Ending the HIV epidemic is now a realistic goal

The COVID-19 crisis continues to dominate headlines, understandably so with daily infection, hospitalization and death numbers at record high levels while economic shutdowns continue to affect the entire world. This level of concern is reminiscent of the early 1980s and the arrival of the human immunodefi virus, which causes AIDS. At the beginning of the HIV epidemic, the disease was viewed by the general public as affecting mostly gay men, and efforts to battle infection rates were slow to come in the early years, but the world eventually saw it quickly grow into a life-threatening concern for all people.

As of 2019, there were around 38 million people worldwide with HIV/ AIDS, including 1.8 million children. As of 2018, about 700,000 people had died of HIV/AIDS in the United States. These staggering statistics highlight the tremendous reach for what can still be a deadly virus if left undetected and untreated.

As we recognize World AIDS Day and HIV/AIDS Awareness Month in December, the good news is that through improved antiretroviral treatments and better preventative medications, death rates have significantly declined and we can now say there nay be an end in sight to this epidemic, which has caused so much heartbreak and loss of life.

Numbers improving

First, it’s important to note that although there is no cure for HIV infection, there are antiretroviral therapies (ART), medications that can increasingly help people to live well with HIV, as opposed to the death sentence the disease was once perceived to be. Also, AIDS-related deaths are down 60% since the peak in 2004, and a long-acting injectable

HIV treatment option is expected to have approval in 2021 that will help with adherence, potentially lower costs and improve outcomes.

Even at a local level, numbers are improving. In San Francisco County, there were only 166 new HIV cases diagnosed in 2019, down from 475 in 2009. The goal is to get that number down to 50 by 2025. Here in Michigan, Wayne County had 300 new HIV cases diagnosed in 2018, with a target of 80 cases by 2025. Numbers this low, while still a concern, were unimaginable during the height of the epidemic.

The federal government also is taking the battle seriously, launching its “Ending the HIV Epidemic” plan, which aims to end the epidemic in the United States by 2030 through scientific advances and improved diagnosis, treatment and outbreak response.

COVID connection

There is an interesting correlation between the fight to end HIV and the battle against COVID-19. On one side, the advances made over the decades in rapid point-of-care diagnostics for HIV are now being applied as states ramp up their testing programs in the battle against COVID-19, helping to limit the spread of the novel coronavirus, SARS-CoV-2.

On the reverse side, we have seen some great outcomes in vaccine development related to COVID, which can only improve how we treat other viruses, such as HIV. This accelerated agenda of COVID-19 research will absolutely benefit the future of HIV testing, treatment and prevention, via continued expansion of the research infrastructure needed to work with both viruses.

In the end, our efforts to battle COVID-19 are helped by what we’ve learned in the HIV fight, and our success in finding COVID vaccines will likely lead to increased success in finally ending the HIV epidemic.

Preventative medication

Another way to help eradicate HIV transmission is for all primary doctors to become comfortable with prescribing PrEP medication to their patients, and giving it to all patients who request it.

PrEP (Pre-Exposure Prophylaxis) is a medication that prevents HIV from spreading, limiting transmission through sexual activity, and is up to 99 percent effective. Many clinics, including Corktown Health Center, offer counseling in addition to PrEP medications to make sure patients are using them correctly, and to discuss safer sex and barrier protection, including condoms and dental dams.

Regular screening for sexually transmitted infections (STIs) is an added layer of protection in addition to the use of PrEP.

Dr. Latonya Riddle-Jones is medical director at Corktown Health Center in Detroit, and an assistant professor of Internal Medicine and Pediatrics at Wayne State University School of Medicine. She is also Vice-Chair, Chief Diversity, Equity & Inclusion Officer for the Department of Internal Medicine at Wayne State. Visit corktownhealth.org