Good news to everyone, the world is moving closer to one of the most important public health goals of our time: eradicating HIV. And in order to do that, we won't even need to cure the disease. We just need to stop the transmission of HIV until it stops.
In the past, this goal would have seemed impossible. HIV has caused millions of deaths and is one of the most devastating diseases mankind has ever known. But now we're at a point where new advancements like a pill, a once-a-day drug, are helping us fight HIV effectively.
HIV is a retrovirus, which means that it integrates copies of itself into the DNA of an infected cell, allowing it to replicate and infect other cells. HIV has developed many ways of evading the human immune system, which makes it difficult to cure.
But by developing ways to stop HIV from replicating, we can stop the spread of HIV itself. This is where antiretrovirals: also known as ARVs: come into play. ARVs are a group of medicines that work in different ways to fight HIV. Some block HIV's access to immune cells and others prevent the virus from replicating.
ARVs also work for prevention in people who do not have HIV. This type of method or approach is called pre-exposure prophylaxis, or PrEP. PrEP works by building up in a person's body and preventing HIV from establishing itself. This means that an HIV negative person who may be at risk of contracting the disease can take certain ARVs to protect themselves, before being exposed.
This is where it becomes especially interesting: in people living with HIV, ARVs can also significantly reduce HIV transmission. This is called "Treatment as Prevention".
Globally, this has the potential to end the HIV epidemic. It is based on the idea that a person living with HIV who takes ARVs can lower the level of the virus in their body until it becomes undetectable. This does not mean that the virus is gone; it can still hide inside cells, ready to reactivate if treatment is interrupted. But as long as it is kept dormant by drugs, HIV remains undetectable. And when HIV is undetectable, it is also non-communicable.
In theory, this means that by testing everyone at risk for HIV and treating those who test positive, we could stop transmission and eventually eradicate HIV.
However, in the real world, things are more complex and complicated. Many people living with HIV around the world do not have access to PrEP or ARVs, and those who are HIV positive may have difficulty taking antiretroviral drugs. These problems are often greater in countries with the highest HIV burden. Taking these drugs depends on having access to a functioning health system, and it is not something that everyone has.This is one reason why stopping the spread of HIV for good will require a significant investment of resources to improve these systems. A study by UNAIDS estimated that it would take between 20 to 30 billion dollars a year to achieve an almost 90% reduction in new HIV infections by 2030. This investment would first ensure that more people get tested and more people can access and maintain care. Achieving this goal and improving health care in general is in the interest of everyone, from individuals to society as a whole.
We have roadmaps that could enable us to end the HIV epidemic in the near future, with the potential to eradicate the disease completely several generations in the future. Between 1996 and 2017, we nearly halved the number of new HIV infections, and for the millions of people still living with the virus, ARV treatments lead to long, healthy lives for most people, we can achieve transmission rates low enough to end HIV once and for all. We getting real close, A world without HIV is no longer unachievable: it is closer than ever.
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