World AIDS Day 2014:  Progress And Challenges Of Changing Patient Demographics

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When discussing AIDS, an image that comes to mind frequently is the dual masks that symbolize the theater—one laughing, one crying.  Because even though there are significant advances being made, there are still many reasons for concern and, for too many people, sorrow.

Thirty-nine million people have died from HIV/AIDS since 1981, and according to the World Health Organization, another 35 million are living with the disease. It is still the deadliest infectious disease in the world.  One reason for this, of course, is that the majority of people with HIV (an estimated 19 million people) don’t know they have the infection, so it can be spread unwittingly.

Effective treatments for HIV/AIDS have been both blessing and a curse in curbing the spread of the disease.  Antiviral treatments can keep people healthy and lower virus levels so that it is harder to transmit, but the fact that effective treatments have become available has led many people to a false sense of security—that even if they were to contract the virus, it can be treated.

So researchers and health officials are faced with a moving target in the treatment and prevention of HIV/AIDS.  The demographics of the disease have changed, both in terms of population groups being affected and by the fact that treatments have extended the lives of patients.

 

The New Faces of HIV/AIDS

From its origins in sub-Saharan Africa and its initial spread in the Western world through the gay and bisexual communities, HIV/AIDS has reached out to impact virtually all populations.  WHO estimates that 2.1 million people worldwide became infected with HIV in 2013, including more than 240,000 children—mostly in sub-Saharan Africa, who contracted the infection from their mothers during pregnancy, childbirth, or breastfeeding.  In the west, the gay/bisexual population is still at the highest risk, but infection through heterosexual contact is also a frequent method of transmission, especially with minority populations including African-Americans and Hispanics.  New infections in the U.S. have been stable for a number of years.

High profile cases such as Magic Johnson and others have helped to humanize HIV/AIDS patients, as has the fact that as patients live longer, more people come in contact with someone personally.  HIV still has a stigma, but it is diminished.

 

How Treatment Has Changed The Virus’ Impact

Earlier this year, we featured a guest blog by pre-eminent AIDS researcher Tom Folks, who recalled some of his early work to isolate and identify the virus.  This was a major step forward, but it started an era of frustration in treatment.  In the 1980s, a 20-year-old with HIV had a life expectancy of 12 years after diagnosis.  With the advent of Anti-Retroviral Therapy (ART), the life expectancy after diagnosis is now 49 years—comparable to non-infected individuals.  This is significant, but as significant is that ART therapies have been made available in lower- to middle-income countries where the majority of HIV-infected people live.  WHO reports that at the end of 2013, 12.9 million people were receiving ART globally, with 11.7 million of those living in low to middle income countries.

That’s very promising, but it still means three of five people living with HIV are not getting the most effective treatments.

 

New Treatments On The Horizon

Treatments for HIV/AIDS have progressed on many fronts, although two events in 2014 have had a negative impact.  The rise of Ebola has drawn attention away from HIV, and when Malaysian Airlines Flight 17 was shot down over the Ukraine, some of the worlds best AIDS researchers were among the victims.  Yet there were numerous projects that offer encouragement:

  • New ways of preventing mother-to-child transfer.  This issue has been virtually eliminated in first world countries, but is still a big problem worldwide.  New drug combinations may help.
  • Education about circumcision, which could reduce infection rates in Africa in particular.
  • Broadly neutralizing antibodies (BNAs), which can suppress more than one strain of the virus.
  • Vaccine therapies, which may either prevent the body from contracting the virus, or have the immune system ignore the virus, preventing its breakdown
  • Gene therapies, which may render the virus harmless.
  • A new focus on preventative education, to make people aware that the infection is still there—and still deadly.

The HIV/AIDS problem worldwide is still huge, but there are more reasons now to focus on the smiling mask rather than tragic one.

What do you want to build today?