Progress against the HIV Epidemic: is the end in sight? Christine Hughes, BscPharm, PharmD, FCSHP Professor, Faculty of Pharmacy & Pharmaceutical Sciences University of Alberta Clinical Pharmacist, Northern Alberta HIV Program GANG meeting, September 29, 2018
Outline What is HIV? Global impact of HIV Treatment of HIV in 2018 (in Africa and around the world) UNAIDS goals and progress Ongoing challenges to end the epidemic
What is HIV? HIV = human immunodeficiency virus Virus recognized in early 1980 s Targets and destroys CD4 (helper) immune cells End result: immune suppression can lead to infections or infectionrelated cancers
How is HIV transmitted?
GLOBAL IMPACT OF HIV
Adults and children estimated to be living with HIV 2016 North America and western and central Europe 2.1 million [2.0 million 2.3 million] Eastern Europe and central Asia 1.6 million [1.4 million 1.7 million] Caribbean 310 000 [280 000 350 000] Latin America 1.8 million [1.4 million 2.1 million] Middle East and North Africa 230 000 [160 000 380 000] Western and central Africa 6.1 million [4.9 million 7.6 million] Eastern and southern Africa 19.4 million [17.8 million 21.1 million] Asia and the Pacific 5.1 million [3.9 million 7.2 million] Total: 36.7 million [30.8 million 42.9 million] www.unaids.org
Global summary of the AIDS epidemic 2016 Number of people living with HIV Total Adults Women (15+ years) Children (<15 years) 36.7 million [30.8 million 42.9 million] 34.5 million [28.8 million 40.2 million] 17.8 million [15.4 million 20.3 million] 2.1 million [1.7 million 2.6 million] People newly infected with HIV in 2016 Total Adults Children (<15 years) 1.8 million [1.6 million 2.1 million] 1.7 million [1.4 million 1.9 million] 160 000 [100 000 220 000] AIDS-related deaths in 2016 Total Adults Children (<15 years) 1.0 million [830 000 1.2 million] 890 000 [740 000 1.1 million] 120 000 [79 000 160 000]
Populations most impacted by HIV differ considerably around the world and even in different regions within a country (e.g. Canada)
Newsweek December 2, 1996
Mid 1990 s: 3 Drug Combination ART introduced Zidovudine/Lamivudine/Indinavir 8AM 4PM 12 MID Fasting (1 hour before/2 hours after meals)1.5 liters of hydration/day
HIV TREATMENT TODAY
HIV TREATMENT in 2018 > 25 licensed antiretroviral (ARV) drugs used in combinations of at least 3 agents regimens are simpler and well tolerated No cure for HIV and no vaccine Goal: suppress virus replication life expectancy of people with HIV approaching near normal
TARGETS TO END HIV/AIDS AS A PUBLIC HEALTH THREAT BY 2030
Prevention is Key People at risk of HIV infection have access to comprehensive HIV prevention services Condoms, pre exposure HIV prophylaxis, clean needles/syringes etc
Not just medical interventions Remove policy barriers to access prevention services Eliminate gender inequalities and end all forms of violence and discrimination against women and girls, people living with HIV and key populations
Reducing stigma Undetectable = Untransmittable People who take antiretroviral therapy daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV negative partner. (Reference: CDC)
PROGRESS IN REACHING UNAIDS TARGETS: ARE WE THERE YET?
Percent change in new HIV infections since 2010 18 %
Ongoing Challenges the road ahead Shortfalls in HIV Funding Contributing to inability to achieve UNAIDS goals Focus on treatment impacts funding for other prevention efforts
Ongoing Challenges the road ahead Prevention of HIV transmission concentration of the epidemic in marginalized populations little progress in reducing number of new infections (including in Canada) strong relationship to social determinants of health, stigma etc
Ongoing Challenges the road ahead Earlier identification of HIV infection WHO has recommended since 2015 that people with HIV start antiretroviral therapy as soon as possible Improves individual health and reduces transmission
Ongoing Challenges the road ahead Ability to achieve treatment success Goal is undetectable viral load requires high level of treatment adherence Addictions, mental health, stigma, poverty, access to care and treatment impact ability to achieve treatment success
We live in a completely interdependent world, which simply means we can not escape each other. How we respond to AIDS depends, in part, on whether we understand this interdependence. It is not someone else's problem. This is everybody's problem. Bill Clinton
THANK YOU FOR THE IMPORTANT WORK THAT YOU DO!