By Scott Dryden-Peterson
The 2000 International AIDS Conference in Durban was a watershed moment. Prevailing opinion turned from thinking that it was impossible to treat AIDS in Africa to believing that it was impossible and immoral not to try. Nelson Mandela, who had stepped down as president of South Africa in 1999, closed the meeting. “Let us not equivocate. A tragedy of unprecedented proportion is unfolding in Africa,” he said. “Let us combine our efforts to ensure a future for our children. The challenge is no less.”
As the AIDS conference returned to Durban last week, that challenge has indeed been confronted collectively and 12.1 million Africans are now receiving antiretroviral therapy. Rate of new infections has fallen and mortality from HIV/AIDS has plummeted.
Below are five important studies presented at last week’s meeting that provide optimism that we can address continued large gaps in prevention and treatment:
- The SEARCH community-based HIV testing and linkage to ART project in Uganda and Kenya was able to exceed UNAIDS 90-90-90 targets. Importantly, coverage was assessed only in those identified at baseline, so may overestimate population performance. However, impressive results nonetheless. Video, Session
- Patients in Haiti randomized to start ART on the same day they received their positive HIV test results were more likely to start ART, be retained in care 12 months later, and have a suppressed viral load. Same day ART halved the risk of death compared with starting ART three weeks later after adherence readiness activities. Video, Session
- Early deaths are common with ART initiation for patients with advanced AIDS. Patients with very low CD4 count (<50) randomized to receive expanded prophylactic/pre-emptive antimicrobial therapy (cotrimoxazole, isoniazid, fluconazole, azithromycin, and albendazole) were 25% less likely to die than those receiving standard care. Abstract
- Instead of the UNAIDS 90-90-90 targets, perhaps we should be focused on the 10-10-10—those people with HIV and unsuppressed viral load. Using population data from 26 districts in South Africa, investigators documented that an approach targeting resources towards regions with high HIV prevalence would miss many of the areas of highest risk of transmission (those with highest prevalence of unsuppressed HIV loads). Abstract
- Risk of HIV transmission from a partner whose viral load has been successfully suppressed on ART is exceedingly low—perhaps zero. No genetically linked HIV transmissions have occurred in the PARTNER study of European couples. Estimates are that it would take on average a minimum 300 years of condomless vaginal sex or 130 years of condomless anal sex for one transmission to occur. Session, JAMA article
Also hopeful is the surge of research led by investigators from low- and middle-income countries, including many scientists from the Botswana Harvard AIDS Institute Partnership, whose contributions are listed here: Botswana Harvard Research at AIDS 2016
Title Image: Opening session of the 21st International AIDS Conference at the Durban International Convention Centre. Photo courtesy of Flickr