Advances in HIV Detection, Care, and Treatment
The Human Immunodeficiency Virus, more commonly known as HIV, continues to be a major global public health issue. According to the WHO, HIV has infected 70 million people and claimed over 35 million lives worldwide since the pandemic began in 1981. 36.9 million were living with HIV as of 2017, with nearly 70% of those cases from Africa.
The declaration of an ambitious target by the United Nations called 90-90-90 has increased global awareness of HIV and fueled desire within the medical community to further advance its detection, care, and treatment. This target states that by 2020
- 90% of people living with HIV will know their HIV status,
- 90% of all people diagnosed with HIV will be receiving antiretroviral therapy (ART), and
- 90% of people receiving ART will have viral suppression.
Current Treatment Standard: ART
Approximately 59% of those living with HIV are receiving antiretroviral therapy (ART) to suppress the viral load within their bodies. ART is recommended immediately upon diagnosis. In May 2019, a landmark, eight-year study published in The Lancet concluded that with the use of antiretroviral therapy (ART), the risk of transmission from condomless sex is effectively zero. The couples involved were serodifferent, meaning one partner was HIV-positive and taking ART, and the other was HIV-negative. There were 782 pairs who participated, recruited from 75 sites in 14 European countries. The study was funded by the National Institute for Health Research in the United Kingdom.
Monthly Regimen: In March 2019, ViiV Healthcare presented data from two studies, both showing results from an injectable two-drug monthly regimen that mirror the results of the current oral three-drug daily regimen of ART. Submitted to the FDA in April, the treatment combines ViiV’s cabotegravir and Janssen’s edurant (rilpivirine). During its March presentation, ViiV stated that not only did the monthly regimen demonstrate non-inferiority to the daily regimen, but also that nearly all participants who switched preferred it over the oral therapy.
Test Kits: In April 2019, Quest Diagnostics launched take-home test kits for an array of STIs, including HIV. For USD$49 each, these tests eliminate the need for potentially uncomfortable discussions about STIs between individuals and their physicians. Individuals are required to bring their test(s) to a designated drop-off location; the test results become available online within a week.
Frailty Meter: In the past, several visits to the doctor were required to measure a patient’s level of frailty. With the development of a new device by Dr. Bijan Najafi of Baylor College of Medicine known as a Frailty Meter, a patient’s frailty can now be measured in seconds using a small motion sensor that is attached to the wrist. Measurements are produced from 20-second flexion and extension movements of a patient’s elbow.
Treating HIV-Related Cancer: For individuals living with HIV, the virus can cause other infections and diseases to occur within their bodies. Of these, many are cancers, including Kaposi sarcoma. Fortunately, the FDA recently gave breakthrough therapy designation to Celgene’s Pomalyst (pomalidomide), a drug to treat the form of Kaposi sarcoma associated with HIV. The drug is only appropriate for patients who have already received chemotherapy.
Although the level of global awareness of HIV and its current statistics are promising, campaigns centered around an end to the pandemic are “only easy to apply when HIV-positive people have access to testing, effective treatment, viral load monitoring to levels of less than 200 copies per mL, and support to reach and maintain viral suppression…A sustained effort is required to increase rates of testing and HIV diagnosis with early initiation of ART and full support to maintain high levels of adherence.” – The Lancet
What other recent advancements regarding HIV have you heard about? Tell us!