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Nearly four decades after the first diagnosis, the fight to treat HIV/AIDs continues.
Health organizations, medical professionals, caregivers, and patients mark World AIDs Day-Dec. 1, 2019-to increase awareness of this decades-long public health concern. While current statistics demonstrate that progress has been made in the diagnosis, prevention, and treatment of human immunodeficiency virus (HIV)-related illnesses, the toll the virus has taken on the world population-an estimated 32 million deaths-is still profound.
The World Health Organization (WHO) estimates that, at the end of 2018, 37.8 million people globally were living with HIV. Of those infected, 79% had been diagnosed, 62% received treatment, and 53% had achieved suppression of the HIV virus (1). The research and development efforts of the bio/pharmaceutical scientists were instrumental in this progress in combatting the virus.
The first AIDS cases were diagnosed in the United States in 1981. In 1987, FDA approved the first therapy against the disease, azidothymidine, a nucleoside reverse transcriptase inhibitor (NRTI) originally developed to treat cancer. Drug-resistant variations of the virus necessitated the development of other antiretroviral drug classes including fixed-dose combination drugs. In 2018, the first biologic treatment, ibalizumab, was approved (2). Currently, FDA lists 131 approved drugs for HIV/AIDS and related infections (3).
Research continues today on antiretrovirals to treat HIV, prophylaxis drugs for HIV-negative people at risk for HIV, and vaccines to prevent HIV or provide a cure for those living with HIV. FDA lists 34 investigational drugs for HIV/AIDS and related infections (3).
While diagnostic tools and therapies have helped make HIV a chronic condition, not a death sentence, for many infected patients, there are gaps in treatments across populations. In a statement to mark World AIDs Day, the National Institutes of Health (NIH) reported that approximately 38,000 people in the US were diagnosed with HIV in 2018; and while the rate of HIV incidence has declined significantly from a peak in the 1990s, progress on further reducing that rate has stalled (4).
Ending the HIV Epidemic: A Plan for America is a Department of Health and Human Services initiative to reduce the incidence of HIV domestically by 75% in five years, and by 90% by 2030. Under this initiative, NIH plans to fund HIV prevention, diagnosis, treatment, and care efforts and will expand partnerships with agencies, community organizations, health departments, and other organizations to determine the best implementation of research advances.
In particular, NIH noted that these efforts will “ensure that hardly reached communities-including the transgender, black, gay, injection drug, and sex worker communities-benefit from these strategies.” Other challenges faced by those vulnerable to HIV-“housing and food insecurity; lack of healthcare access; and pervasive stigma, discrimination, and criminalization” must also be addressed, NIH reported (4).
On a global scale, WHO reports that in 2018, 62% of adults and 54% of children living with HIV in low- and middle-income countries were receiving lifelong antiretroviral therapy; however, there were 1.7 million new infections in 2018 and 770,000 people died from HIV-related causes (1).
Of note, NIH and the Bill & Melinda Gates Foundation recently announced investments of $100 million over four years to develop affordable, gene-based cures for sickle cell disease and HIV (5), an example of the ongoing efforts to help those afflicted-and eradicate additional infections-that deserves year-round attention.
1. WHO, HIV/AIDs, www.who.int, accessed Nov. 25, 2019.
2. NIH, Antiretroviral Drug Discovery and Development, www.niaid.nih.gov.
3. NIH, AIDsInfo, aidsinfo.nih.gov, accessed Nov. 25, 2019.
4. NIH, “NIH Statement on World AIDS Day 2019,” Press Release, Nov 25, 2019.
5. NIH, “NIH Launches New Collaboration to Develop Gene-Based Cures for Sickle Cell Disease and HIV on Global Scale,” Press Release, Oct. 23, 2019.
Vol. 43, No. 12
When referring to this article, please cite it as R. Peters, “Fighting the Good Fight," Pharmaceutical Technology 43 (12) 2019.