Several advancements have been made in the fight against HIV, however, the pandemic persists. The treatment and prevention options that are available are very effective if adhered to, but are they enough to stop the pandemic?
In a recent commentary
, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), says that from “a practical standpoint,” probably not. Rather, the development of a moderately effective HIV vaccine—coupled with the implementation of existing treatment and preventive modalities—is “essential” to ending the pandemic.
Dr. Fauci first shared his thoughts on this topic at the 9th IAS Conference on HIV Science (IAS 2017
) in Paris, France. “Theoretically, yes. I say, ‘yes, theoretically’ because advances in HIV science over the past 35 years have been nothing short of breathtaking [in all areas], not least of which in [the area] of treatment.”
Dr. Fauci admits that theoretically, the pandemic can meet its end without the vaccine, but it’s highly unlikely and would be incredibly difficult to accomplish. With 30 “highly effective anti-HIV drugs” available, HIV-positive individuals are able to live just as long as someone who is uninfected with the virus. By adhering to a treatment regimen consisting of 3 more anti-HIV drugs, infected individuals are able to reduce their viral load low enough so that their likeliness of passing the infection on to others is “extremely unlikely.” Therefore, if everyone with HIV “could be identified, accessed, and treated, it would be possible to stop all infections and end the epidemic,” Dr. Fauci writes.
Not only have we come a long way when it comes to treating those infected, but massive strides have been made in the prevention of the virus. The biggest means of prevention? Pre-exposure prophylaxis, or a single pill that is comprised of 2 different anti-HIV drugs, that can decrease the likeliness of infection via sexual intercourse in those who are at risk by a whopping 90%—if adhered to properly.
“Accordingly, if both of these treatment and prevention modalities were effectively implemented throughout the world, the HIV/AIDS pandemic would end,” Dr. Fauci admits. However, it’s unlikely that the pandemic can be brought to an end without a vaccine. He points out, “Although an estimated 19.5 million of the estimated 36.7 million HIV-infected people globally are receiving anti-HIV therapy (an extraordinary accomplishment), more than 17 million people are not receiving therapy. This leaves a substantial treatment gap.” Those who are not on treatment are likely to pass the infection onto others, thus keeping the pandemic going.
He also points out that although PrEP has proven highly effective, “only a very small percentage of these individuals are actually taking these medications.” In fact, in the United States, it is estimated that only 10% of those who should be receiving PrEP are actually doing so; the percentage is even lower in other countries.