HIV: THE TOOLS ARE THERE, THE FUNDING NEEDS TO FOLLOW
September 8, 2016
Summer is coming to an end. A beautiful sun-filled summer that we hope you’ve been able to enjoy to the fullest. To mark the return to school and work, we offer you an opportunity to catch up on the latest on HIV for the summer season, with a selection of news that caught our attention, mainly from the 21st International Conference on HIV/AIDS, held in Durban, South Africa, from the 18th to the 23rd of July 2016.
It’s confirmed. People living with HIV whose viral load is undetectable cannot transmit the virus to their partners.
An american study published on the 12th of July in the Journal of the American Medical Association monitored 1,166 serodiscordant couples, a third of them same sex, for 16 months and found that there was no HIV transmission between partners when the viral load of the HIV-positive partner could not be detected. The medical treatment used to reduce the viral load can thus, without the shadow of a doubt, also be considered a very effective prevention method since it blocks the transmission of the virus. The relevance of this approach, known as Treatment as Prevention (TasP), has thus been confirmed once again, since it is a significant contributor to the decline of the epidemic.
PrEP “on demand”: A promising approach
Pre-exposure prophylaxis (PrEP) continues to demonstrate its effectiveness and each new study shows that it considerably reduces the risk of HIV transmission. The Truvada medication, which prevents the virus from multiplying, was, moreover, approved by Health Canada as a preventive treatment. A Canadian study confirmed that, when taken continuously, it has a 98% rate of success in preventing infection of persons newly exposed to the risk of transmission.
PrEP “on demand”, a one-off prophylactic treatment prescribed during bouts of high risk of exposure to transmission, occupied a place of prominence in the debates at the Durban conference. A first study had established its effectiveness at 86%. A new French study, conducted from November 2014 to 2016 with 362 individuals, yielded results that were even more spectacular. Only one person – who, in fact, had interrupted the PrEP – was infected.
When well managed, PrEP “on demand” represents a promising approach for populations that are highly vulnerable to the risk of HIV transmission, have very high prevalence rates, and among whom the transmission chain seems difficult to break. Not only does it have fewer secondary effects than the continuous treatment formula, but it, moreover, leads to substantial savings which could encourage its development among the biggest pools of high-risk populations.
Objective 90-90-90: An ambitious target
At the Durban conference, many actors in the fight against HIV/Aids denounced an enormous gap between the promises to end Aids and the reality on the ground, with funding insufficient and health systems on the brink of implosion.
Funding continues to be the main challenge facing the attainment of the 90-90-90 objective by the year 2020: 90% of persons with HIV knowing their status; 90% of persons tested receiving lasting antiretroviral treatment; 90% of persons under treatment having an undetectable viral load.
Today, 51% of persons with HIV do not know that they have the virus. Three out of four have no access to treatment, and the rate is 9 out of 10 among children. We have all the tools we need to close the gap, but the challenge continues to be huge because of the cost of medication, infrastructure costs, and the human and medical resources needed. Without real political will, we will not be able to attain the 90-90-90 target.
Sources: La Presse, Ici Radio-Canada, Seronet