World AIDS Day marks successes, progress and remaining challenges

Today, December 1, is World AIDS Day. This is a day to raise awareness about AIDS and reflect on those who have lost their lives to the virus. This year’s theme is “Let the Community Lead.” Networks of communities, key populations and youth leaders living and affected by HIV have been and will continue to be critical to progress in the HIV response.

HIV/AIDS has claimed 40.4 million lives, according to the World Health Organization (WHO), and the virus/AIDS continues to spread in all countries, with some countries reporting an increase in incidence rates following previous declines.1

It is also a moment to remember the first generation of people who contracted HIV and subsequently died, as well as the clinicians and public health officials who did their best in the absence of antiretroviral therapy (ART).

In officially proclaiming World AIDS Day, President Joe Biden reminded the nation of the tremendous toll this has taken. “I urge our nation and its federal and territorial governors, relevant officials from all branches of government, and the American people to join the HIV community in commemorating those who have died from AIDS and providing support, dignity and compassion to those living with HIV. .”2

Even today, millions of people do not receive consistent care. WHO reports that 9.2 million people globally do not have access to HIV treatment, 1,700 people die from HIV-related causes every day, and 3,500 people are infected, many of whom are unaware of their status or unable to access treatment.3

It is also a day to recognize progress, especially since medicine has been able to transform HIV/AIDS from a disease with high mortality to a treatable, chronic condition. With the advent of ART and PrEP, and new developments in treatment including long-acting injectables and other evolving modalities such as female HIV prevention rings, there is much to be thankful for.

Listed below are some of the latest developments related to HIV/AIDS.


legislative front

One area of ​​concern for people living with HIV involves insurance copays and drug coupons. Specifically, insurance companies have the right to refuse to count copay coupons or prescription drug rebates toward a patient’s deductible or out-of-pocket maximum. Some people rely on co-pay vouchers to pay for prescriptions, and for people living with HIV who need ART, this care option may make a difference.

Learn more about how one woman coped with her chronic health condition.

That defeat and a U.S. District Court ruling resulted in a major victory for patients who rely on prescription drugs.4 The court ruled that in most cases, insurers are required to count copay assistance toward a beneficiary’s out-of-pocket maximum, so it is illegal for insurers to effectively double-charge patients by pocketing the aid. . 5

However, two actions announced by the Biden administration may prevent people from receiving these benefits. The government would not implement the court’s ruling, and they appealed to the U.S. Court of Appeals for the D.C. Circuit.

The HIV+ Hepatitis Policy Institute, Diabetes Leadership Council and Diabetes Advocacy Alliance, which were plaintiffs in the case, issued a statement in response to the ruling. “We cannot understand why the Biden administration, which supports access and affordability of prescription drugs for the American people, would appeal this decision,” said Carl Schmid, executive director of the HIV+ Hepatitis Policy Institute.6


novel form

This week, the Population Council and IPM South Africa announced that the dapivirine vaginal ring (DVR), a product designed to help women reduce their risk of HIV infection, has received regulatory approval or been authorized through an import license and is available in the Middle East and Used in 11 countries in Africa. Southern Africa. HIV prevalence remains highest in Africa, particularly in the sub-Saharan region of the continent. According to the Population Council and IPM South Africa, the rings are currently being provided to women through more than 30 implementation and pilot studies across six countries: Swaziland, Kenya, Lesotho, South Africa, Uganda and Zimbabwe.7

“Women are bearing the brunt of the HIV/AIDS epidemic,” Jim Sailer, interim co-chair of the committee and executive director of the committee’s Biomedical Research Center, the nongovernmental organization spearheading the international rollout of DVRs, said in a statement. . “The virus is one of the greatest threats to women’s health and well-being. Every three minutes in sub-Saharan Africa, an adolescent girl or young woman is infected with HIV. If we don’t curb the HIV epidemic among women, we won’t Achieve the Sustainable Development Goal (SDG) to eliminate HIV by 2030. “Women should have options to protect themselves from this lifelong disease. “7

Research

In recent years, there have been new developments in ART and PrEP therapies, including long-acting injectables and making management and compliance with preventive measures more seamless.

Another consideration in HIV prevention is studying and addressing vulnerable populations. In Africa, women are at high risk for HIV infection, while globally another obvious group to consider is infants.

A new study finds that certain antibodies that cross the placenta are associated with improved survival in babies infected with HIV through breastfeeding.The study was published in Infectious Diseases Open Forum, Preexisting antibodies against a specific region of Env, a protein on the surface of HIV, are associated with a delay in HIV infection in infants exposed to the virus and with lower amounts of virus circulating in the blood of HIV-infected infants. Both conditions are known to help prolong the survival of HIV-infected infants.8

Env is also a key target for neutralizing antibodies by vaccine developers. In terms of vaccines, Moderna has developed 2 HIV vaccine strategies using germline targeting and immune-focused approaches. Earlier this year, Moderna announced two trials of these vaccines.

In January, Moderna announced the start of a Phase 1 trial of its IAVI G002 HIV vaccine. The companies are collaborating to test the HIV vaccine antigens mRNA-1644 and mRNA-1644v2-Core, sponsored by IAVI and supported by the Bill & Melinda Gates Foundation.

Another HIV vaccine trial is an open-label, multicenter, randomized study (HVTN 302) that will evaluate the safety and immunogenicity of its experimental HIV trimer mRNA vaccine (mRNA-1574). The trial is expected to enroll approximately 100 HIV-negative adults, aged 18 to 55 years.

To learn more about the challenges and progress being made with HIV vaccines, read an article published in Current magazine infect publication.


what’s left

The test of our progress is not whether we add more for those who have much; it is whether we provide enough for those who have little. ——Franklin D. Roosevelt

Roosevelt’s quote above can be broadly applied to both categories of people living with HIV. There are people who have health insurance, are receiving continuity of care, and have been able to reduce their HIV viral loads; there is a secondary group that may experience health disparities, including being limited to being uninsured and having viral loads that cannot be controlled.

For the former group, HIV/AIDS can be considered a chronic disease that requires HIV treatment, but it is a disease that can be lived with. For the latter group, they have an active virus that wreaks havoc on their health.

With days of advocacy like today’s, and broad initiatives like Ending the HIV Epidemic, HIV incidence can be reduced and further progress made in overall reductions.

refer to

1. HIV and AIDS. Quinn. Updated July 13, 2023. Accessed December 1, 2023. https://www.who.int/news-room/fact-sheets/detail/hiv-aids

2. Announcement of World AIDS Day 2023. White House press release. November 30, 2023. Accessed 1 December 2023. https://www.whitehouse.gov/briefing-room/presidential-actions/2023/11/30/a-proclamation-on-world-aids-day-2023/# :~:text=Now%2C%20Therefore %2C%20I%2C%20JOSEPH, 2023%2C%20as%20World%20AIDS%20Day.

3. WHO celebrates the role communities play in driving an end to AIDS. World Health Organization press release. November 29, 2023. Accessed: December 1, 2023. https://www.who.int/news/item/29-11-2023-who-celebrates-the-role-of-communities-in-driven-progress-towards-ending-aids

4. Copay assistance for medications must now be considered in most cases. HIV + HEP Policy Institute press release. October 2, 2023. Accessed 1 December 2023. https://hivhep.org/press-releases/court-strikes-down-hhs-rule-that-allowed-insurers-to-not-count-copay-assistance/

5. Copay Assistance 101. Oncolink. September 19, 2022. Accessed 1 December 2023. https://www.oncolink.org/support/insurance-legal-employment-financial-concerns/access-to-medications/co-pay-assistance-101

6. HIV+ Hepatitis Policy Institute, Diabetes Leadership Council, and Diabetes Advocacy Alliance Notify the court that it will defy the ruling and not force patients to obtain a victory press release. November 28, 2023. Accessed: December 1, 2023. https://hivhep.org/press-releases/us-government-appeals-drug-copay-assistance-court-ruling/

7. An innovative HIV prevention product that promotes women’s choice – the dapivirine vaginal ring (DVR) – is gaining momentum across Africa. Population Council Press Release. November 30, 2023. Accessed 1 December 2023. https://popcouncil.org/media/innovative-hiv-prevention-product-for-women-that-promotes-choice-dapivirine-vaginal-ring-dvr-gains-momentum-across-africa/

8. Yaffe, South Africa et al. Passive acquisition of constant region 5-specific antibodies is associated with improved survival in infants infected with human immunodeficiency virus. Open Forum on Infectious Diseases. DOI: 10.1093/ofid/ofad316 (2023).

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