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The world is getting closer
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to achieving one of the most important
public health goals of our time:
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eradicating HIV.
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And to do this, we won't even have
to cure the disease.
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We simply have to stop HIV from
being transmitted
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until eventually it fizzles out.
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Once, this goal would have
seemed impossible.
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HIV has caused millions of deaths
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and is one of the most devastating
diseases that humanity has ever known.
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But we're now at a point where new
advances
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such as one-pill, once-a-day medications
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are helping us tackle HIV
in effective ways.
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HIV is a retrovirus–
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meaning it integrates copies of itself
into an infected cell's DNA,
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allowing it to replicate and
infect other cells.
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HIV has evolved numerous ways to evade
the human immune system,
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which makes it difficult to cure.
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But by developing ways to
block HIV replication,
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we can stop the spread of HIV itself.
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That's where antiretrovirals–
a.k.a. ARVs– come in.
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ARVs are a group of drugs which work
in different ways to combat HIV.
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Some block HIV's access into immune cells,
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and others work by stopping the
virus itself from replicating.
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ARVs also work preventatively in people
who don't have HIV.
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This type of approach is called
pre-exposure prophylaxis, or PrEP.
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PrEP works by accumulating in a
person's body
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and preventing HIV from
establishing itself.
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That means an HIV-negative person who may
be at risk of contracting the disease
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can take certain ARVs
to protect themselves,
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before they become exposed.
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Here's where it gets
especially interesting:
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In people with HIV, ARVs can also
dramatically reduce HIV transmission.
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This is called “Treatment as Prevention.”
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On a global scale, this has the potential
to end the HIV epidemic.
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It's based on the idea that someone with
HIV who takes ARV's
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can lower the virus level in their bodies
until it becomes undetectable.
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That doesn't mean the virus is gone;
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it could still be lurking within cells,
ready to reactivate if treatment stops.
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But so long as it's kept
dormant with drugs,
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HIV remains undetectable.
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And when HIV is undetectable,
it's untransmittable, too.
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In theory this means that by testing
everyone who's at risk of HIV
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and treating those who test positive,
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we could stop transmission and
eventually eradicate HIV.
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In the real world, however,
things are more complex.
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Many at-risk HIV negative people across
the world
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do not have access to PrEP or ARVs,
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and those who are HIV positive may
experience challenges to taking ARVs.
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These problems are often greatest in
countries
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where the burden of HIV is highest.
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Getting these medications depends on
access to a functioning healthcare system–
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and this isn't something everyone has.
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That's part of the reason why stopping
the spread of HIV for good
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will require a significant investment of
resources to improve those systems.
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One study carried out by the UNAIDS
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estimated that between 20-30 billion
dollars per year
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would be needed to achieve
a nearly 90% reduction
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in new HIV infections by 2030.
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This investment would ensure more people
would get tested in the first place,
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and more would be able to access and
maintain treatment.
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Achieving this goal and improving
healthcare in general
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is in everyone's best interest,
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from individual people to
society as a whole.
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We have roadmaps that could allow us
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to bring the HIV epidemic to an
end in the near future,
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with the possibility of eradicating the
disease altogether
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several generations in the future.
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In the period from 1996 to 2017
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we almost halved the number
of new HIV infections,
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and for the millions of people who still
live with the virus,
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ARV treatments enable most to lead long
and healthy lives.
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With continued and increased investments,
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we can get transmission rates low enough
to end HIV once and for all.
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A world without HIV is no longer
inconceivable:
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it's closer than ever.
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