As the World Health Organisation unveils its ambitious plan to end the AIDS epidemic completely by 2030, we discuss the path that HIV has ravaged throughout the last several decades of human history, and why hope is now finally on the horizon.
In the newly emerging capital of the Democratic Republic of Congo in the 1920s, a hunter kills and eats a chimpanzee infected with Simian Immunodeficiency Virus (SIV), allowing the virus to pass onto him.This is not a rare occurrence; such a type of lentivirus that is able to attack the immune system of monkeys and apes has been found in no fewer than 36 primate species in sub-Saharan Africa. Yet on this single occasion the virus begins to adapt to its new host, evolving to enter and replicate inside human T-Cells, and eventually cause a shutdown of the immune system.The hunter most likely dies of a minor infection and the first case of human immunodeficiency virus announces itself.
In the years that followed no one could have predicted the epidemic that was about to unfold. Extensive transport links and a growing sex trade pushed HIV beyond the confines of the capital, allowing a specific B subtype of the HIV-1 strain to reach Haiti by the 1960s and spread rapidly from there.This variant of HIV spread uncontrollably across the globe, dominating regardless of geographical variation; it has laid claim to 75 million infections to date. However it wasn’t until 1981, when reports of rare cancers and opportunistic infections began to crop up amongst gay men in New York and California, that the medical community began to focus on the infectious disease that had triggered these unexpected occurrences.
After decades of research, funding and the perseverance of countless individuals, HIV is no longer the death sentence it once was. Following the success of anti-retroviral therapy (ART), HIV viral levels can be suppressed to such an extent as to allow the patient’s own immune system to strengthen and regain the capacity to fight off other infections.
Now focus has switched to a different concept: treatment as prevention. New research suggests that if the viral load can be reduced to undetectable levels using ART, it is nearly impossible to pass HIV onto another individual. A vaccine, once deemed unachievable due to HIV’s ability to evade detection and its rapid mutation rate, is now in the making.This is thanks to antibodies collected from HIV-infected patients, particularly those who seem to have an innate resistance against disease progression to AIDS.
These breakthroughs have slowed the trajectory of AIDS, but unless we aim to halt the epidemic in the next five years we risk resurgence; as the increasing number of cases become harder to contain, the long-term need for HIV treatment increases, and costs begin to snowball. If the epidemic is to be stopped completely, a rapid scale-up needs to be reached by 2020. The aim is to diagnose 90% of all people infected with HIV, start 90% of these patients on ART, and suppress viral load to undetectable levels in 90% of the treated group. This ambitious “90-90-90” target puts us in the fast lane to ending the AIDS epidemic in the next decade.This would mean 28 million HIV infections and 21 million deaths averted by 2030. From an economic perspective, the return is expected to be 15-fold and US $24 billion would be saved in costs.
Yet the journey towards achieving these statistics won’t be easy. Countries will need to maximise their capacity to diagnose, treat and reduce costs whilst expanding scale. International assistance is essential; without global funding those countries hit the worst by AIDS will continue to suffer disproportionately. Innovation is still required to create more effective and long-term medication for both treatment and prophylaxis, and in order to truly end the AIDS epidemic a vaccine and a cure need to be delivered. None of this is possible unless international relations strengthen, and research and resources are shared. Now, more than ever, it is vital that the international community recognises that ending the AIDS epidemic is a global obligation with global benefits.
There can be no doubt that we have come a remarkable way since our first encounter with HIV. The obstacles that we still face should not detract from our triumphs in the prevention and treatment of a virus that has single-handedly challenged the development of entire countries and shaped the face of scientific research.
Faced with an enormous task such as this, it can be easy to overlook the power of the individual in the fight against AIDS.Yet every contribution, no matter how small, is one step closer to ending this chapter in human history.
If you’d like to join our fantastic team at UCLYouth Stop AIDS, we welcome you to come along to our Freshers’ Fayre stand and participate in Positively Red Week in the upcoming term.
by Camilla Massardi