THERE'S MORE TO CELEBRATE THIS WORLD AIDS DAY

Treatment breakthroughs mean there’s much to celebrate this World Aids Day.

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It’s been four decades since the first cases of AIDS were reported, and new data shows that dozens of countries have “achieved or exceeded” the 2020 targets set by the UN General Assembly in 2016.

Globally, the number of people on treatment has tripled since 2010, and the rollout of affordable, quality treatment is estimated to have prevented 16.2 million deaths since 2001.

South Africa has the largest antiretroviral (ARV) programme in the world, with more than six million people on treatment, which has brought a big increase in life expectancy and a decrease in HIV transmissions, reports the Wits University-based Ezintsha research group.

But the country is not yet reaching its targets for treatment coverage and overall HIV prevention, according to the Thembisa model (a mathematical analysis of the epidemic here).

It found that while South Africa had committed to reaching the UN’s 90-90-90 fast-track targets by 2020 – to ensure 90% of people with HIV are tested and know their status, 90% are receiving treatment, and 90% of those on treatment have a suppressed viral load – it had reached 90-68-88.

This puts the total viral load suppression in all people in SA living with HIV at 55% – 18 percentage points below the target of 78%. Leigh Johnson, lead developer of the Thembisa model, cites among factors hampering progress, low ARV coverage and the need to improve retention levels of people in care (with many patients lapsing in their treatment).

But there’s been promising progress recently, in the form of a simpler, longer-lasting combination ARV pill. The three-in-one tablet TLD (tenofovir/lamivudine/ dolutegravir) was launched by the Dept of Health in 2019.



A SHOT OF HOPE
Now the focus is on the development of ARV injections, required just monthly or every six months, to be available in South in the next few years. “There’s also the possibility of an annual implant, similar to implantable contraception,” says Prof Francois Venter, divisional director of Ezintsha.

Currently, a combination of two medications in long-acting injectable form is being considered for people with HIV in sub-Saharan Africa, Prof Venter says.

In March this year in The Lancet journal, he and colleagues reported modelling the potential effects of introducing monthly injections (two shots in the big muscle of the buttocks) of cabotegravir and rilpivirine, compared to dolutegravir-based pills. Drug regulators in the US and Europe have already approved the injections.

In their model, all policies for the introduction of the injections were predicted to lead to positive outcomes: “an increased proportion of people on antiretroviral therapy (ART), increased viral load suppression and decreased AIDS-related mortality.”

However, to be cost-effective, the injections may need to be targeted at those who would otherwise be less likely to adhere to ART – “a thorny problem, as the injectables used currently are prone to resistance,” according to Prof Venter.

FINE-TUNING THE TREATMENT
Another breakthrough in July this year saw researchers at an International AIDS Society conference presenting on a new ART medication called lenacapavir – a long-acting drug still in research stage.

If it can be combined effectively with other medicines, it would require an injection only twice a year in the stomach, making it possible to self-inject, reports Prof Samir Gupta of Indiana University in the US.

He presented on a small study in people with multi-drug-resistant HIV, who had the jab alongside some daily pills. It was found to be “well tolerated and safe” but larger studies are needed, and second (and possibly third) drugs that also need to be taken every six months must be developed in order to achieve a twice-yearly injection alone.

The benefits of long-lasting treatment would not only be the need for fewer doses, but greater discretion than daily dosing, explains Prof Venter. He reports “great enthusiasm from patients” but is concerned that with our clinics already overburdened, there may be “operational challenges”, and alternative service providers may be needed to be brought in. The experience gained from the Covid-19 vaccine rollout may help prepare the way.

A FUTURE CURE
Results from new research published in the journal Nature Communications could point to the beginning of the end of HIV.

According to Kamel Khalili, a senior researcher at Temple University in the US: “We show for the first time that a single inoculation of our CRISPR gene-editing construct, carried by an adeno-associated virus (a harmless virus endemic in humans and animals), can edit out the SIV genome (simian immunodeficiency virus, found in primates) from infected cells.”

If this can be replicated in humans, it could one day move HIV/AIDS from being a “chronic disease” managed through ART to one that is “cured”.

SOUTH AFRICA'S HIV HEROES
Raising awareness about living healthily with HIV is as vital as treatment breakthroughs, and a number of public figures are doing just that:

MUSA ‘QUEEN’ NJOKO
The gospel singer and motivational speaker was 22 years old when diagnosed, and one of the first women to publicly disclose her status. She’s been living with HIV for more than 20 years.

ZACKIE ACHMAT
The co-founder of the Treatment Action Campaign (24 years ago) has lived with HIV since 1990, refusing treatment until this was made accessible for all in SA.

CRISELDA KANANDA
The radio host and AIDS activist, who has been HIV positive for 25 years, also speaks out on abuse against women.

THABANG SEFATSA
The former footballer has gone public with his status, highlighting the need for soccer bosses to support players living with HIV.


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