HIV/AIDS: No longer a death sentence?

Scientific breakthroughs have helped us chart an impressive course to the HIV/AIDS response such that in the fourth decade of the epidemic, we are already talking of ending AIDS. A death sentence at the outset, HIV is now a chronic disease. It is unique in the sense that vaccine for this communicable disease still eludes us and cure is yet not possible. Despite this, we have been able to not only control but have also managed to reverse the epidemic in large parts of the globe.

For us to reach this stage, contributions have come from a wide variety of stakeholders – national governments who have provided the leadership; funding agencies that spearheaded the response and needed research; development agencies including the UN that collaborated and joined forces to support countries in addressing the epidemic and last but not the least communities who continue to relentlessly fight for the right to affordable and equitable access to treatment and without whom we would not be where we are today.

Moving ahead, we need to ensure that the bio-medical response addresses both prevention and treatment. The division is now more blurred than ever with the scientific advances that have firmly positioned treatment as prevention. Starting treatment early not only improves quality and longevity for the infected individual but also prevents further transmission to partners.

With effective HIV control, we have been able to reduce the number of direct HIV related deaths and adverse outcomes. As people continue to live longer on antiretroviral treatment, not only do they face the common problems of aging like non-HIV population, they are at heightened risk of non-AIDS conditions such as heart disease due to persistent inflammation. These conditions, so far mostly studied in the U.S. and Europe are now becoming important in the developing world. These additional co-morbidities and the shift of HIV care to chronic disease management could overburden already stretched health care systems.

These could be addressed if we were to find a potent vaccine to prevent HIV and cure for HIV once infected. A number of cases, including the so-called "Berlin patient" the "Mississippi baby", and the "Visconti" cohort, have given us hope and impetus in our search for HIV cure. Our quest for a vaccine continues. However, realistically speaking, a scalable cure or a vaccine is not foreseen in the near future. Until, then, we must continue and enhance our efforts to ensure that health systems are prepared to safely and effectively deliver long-term chronic HIV and related care.

We must not forget that bio-medical interventions alone will not take us to the finish line. In order to achieve an AIDS free world; we need to blend the bio-medical and social-behavioural interventions that ensure universal access to prevention and care of HIV in a health and social system that respects human rights, sexual diversity and gender equity.

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Dr. Poonam Khetrapal Singh is the Regional Director – Elect of WHO South East Asia Region.