every 1,000 becomes infected each year.  Now, a nearly two-decade analysis by researchers from UCLA and Denmark, yields the first proof that the approach could be effective.   Reviewing Danish medical records, they found that the treatment-as-prevention strategy has brought Denmark’s HIV epidemic to the brink of elimination.

The study found that in 2013, the country had only 1.4 new HIV infections per 1,000 men who have sex with men, Denmark’s major risk group.

Professor Sally Blower, the study’s senior author and director of the Center for Biomedical Modeling at UCLA, said: ‘The Danes have done what nobody else in the world has been able to do.  They have almost eliminated their HIV epidemic, and they have achieved this simply by providing treatment.’

The paper notes, however, that the treatment programs in Denmark are exceptional.  ‘Treatment makes people less infectious,’ said Justin Okano, the study’s lead author and a statistician in Blower’s research group.

‘In Denmark, 98 per cent of patients take all of their HIV medications, which is why treatment as prevention has worked there.   ‘Unfortunately, adherence levels are nowhere near as high in other countries.’

The findings, which appear online in the Lancet Infectious Diseases, are based on a sophisticated statistical analysis of data from the ongoing Danish HIV Cohort Study, which began in 1995.

That project, which tracks all Danish men who have sex with men, and who have been diagnosed with HIV, was established and is run by Jan Gerstoft and Niels Obel, clinicians and epidemiologists in Denmark who also are co-authors of the new study.

For the current study, the researchers used an approach called CD4-staged Bayesian back-calculation to determine the number of Danish men who have sex with men, and who had become infected with HIV each year between 1995 and 2013.

They found that the number of infections has been decreasing since 1996, when effective HIV treatments were introduced in Denmark.   They then measured the correlation between the decrease in the number of HIV infections each year and the increase in the number of people who began treatment, and they found that the two were highly correlated.

‘What we found was very exciting,’ said Dr Laurence Palk, a co-author of the study and a postdoctoral fellow in Professor Blower’s lab.  Our results show treatment as prevention has been slowly but steadily working to end the Danish epidemic.’

The team calculated that by 2013, when the epidemic was close to elimination, there were only approximately 600 men in Denmark who have sex with men, and who were infected with HIV but had not been diagnosed.

‘Now that the number is so low, it would be fairly easy to do a social media campaign and get these men to be tested,’ ‘If they accepted treatment, it would essentially end this epidemic.’ – Dr Palk said.

Professor Blower, who also is a professor in residence at the Semel Institute for Neuroscience and Human Behavior, said: ‘Over 15 years ago, we made predictions based on mathematical models that treatment as prevention could work and be an effective elimination tool.  ‘It’s wonderful to see that this has actually happened.’

The researchers chalk up Denmark’s success to many factors, including the country’s universal health care system and the availability of free treatment for all people who have been infected with HIV.

However, the largest number of people with HIV – 25 million – live in sub-Saharan Africa, where health care systems are overextended and there are far fewer resources.

Professor Blower said that for the treatment-as-prevention approach to eliminate HIV epidemics throughout the world, all countries would need to emulate Denmark’s treatment programs.

‘Even in resource-rich countries, this would take a huge amount of money and effort,’ she said.  ‘The goal of elimination through treatment is aspirational, but Denmark has shown that – at least in resource-rich countries – it’s achievable.’

Want more? – see these links.

• Danish HIV research could revolutionise treatment internationally
• HIV: No longer an epidemic in Denmark

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The fight goes on against HIV

The progress made in the treatment of HIV infection in recent years cannot be overstated. What was once a death sentence is now treatable. A HIV patient beginning treatment today can hope to have to a normal life expectancy, albeit one dependent on continuous medical treatment. Those with undetectable viral loads have almost no chance of transmitting infection, nor does infection prevent people going on to have children.

Story via The Pharmaceutical Journal
@PJOnline_News

You would find it hard to believe therefore that this month the headline ‘Hollywood HIV panic’ ran in the UK’s biggest circulation tabloid The Sun in reference to an actor being diagnosed with HIV. Charlie Sheen announced soon after that he has been living with HIV for the past four years. The worst part about the illness, said Sheen, is the shame that comes with it. People do not take action or get help because of the stigma, he added.

In the West, you could have been forgiven for thinking we had grown to accept people living with HIV. Many individuals who have challenged the early misconceptions about HIV/AIDS and many more people who have learnt to embrace their status and campaign for greater public acceptance have done much to reduce the stigma of disease and educate the public about HIV infection.

Yet stigmatisation of people living with HIV remains a major problem worldwide. The World Health Organization (WHO) cites fear of stigma and discrimination as the main reason why people are reluctant to get tested, disclose their HIV status and take antiretroviral drugs.

Some national governments still deny the existence of HIV, dismissing it as a disease of the West confined to those who are sexually deviant. It is in these countries where those living with the virus will continue to die unnecessarily.

Stigma creates a culture of fear, and this fear could lead to people refusing to get tested, begin treatment and stop the virus from spreading further.

Nonetheless, in the past few years great progress has been made in the battle against the HIV epidemic. Previously, diagnosing HIV infection was cumbersome and slow. The standard medical practice was to hold off initiating treatment until a patient’s CD4 cell count dropped to a level where they were at higher risk of developing AIDS. Much attention is now directed at identifying those at risk and swiftly diagnosing those infected with the virus, and there is growing evidence that those diagnosed should be started on treatment as soon as possible. For example, the START trial, carried out in 35 countries, was stopped over a year early after interim results showed that the health benefits of starting antiretroviral drugs immediately, regardless of CD4 cell counts, outweighed the potential risk to health. The WHO recommends that anyone infected with HIV should begin antiretroviral treatment as soon as possible after diagnosis.

The use of treatment as prevention (TasP) — a HIV prevention method that uses antiretroviral treatment (ART) to decrease the risk of HIV transmission — continues to grow. In 2011, the landmark study HPTN 052 showed early initiation of antiretroviral (ARV) treatment in those with a CD4⁺ cell count between 350 and 550 for the HIV-infected partner in a serodiscordant couple reduced HIV transmission to the HIV-negative partner by 96%.

Moreover, this year the WHO recommended that pre-exposure prophylaxis (PreP) — giving ARVs to protect people from HIV before potential exposure — should be offered to all those who are at substantial risk of HIV infection (previously, it was recommended that only certain affected populations, such as sex workers, men who have sex with men (MSM) and people who inject drugs, received PreP).

Earlier in 2015, the world exceeded the AIDS targets of Millennium Development Goal 6 — halting and reversing the spread of HIV, with new HIV infections falling by 35% and AIDS-related deaths decreasing by 41%.

Meanwhile, new ARTs continue to enter the market and new formulations are being researched.

All of these indicate that the fight against HIV and AIDS is heading in the right direction in terms of drug treatment and research. However, if further progress is to be made, this will depend on identifying everyone who has the virus, which continues to be a challenge — and stigma plays a large part in this.

So although we have come a long way, there is still more to do, particularly in terms of educating people and changing their attitudes towards HIV, if we are to ever see the last of this virus.

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