IDWeek 2018 — We are not on track to end AIDS

  • Emily Willingham, PhD
  • Clinical Essentials
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  • Melanie Thompson of AIDS Research Consortium of Atlanta presented what's hot in HIV clinical science.
  • People with HIV can live a near-normal lifespan free of AIDS with early and continuous antiretroviral therapy (ART).
  • We know how to prevent HIV infections but are not on track to end AIDS.

Why this matters

  • Some populations are being left behind.
  • Funding declining while care/treatment needs increase.
  • Fewer than half of people with HIV are virally suppressed.

Key highlights

  • Health disparities, structural barriers remain key issues.
  • Case numbers hit records lows in some places (e.g., San Francisco), but disparity gap widens.
  • Black men living with HIV have highest mortality rates; e.g., in Atlanta, 80% of newly diagnosed are black men.
    • Thompson says, “We are not going to end anything until we stop leaving people of color behind.”
  • Treatment is prevention, she says, if there is zero transmission and virus is durably suppressed.
    • She cites PARTNER 2 study, where transmission was 0 from main partner, despite high rates of condom-free sex.
    • Pre-exposure prophylaxis (PrEP) works, but the problem is that among population indicated for PrEP, only 8% were prescribed it in 2015 (mostly white men; only 1% of black people who needed it got it).
  • Despite new drugs approved or on the horizon, costs remain unclear.
  • New looming problems include:
    • Neural tube defect signal detected in Botswana with dolutegravir.
    • Other potential developmental neurological signals with in utero exposure to efavirenz. 
    • Other considerations are structural barriers to, e.g., rapid ART start, which can cut time to viral suppression in half.
    • People with HIV are aging, so comorbidities are increasing; e.g., HIV doubles cardiovascular disease risk.
  • Without change, says Thompson, another 55,000 people with have a new HIV infection by 2030.
  • Implementing 95-95-95 targets would drop that to 19,000/years; adding in PrEP would decrease to 14,000.

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