While AIDS has claimed the lives of approximately 40 million people over the last few decades, the expanded availability of effective treatments and prophylaxis has slashed the annual death toll by two-thirds, saving tens of millions of lives. Additional work to expand testing and treatment could turn the tide against HIV infection itself.
A report in The Economist states that there are approximately 39 million people in the world infected by HIV, which, untreated, causes AIDS. More than half of those people live in Africa. Because there is currently no cure, everyone with HIV requires lifelong antiviral treatment.
Fortunately, programs like the US’s PEPFAR “President’s Emergency Plan for AIDS Relief” (initiated by President George W. Bush, and set to expire on September 30 if not extended) have successfully made such treatment broadly available, through contributions of antiviral medications.
UNAIDS sets a goal of “95-95-95": 95% of those with the virus know they are infected, 95% of those who know they are infected receive treatment, and 95% of those receiving treatment succeed in suppressing the virus to undetectable levels (which means they are extremely unlikely to spread the virus to others). Progress towards this figure continues. From figures of 71-48-40 in 2015, the levels reached 86-76-71 in 2022.
To boost the level of protection, expanded testing and treatment of currently under-treated groups, such as men and young women and girls, is necessary.
One significant tool could be long-lasting prophylaxis. Pre-Exposure Prophylaxis (PrEP) by drugs such as Truvada reduce an individual’s chances of becoming infected by around 99%. But it must be taken every day. Development of longer-lasting antivirals is underway. For example, Viiv’s two-month injection will be available to PEPFAR in October, and Gilead is testing the antiviral drug lenacapvir on a dosing schedule as extended as once every six months.
By reducing the level of new infections (currently estimated at over 1 million per year), health will significantly improve, and the need for treatments will decline.
New treatments and expanding the quality of healthcare delivery will play a big role in improving health. Already, life expectancy across sub-Saharan nations has increased by 17% from 2001 to 2019. In particularly hard-hit countries, the improvements have been even greater: Zimbabwe and Eswatini, which had life expectancies over 60 before AIDS and saw life expectancy plummet to the low 40s in the early 2000s, had again achieved a life expectancy of 60 by 2019.
(This report from The Economist came just in time for Biden to refer to the success of PEPFAR at the UN General Assembly.)
