Are we close to ending HIV? Part I: Making new diagnoses rare
By Julie Jordan
Published March 21, 2019
In 1981, the world saw its first case of human immunodeficiency virus or HIV. In February, the President announced he intends to prioritize ending HIV by 2030. Since then, the Centers for Disease Control and Prevention issued a report stating new HIV infections have stopped going down. More recently, the media reported an HIV positive individual cured.
With so many different messages about HIV being conveyed, it’s easy to misunderstand the status of the disease. How close are we to ending HIV, really?
HIV attacks the body’s immune system and interferes with its ability to fight infections, creating vulnerability to opportunistic infections or cancers, by targeting CD4 cells (T cells) which help the immune system fight off infections. Once a person’s CD4 cell count is below 200, they are in the third and final stage of HIV known as acquired immune deficiency syndrome, or AIDS. Those who progress to AIDS may live about three years without treatment. Once they have an opportunistic infection, their life expectancy goes down to one year.
Many have been working to "end HIV" or to "find a cure" since the first infection almost 40 years ago. But there is a more accurate way to describe the "elimination" goal.
“With collaboration, reaching this goal of getting to zero new HIV diagnoses or making new HIV diagnoses a rarity is achievable,” said Gregory S. Felzien, M.D., HIV medical advisor for the Georgia Department of Public Health. “We should avoid the word ‘elimination’ with HIV, because there is too much room for misinterpretation.”
The most widely-available treatment for HIV is antiretroviral therapy, or ART. In 1997, U.S. HIV death rates dropped for the first time at 47 percent due to ART. But the treatment never fully removes the virus from the blood. Rather, if ART is taken as prescribed by HIV positive individuals, it can reduce the viral load—the amount of HIV in the blood—to an undetectable level called “sustained viral suppression.” Once sustained viral suppression is reached, the risk of transmitting HIV through sex is reduced to almost zero. And the HIV positive person’s quality of life is greatly improved.
But HIV is never completely eliminated once diagnosed. Therefore, for now, the emphasis is on making new HIV diagnoses a "rarity," not eliminating the disease.
Other misleading verbage about HIV has been used in headlines in recent months suggesting a "cure." The cure that was reported in the London man described a rare situation where a genetic mutation in a European man made him resistant to HIV. This individual donated bone marrow to the HIV-positive London man, and after his body began to accept the bone marrow transplant, tests showed there was no HIV in his blood. This was a triumph with limitations:
Most experts say it is inconceivable such treatments could be a way of curing all patients. The procedure is expensive, complex and risky. To do this in others, exact match donors would have to be found in the tiny proportion of people — most of them of northern European descent — who have the CCR5 mutation that makes them resistant to the virus. – NY Times
For most HIV positive people, living with sustained viral suppression (and almost no risk of transmitting the virus through sex) is the best possible scenario science will allow. For those at high risk of acquiring the virus—gay and bisexual men, African Americans, Latinos, injection drug users and transgender individuals—prevention is key. And reaching the goal of getting to zero new infections, or making new infections a rarity, is only possible with effective prevention methods.
These methods will be discussed in Part II.