Trying to eradicate HIV from all parts of the body has been "devilishly difficult," says the president of the International AIDS Society (IAS).
But encouraging developments in therapy and prevention were among the good-news stories coming out of the eighth international HIV/AIDS conference as the four-day meeting wound down in Vancouver on Wednesday.
The progress in the fight against HIV/AIDS, from the grim forecasts of the 1980s and early '90s, is "one of the great achievements in medicine and public health, honestly," according to IAS president Dr. Chris Beyrer, a co-principal investigator of the Johns Hopkins Center for AIDS Research in Baltimore.
- Early HIV treatments heralded for asymptomatic patients
- French teen in HIV remission 12 years after stopping treatments
- Mother-to-child HIV transmissions exceedingly rare in Canada
Two studies presented in Vancouver suggest that starting therapy before AIDS symptoms appear, or before levels of a certain kind of white blood cell falls below a specific threshold, can dramatically delay the development of AIDS-related events and death.
Previously, there has been concern that giving anti-retroviral therapy to asymptomatic patients earlier might increase patients' risk of cardiovascular and renal disease.
A number of studies presented in B.C. focused on pre-exposure prophylaxis (PrEP) preventive treatment — which involves a healthy person taking anti-retroviral drugs prior to engaging in sex with an HIV-positive partner.
There was optimism related to results of PrEP studies that focused on men who engage in sex with men in U.S. cities, and on couples in Botswana, where the disease has spread through the heterosexual community.
Dr. Julio Montaner, director of the B.C. Centre for Excellence in HIV-AIDS, told CBC News the stakes are too high for complacency now despite real progress.
"It is critically important that this effort be sustained … we need to be persistent and if we are persistent, we are going to see the end of the pandemic [by 2030]," he said.
Montaner is encouraged the United Nations has adopted the triple-90 goal by 2020 towards ending AIDS 10 years later:
- 90 per cent of individuals aware of their HIV status.
- 90 per cent of those infected on anti-retroviral therapy.
- 90 per cent of those being treated showing undetectable viral loads.
HIV no longer 'a death sentence'
Ron Rosenes of Toronto embodies the strides made in the last three decades. He has lived with HIV for nearly half his life, and at 68, is among the first group to experience the effects of aging with the disease ever present.
'As you can imagine to find out in 1987 that you have been diagnosed with HIV was basically to be given a death sentence.'
- Ron Rosenes, 68, decades-long HIV survivor
"As you can imagine to find out in 1987 that you have been diagnosed with HIV was basically to be given a death sentence," Rosenes told CBC News. "[They told] people like me to get our affairs in order."
Rosenes recalls some extremely difficult years following the diagnosis. But the 1996 conference, also in Vancouver, heralded the effectiveness of anti-retroviral drugs, which suppress the ability of HIV replicate and infect cells. The triple-drug cocktail stops the infection from progressing to AIDS.
"I managed to survive until that time and since then, thanks to improvements in medications, I have restored my immune system to a certain degree," he said.
As effective as they are, the medications can bring complications with respect to other medical conditions and the aging process.
"They can live full lives, but they are living full lives requiring daily medication and still having the complications of a chronic viral infection that we don't know how to cure," said Beyrer.
The inflammation caused by HIV can accelerate the aging process, and even individuals whose HIV is suppressed are at risk of cardiovascular disease and a number of cancers.
Of course, in the studies attendees in Vancouver heard presented, the drugs were provided without charge.
Millions still with no drug access
The UN last week announced that an earlier-stated goal of treating 15 million people worldwide with anti-retrovirals has been met nine months ahead of schedule.
But that leaves about 22 million people who don't have access to the drugs, let alone at the earliest opportunity.
Opposition and indifference from governments to public health options for marginalized patients is still a problem.
"We don't dictate how people engage with others, whether they use drugs, engage in commercial sex, and the feds don't like any of that and they feel because we support these people from a health perspective, that somehow we are promoting those activities," said Montaner.
Doctors Without Borders on Wednesday said in statement that in many of the countries most in need of a preventive approach to HIV, the cost of the anti-retrovirals can be hundreds of dollars greater per person per year, and in a case like war-torn Ukraine, thousands.
"Countries are increasingly constrained in accessing affordable generic medicines, and this spells disaster for the global HIV response," Dr. Peter Saranchuk, advisor to Doctors Without Borders, said in the statement.
The organization called on the U.S., Japan, the EU and the pharmaceutical industry to resolve patent and intellectual property laws that block access to generic drugs in countries in need.
Without serious changes, it is suggested, 90/90/90 will be just a great-sounding, but unachievable goal.