Tremendous strides have been made in both treatment and prevention of AIDS and it is no longer among the 10 leading causes of death globally, however an estimated 39 million people were living with the disease globally in 2022. HIV treatments has become more manageable and are reaching more patients than ever before, yet huge geographic disparities, stigma issues and blind spots, such as the prevalence of non-communicable diseases arising from AIDS, remain.
HIV remains, despite available options, a global health issue that needs to remain high on the agenda
Bettina Bauer, VP of the global commercial product strategy, HIV, COVID-19 & emerging viruses, Gilead Sciences
“So much progress has been made in the last 35 years,” says Bettina Bauer, VP of the global commercial product strategy, HIV, COVID-19 & emerging viruses at Gilead Sciences, a company that has been working on HIV throughout those years.
According to UNAIDS, the joint United Nations Programme on HIV and AIDS, an estimated 76 percent of all people living with HIV accessed antiretroviral therapy (ART) in 2022 and for Ms Bauer, treatments have become more effective and more widespread. “There are an estimated 6 million people 50 years and older living with HIV globally. This is a positive consequence of improvements in HIV treatments and increasing rates of treatment uptake.”
“AIDS has become a medically manageable chronic condition that is no longer among the 10 leading causes of death globally,” Lenias Hwenda of Medicines for Africa confirms. Global AIDS-related deaths have in effect been reduced by 69 percent since 2004.
However, AIDS has by no means been eradicated and a number of issues around access persist. “HIV remains, despite available options, a global health issue that needs to remain high on the agenda,” Bauer confirmed. “There are many things still to be done to contribute to the overarching goal of ending the epidemic for everyone, everywhere,” she said. “What makes me frustrated is that even in developed countries, so many people do not have access and there are still many underserved patients and populations.”
No Cure or Vaccine
Treatment options have greatly improved and living with AIDS has become more manageable. “Nowadays, the question is not survival, but how to bring patients a better quality of life. That is the aim of the kind of innovations we are bringing forward now,” says Vítor Papão, GM, Gilead Sciences Middle East & Russia. “These innovations include reducing the pill burden to a single tablet regimen administered on a daily basis and long-acting antivirals that do not need to be administered every day.”
The number of people who newly acquire HIV has also progressively declined over the years. However, there is still no cure for AIDS. “Even though antiretroviral treatments have significantly improved the life expectancy and quality of life for people living with HIV, without a cure for HIV, preventing infection remains our best public health tool for limiting this epidemic,” says Ms Hwenda.
Testing is a key component to prevention. While about 86 percent of people with HIV knew their status in 2022, according to UNAIDS 14 percent, or about 5.5. million people, did not know they had HIV and still did not have access to HIV testing.
Moreover, there is currently no available AIDS vaccine and because of HIV’s unique characteristics such as its rapid replication and mutation, typical vaccine approaches tend to fail. Yet both big pharma and biotech companies continue their efforts to advance AIDS vaccine candidates using novel approaches. In 2022 IAVI and Moderna began clinical trials for an mRNA HIV vaccine antigen, yet other companies, like Janssen, have abandoned their candidates after disappointing trial readouts. “HIV vaccine development comes with a lot of risk,” said then global therapeutic area head of infectious diseases and vaccines, Johan Van Hoof, in a 2021 interview.
Of the world’s estimated 39 million people living with AIDS, Eastern and Southern Africa account for 20.8 million. “We do recognise that the greatest need for HIV treatment is in low- and middle-income countries,” states Bauer. “We put innovative programmes and partnerships in place to expand global access to our medicines, and advance global health equity.”
In Bauer’s view, Gilead’s efforts to license its intellectual property to generic drug manufacturers to sell versions of their HIV medicines in resource-limited countries are contributing to improving access. “In 2011, Gilead became the first pharmaceutical company to join the Medicines Patent Pool,” she asserts. “By 2021, HIV medicines were made available to an estimated 16.5 million people living with HIV in resource-limited countries around the world through organisations that benefited from licensing agreements with Gilead.”
Stigma around AIDS and HIV infection is another issue that does not facilitate treatment, even in developed countries. The Terrence Higgins Trust, the UK’s leading HIV and sexual health charity, found that 74 percent of people living with HIV in the UK have experienced stigma or discrimination due to their status. “For HIV in general, there is a culture of not speaking up,” says Dustin Haines, Gilead’s VP & GM for Asia, Turkey, Middle East.
For Mr Haines, partnering with community groups represent an effective way to address the issue. “We must create a space where people can safely have conversations and come together to be open and share their experiences. Community groups are trying to fix the problems and fill gaps, and we see ourselves as a valuable partner to help them bridge these gaps more effectively.”
“Medications are only one piece of the puzzle, especially if you think about stigma, discrimination, and the reasons why people do not have access or use all of the options available to them,” Bauer agrees.
Although AIDS mortality has decreased, higher rates of non-communicable diseases among people living with HIV have contributed to their persisting mortality. “Antiretroviral therapy (ART) for HIV enables people living with HIV to lead long and productive lives. However, they are now becoming susceptible to NCDs in later life,” reads a report on NCDs from UNAIDS.
The impact of NCSs is particularly notable in low and middle income countries (LMICs). According to UNAIDS, the four NCDs that account for the greatest number of comorbidities among people living with HIV in LMICs are cardiovascular diseases (CVD), cervical cancer, depression, and diabetes. The risk of cervical cancer, for example, among women living with HIV is five time higher than that of women who do not have HIV.
HIV gains are not being fully realised because health systems neglect non-communicable diseases (NCDs) which subsequently take the lives saved by HIV/AIDS programs
Lenias Hwenda, Medicines for Africa
“Billions of dollars have been invested in saving millions of lives from HIV/AIDS. The success is however clouded by the fact that long-term HIV/AIDS survivors are increasingly losing their lives to unmanaged non-communicable diseases,” says Hwenda. “At a population level, HIV gains are not being fully realised because health systems neglect non-communicable diseases (NCDs) which subsequently take the lives saved by HIV/AIDS programs.”
Hwenda argues that a single disease focus is no longer valid and that countries and international institutions need to look at the overall healthcare picture. “HIV programs are no longer meeting the medical needs that people living with HIV have today,” she claims. “It is necessary to evaluate whether investing billions of dollars to save lives from a single disease whilst several other chronic conditions that are equally likely to take the lives saved are left unaddressed is still a compelling value proposition.”