Why HIV/AIDS should matter

Based on the news that the HIV/AIDS pandemic has been halted and is beginning to reverse, it is easy to conclude that the disease no longer poses a health threat and could readily be dealt with on a country-by-country basis, using international organizations to distribute and monitor adherence to affordable antiretroviral medications. This conclusion may be reinforced by data showing that many of the people living with HIV reside in sub-Saharan Africa (25.0 million out of a global population of 35.3 million with HIV; 2012 estimates).  

Some Americans may also point to the low adult HIV prevalence (0.2% versus 4.7% in sub-Saharan Africa) in this country and declining fatalities as signs of treatment success and an opportunity to reduce financial aid to other countries showing similar successes. Alternatively, international organizations should be encouraged to work with local governments, thus enabling the US government to allocate more resources to non-AIDS-related, domestic health issues. However, is it appropriate to become complacent about HIV/AIDS in the United States and elsewhere? A closer examination of the numbers suggest that the answer is no. Only 25% of HIV-infected individuals in the USA have suppressed viral loads and only one in four people are able to reap full treatment benefits by successfully navigating the HIV care continuum. Moreover, the disease may be under-reported in this country, as the number of people with undiagnosed HIV is estimated to be one in six.

As the date for AIDS Walk New York approaches (May 18th), it is time to reflect on how each one of us could contribute to maintaining awareness about the disease and the effect each donation may have on the illness and quality of life of affected individuals (see AIDS Walk infographic). However, sustaining the fall in new HIV infections elsewhere, especially in sub-Saharan Africa, will require smarter investments and strategic efforts on the part of both individuals and organizations.

Moreover, while new HIV infections have declined by more than 50% in selected countries between 2001 and 2012, there are several reasons to avoid complacency:

·         The presence of dormant, undetectable amounts of HIV in cells may make it difficult to eradicate all vestiges of this rapidly-changing virus

·         An increase in the number of cases in different regions (e.g., New Jersey; HIV cases diagnosed among Hispanics in Florida increased by 76% between 1999 and 2008;  an estimated 12.2% of South Africans were infected with the virus in 2012; Ugandan HIV prevalence rates rose from 6.4% in 2005/6 to 7.2% in 2012)

·         Although the transformation of the disease into a chronic ailment is cause for celebration, HIV/AIDS remains expensive to treat (up to $402,000 discounted average lifetime costs depending on disease status). In addition, early diagnosis and effective treatment is important in order to improve quality-of-life estimates and reduce HIV transmissions

·         The prevalence of transmitted drug resistance in middle- and low-income countries is approximately 7% and up to 17% of newly infected patients in high-income countries carry at least one major drug-resistance mutation. The problem of drug resistance has not been solved and requires different strategies and ongoing monitoring (1).

Source

1.    Pennings PS. HIV Drug Resistance: Problems and Perspectives. Infect Dis Rep. 2013;5(Suppl 1):e5.