Map of life expectancy at birth from Global Education Project.

Monday, December 01, 2014

The end of HIV?

I don't know why we need to have single days when we're supposed to think about stuff we probably should be thinking about regularly (e.g., why do we have National Pickle Week when pickles matter all the time?) but for what it's worth, today is World AIDS Day.

The One Campaign (Bono's charity) says there's good news: we're at a "tipping point" in that the number of people newly receiving HIV treatment now exceeds the number of new infections. Furthermore, the global incidence of HIV has fallen by 40% since 2001. This is no doubt for a combination of reasons, including better awareness and changes in people's behavior, but one reason is that more people are in treatment. People who take their medications regularly and have suppressed viral loads are much less infectious, maybe even not at all.

But, I don't think this is really a tipping point. There are several problems with that rather glib assertion. The first is that just because people are enrolled in treatment and have a prescription doesn't necessarily mean that they are going to remain in treatment, and remain adherent to their medications. It is definitely not the case that the number of people with unsuppressed HIV viral loads is decreasing. The number of people enrolled in treatment would need to greatly exceed new infections, and adherence to treatment would need to be better, in order for that to happen.

The second problem is that the expansion of treatment may not be sustainable. The wealthy countries are reducing their financing for HIV treatment in poor countries, and the poor countries still can't afford it. Where there is civil conflict, as in some of the areas of Africa most afflicted, treatment rates may well decline. And, since there are more and more HIV infected people alive, the number of people we need to treat is still growing, even as resources are more constrained.

Finally, we are never going to eradicate HIV by treating people. Some people are always going to be out there undiagnosed for a while, and infecting others. The only likely way to eradicate the disease is to have a highly effective vaccine, and that still isn't in sight. Possibly a cure could do it eventually, in principle, but we can cure syphilis and  gonorrhea and they're still with us.

Alas, HIV is just part of our world now. It isn't going away.


friend said...

A friend of mine lived with HIV for a long time. He went on disability in the mid-1990's, stayed alive far longer than he expected with the treatments. But there was a toll. He suffered, emotionally and physically. And he died recently, suddenly, at 56.

He was lucky in that he lived in San Francisco, and had access to care, and lots of people adored and admired him. But he would have been luckier to never have had it in the first place.

Cervantes said...

Yes. It's not clear if it's drug side effects, or residual disease process, or some combination, but people on ARVs, even if they have suppressed viral loads, do seem to be at high risk for metabolic syndrome, diabetes, and atherosclerosis. So you can live with it a long time, but yeah, you're definitely better off without it.