Fauci: Can’t call ‘Timeout’ on HIV pandemic despite Covid, Monkeypox

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MONTREAL, August 8 – Dr. Anthony Fauci, one of the world’s top virologists and director of the US National Institute of Allergy and Infectious Diseases (NIAID), has called for a refocus on HIV/AIDS, fearing that progress in the treatment of AIDS has stalled since Covid hit.

The Covid-19 pandemic has undermined the HIV/AIDS response on all fronts, with declining HIV testing and prevention services – such as harm reduction services for people who use drugs – facing disruption in many countries, Dr. Fauci said.

Data from the United States Centers for Disease Control and Prevention (CDC) showed a 17% drop in HIV diagnoses in the United States and dependent regions in 2020, down to 30,635 people, partly due disruptions in clinical care services and shortages of HIV testing during the Covid-19 pandemic.

Fewer HIV-positive people started antiretroviral treatment (ART) in 40 of 50 countries in 2020, while harm reduction services for people who use drugs were interrupted in two-thirds of 130 countries in the same year, said the Dr Fauci, quoting the UN Secretary. – General’s report in May.

“We need to put HIV/AIDS back on the radar screen of the public health community at all levels, despite the fact that we are going through simultaneous epidemics of a historic pandemic with Covid and the emerging epidemic of monkeypox,” Dr. Fauci said at the 24th International AIDS Conference (AIDS 2022) in Montreal, Canada, on July 31.

The HIV treatment gap remains large globally, with 9.7 million people living with HIV still not on ART, despite data showing a dramatic decline in AIDS deaths worldwide with a increasing ART coverage over the past two decades. About 38.4 million people were living with HIV as of last year.

Dr Fauci said advances in ART have also allowed many HIV-infected adults to have “near-normal” lifespans.

In addition to getting people on treatment, there are also treatment gaps in adherence to ART – which is essential for suppressing viral load and achieving optimal HIV care.

Dr. Anthony Fauci, Director of the US National Institute of Allergy and Infectious Diseases (NIAID), highlighting the results of a study on actual adherence to antiretroviral therapy (ART) in more than 206,000 HIV-positive people in the United States, at the 24th International AIDS Conference (AIDS 2022) on July 31, 2022 in Montreal, Canada.

A study of real-world ART adherence in more than 206,000 HIV-positive people in the United States showed that 42.5% of participants had poor ART adherence, Dr. Fauci said.

“These are US statistics, but in many ways there are variations across the world.

“If you look at the dark blue, bottom left, the optimal compliance, meaning the percentage of days covered above 90%, is below 39%. People with suboptimal but reasonable adherence, between 80 and less than 90%, are considered at around less than 19%.

“But look at the red slice of the pie for membership where the percentage of days covered is less than 80%. That’s almost half of those in the United States, a developed country,” Dr. Fauci said.

Besides treatment, access to preventive tools such as pre-exposure prophylaxis (PrEP), a highly effective drug that can reduce the risk of contracting HIV, remains uneven.

Truvada, one of the leading brands of PreP, was the first drug approved by the United States Food and Drug Authority (FDA) that reduces the risk of sexually acquired HIV infection. According to the CDC, PrEP reduces the risk of contracting HIV through sex by 99% and injection drug use by at least 74%.

“So we know it’s a fact. But going back to the balance between implementation and discovery, the cumulative number of PrEP initiations, although it has increased significantly to about 2.8 million, is the good news.

“But the sobering and somewhat distressing news is that the global need is measured in the tens of millions, far more than we are doing,” Dr Fauci said, citing data from PrePWatch.

U=U: Undetectable = Untransmittable

Protesters from the U=U (“Undetectable equals Untransmittable”) movement on stage before the start of the “HIV in 2022 and Beyond: A View from NIAID” session during the 24th International AIDS Conference (AIDS 2022) on July 31, 2022 in Montreal, Canada. Photo by Marcus Rose/ IAS.

Earlier in the session, protesters from the U=U (“Undetectable = Untransmittable”) movement took center stage in a rallying cry for more investment in people living with HIV.

“I=U”, a short phrase used by HIV researchers and advocates, is an affirmation of clinical evidence that people living with HIV, who respond to antiretroviral drugs and achieve an “undetectable” viral load (the amount of HIV in the blood), cannot sexually transmit the virus to other people.

In other words, ART is HIV treatment that is also prevention.

“We are tired of your excuses. We are tired of your bullshit. We know as people living with HIV that we are the best tool to end HIV. Today we call on governments, policymakers and donors to invest in people living with HIV,” said Michael Ighodaro, a Nigerian activist and advocate for LGBTQ rights and HIV prevention.

“We know that when you invest in us we can achieve U=U, and when we achieve U=U there will be a drastic reduction in new infections, and that means we can end HIV.

“It’s not just a personal benefit for us. It’s a public health benefit, it’s an economic benefit. Invest in people living with HIV and end HIV today,” said Ighodaro.

Global efforts to tackle HIV in 2022 and beyond should not only cover implementation gaps, such as access to testing and PrEP, as well as adherence to ART, Dr Fauci said , but also the development and delivery of improved treatment and prevention interventions.

He cited recent advances in the development of long-acting ARTs that allow HIV drugs to be consumed over longer intervals instead of daily and ongoing studies on the use of antibodies widely. neutralizers (bNAb) against HIV.

“To me, it’s unconscionable for us now – because we face so many other challenges – to slow down everything we do with HIV. In fact, we need to accelerate what we are doing with HIV,” Dr. Fauci said.

“Treat simultaneously, as I do every day, Covid, monkeypox and HIV, we can do all three at the same time. This idea that one is in competition with the other is understandable, but not acceptable. We must put all our forces on all three at the same time.

He added: “Remember this (HIV/AIDS) is a 40-year pandemic, and this cannot be a timeout. You don’t call a timeout on a pandemic and say “come back next year”.

“You have to keep going with all your might to keep fixing it, and that’s what saddens me is when the supply chains stopped, when the testing stopped, when the TB work (TB) stopped – it was something that was really painful.

“We have to get back on track. »

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