Posted on October 26, 2017
Source: New England Journal of Medicine
"There are now an estimated 19.5 million people worldwide living with HIV and receiving antiretroviral therapy (ART). That’s approximately half of all people thought to be living with the virus in 2017 — an extraordinary achievement in global health and human solidarity. The United Nations agencies, led by the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), have committed to the goals of ending the AIDS pandemic as a public health threat by 2030 and ensuring that by 2020, 90% of people with HIV infection know they have it, 90% of those infected are receiving ART, and sustained viral suppression is achieved in 90% of those receiving treatment. This last goal is critically important both to individual health and survival and to epidemic control of HIV, since data continue to mount showing that viral suppression greatly reduces the risk of continued transmission — whether sexual or perinatal — of the virus.
It would arguably be enormously difficult to achieve epidemic control simply by expanding ART. Too many people and communities — from adolescents in Africa, to sexual minorities and transgender people in many countries, to injection-drug users in Eastern Europe and Central Asia — are currently excluded from care. We believe that enhanced primary prevention of infection, by means of targeted use of preexposure prophylaxis (PrEP) for people at substantial risk and probably a preventive vaccine, will be required for ultimate control. Nevertheless, treatment can have — and is having — substantial effects on the rate of new infections, including in some of the world’s most HIV-burdened countries, as shown by recent data from Swaziland. The emergence of HIV drug resistance is a very real threat to these gains."