World AIDS Day 2016: Is an End to The HIV/AIDS Pandemic in Sight?

A total 36.7 million individuals around the globe are living with HIV/AIDS and the disease has caused over 35 million deaths. Today (December 1, 2016) marks the 35th anniversary of the first reports that were published on HIV/AIDS and it is on this, World AIDS Day, that researchers come together to reflect on all of the advancements that have been made in the fight against the disease and identify what needs to be done next. The goal? To put an end to the HIV/AIDS epidemic.

In honor of World AIDS Day, the National Institutes of Health (NIH) released a statement to the public to showcase a number of recent achievements and explain future research goals. According to the NIH, one of the biggest successes lies in the different treatment options that have been developed and refined over the years, namely antiretroviral therapy (ART). This therapy simultaneously works to reduce transmission of the virus to others, as well as suppress the virus so that those who are infected can live longer lives.

According to the NIH, “Antiretroviral has been transformational for both individuals and communities. Large studies conducted in diverse settings, from US cities to African villages, have demonstrated the power of treatment to preserve the health of those living with HIV.”

By taking a prescribed daily ART regimen, or combination of HIV-fighting medicines, the therapy works to cut down the amount of the virus that is inhabiting an infected individual’s body. With less virus in the body, the individual’s immune system has more of an opportunity to regroup and continue to fight off different infections and cancers that HIV-infected individuals are more susceptible to contracting as a result of their infection, according to the US Department of Health and Human Services.

The NIH notes that research has shown that the more testing that is done for HIV, the more people learn about opportunities for treatment and support in fighting the virus if they are infected or become infected. According to the NIH, “The power of treatment as prevention cannot be underestimated in helping to achieve global targets to dramatically reduce new infections and improve the health of those already living with HIV.” Testing and treatment are especially important for those who are at higher risk of infection, such as men who have sex with men (MSM). In a past Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention (CDC), researchers examined HIV incidence surveillance data to see if MSM were completing routine testing. The researchers found that more MSM were going for testing, but many were not adhering to treatments that were provided due to a number of unmet ancillary needs, such as proper food/nutrition, access to mental health care, and a need for transportation assistance, among others. The CDC continues to address these unmet needs in at-risk populations.

Although an arsenal of preventive tools have already proven to be effective in the fight against the virus thus far—antiretroviral therapy, condoms, lubricants, voluntary male circumcision, pre-exposure prophylaxis—researchers are constantly working towards the development of new, innovative ways of infection prevention. The first new HIV vaccine efficacy study in seven years, dubbed HVTN 702, was recently launched by the NIH in South Africa. Enrollment started on October 26 in an area where 3,700 people are infected with HIV each day. The researchers are currently studying whether a vaccine regimen can effectively provide adults with adequate protection against the virus.

Another prevention effort, titled the Antibody-Mediated Prevention Trial (AMP), was launched by the NIH back in April. This effort consisted of administering broadly neutralizing antibodies to individuals intravenously to see if the antibodies could provide them with adequate HIV protection. The researchers hopes that the on-going trial will yield findings that can be used to inform future HIV prevention efforts as well as vaccine developments.

Research efforts continue to be aimed at helping those populations at highest risk of infection. One such population is the population of women. A total of 16.1 million women worldwide are estimated to be HIV-positive and millions more are at risk of infection. When it comes to targeting the needs of women worldwide, the NIH has made strides through testing of the dapivirine-infused vaginal ring, developed by International Partnership for Microbicides (IPM), which proved successful in reducing the risk of infection by 27% in its Phase III study. (A parallel Phase III efficacy study conducted by IPM showed 31% efficacy.) The NIH noted that adherence to the ring may actually increase its effectiveness. Two studies launched in July will continue to explore this idea and investigate obstacles or complications that may prevent women from adhering to the ring.

Efforts are also being made to address underserved populations and those not routinely studied, such as pregnant women. Studies such as the PROMISE study, addressed ways to prevent transmission of the virus from mother-to-infant throughout the entire timeline of pregnancy, birth, and breastfeeding and found that by taking a three-drug HIV regimen while breastfeeding, HIV-positive mothers were actually able to prevent transmission to their infants.

Another issue being addressed is the fact that those who are living with HIV are developing more chronic infections than those who are not infected by the virus. In the REPRIEVE study, researchers are currently taking the clinical trial to an international scale, and are looking at whether or not a statin drug can prevent HIV-positive individuals from developing heart disease.

Researchers have also put their efforts into preventing viral rebound after infected individuals finish antiretroviral therapy. According to the NIH, researchers made headway in this goal with an animal study that was conducted in October. “An antibody directed against a cell surface marker involved in the homing of lymphocytes to the gut given together with antiretroviral therapy for 5 weeks in monkeys infected with a monkey version of HIV led to a sustained suppression of viral rebound for up to 2 years following discontinuation of all therapy.” Another study is now in the works which is aimed at further exploring how this strategy can be translated to HIV-infected humans.

All of these efforts have made researchers around the world optimistic that the HIV pandemic can be brought to an end. With researchers making a number of different advancements every day, they are learning more and more about a virus that has claimed an overwhelming number of lives. Equipped with an arsenal of knowledge, researchers may finally be able to put a end to it.