Progress against the HIV Epidemic: is the end in sight? Christine - - PowerPoint PPT Presentation

Progress against the HIV Epidemic: is the end in sight?

Christine Hughes, BscPharm, PharmD, FCSHP Professor, Faculty of Pharmacy & Pharmaceutical Sciences University of Alberta Clinical Pharmacist, Northern Alberta HIV Program GANG meeting, September 29, 2018

Outline

• What is HIV?
• Global impact of HIV
• Treatment of HIV in 2018 (in Africa and

around the world)

• UNAIDS goals and progress
• Ongoing challenges to end the epidemic

What is HIV?

• HIV = human immunodeficiency

virus

• Virus recognized in early 1980’s
• Targets and destroys CD4 (helper)

immune cells

• End result: immune suppression

– can lead to infections or infection‐ related cancers

How is HIV transmitted?

GLOBAL IMPACT OF HIV

Total: 36.7 million [30.8 million–42.9 million]

Middle East and North Africa

230 000

[160 000–380 000]

Middle East and North Africa

230 000

[160 000–380 000]

Western and central Africa

6.1 million

[4.9 million–7.6 million]

Western and central Africa

6.1 million

[4.9 million–7.6 million]

Eastern Europe and central Asia

1.6 million

[1.4 million–1.7 million]

Eastern Europe and central Asia

1.6 million

[1.4 million–1.7 million]

Asia and the Pacific

5.1 million

[3.9 million–7.2 million]

Asia and the Pacific

5.1 million

[3.9 million–7.2 million]

North America and western and central Europe

2.1 million

[2.0 million–2.3 million]

North America and western and central Europe

2.1 million

[2.0 million–2.3 million]

Latin America

1.8 million

[1.4 million–2.1 million]

Latin America

1.8 million

[1.4 million–2.1 million]

Eastern and southern Africa

19.4 million

[17.8 million–21.1 million]

Eastern and southern Africa

19.4 million

[17.8 million–21.1 million]

Adults and children estimated to be living with HIV  2016

Caribbean

310 000

[280 000–350 000]

Caribbean

310 000

[280 000–350 000]

www.unaids.org

36.7 million [30.8 million–42.9 million] 34.5 million [28.8 million–40.2 million] 17.8 million [15.4 million–20.3 million] 2.1 million [1.7 million–2.6 million] 1.8 million [1.6 million–2.1 million] 1.7 million [1.4 million–1.9 million] 160 000 [100 000–220 000] 1.0 million [830 000–1.2 million] 890 000 [740 000–1.1 million] 120 000 [79 000–160 000]

Number of people living with HIV People newly infected with HIV in 2016 AIDS-related deaths in 2016

Total Adults Women (15+ years) Children (<15 years) Total Adults Children (<15 years) Total Adults Children (<15 years)

Global summary of the AIDS epidemic  2016

Populations most impacted by HIV differ considerably around the world and even in different regions within a country (e.g. Canada)

Newsweek December 2, 1996

Mid‐1990’s: 3‐Drug Combination ART introduced Zidovudine/Lamivudine/Indinavir

Fasting (1 hour before/2 hours after meals)1.5 liters of hydration/day

8AM 4PM 12 MID

HIV TREATMENT TODAY

HIV TREATMENT in 2018

• > 25 licensed antiretroviral (ARV) drugs

– used in combinations of at least 3 agents – regimens are simpler and well tolerated

• No cure for HIV and no vaccine

– Goal: suppress virus replication – life‐expectancy of people with HIV approaching ‘near normal’

TARGETS TO END HIV/AIDS AS A PUBLIC HEALTH THREAT BY 2030

Prevention is Key

• People at risk of HIV infection have access to

comprehensive HIV prevention services

• Condoms, pre‐exposure HIV prophylaxis, clean

needles/syringes etc

Not just medical interventions

• Remove policy barriers to access prevention

services

• Eliminate gender inequalities and end all

forms of violence and discrimination against women and girls, people living with HIV and key populations

Reducing stigma

• Undetectable = Untransmittable
• People who take antiretroviral therapy daily as

prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV‐negative partner. (Reference: CDC)

PROGRESS IN REACHING UNAIDS TARGETS: ARE WE THERE YET?

Percent change in new HIV infections since 2010 ‐18 %

Ongoing Challenges…the road ahead

• Shortfalls in HIV Funding

– Contributing to inability to achieve UNAIDS goals – Focus on treatment impacts funding for other prevention efforts

Ongoing Challenges…the road ahead

• Prevention of HIV transmission

– concentration of the epidemic in marginalized populations – little progress in reducing number of new infections (including in Canada) – strong relationship to social determinants of health, stigma etc

Ongoing Challenges…the road ahead

• Earlier identification of HIV infection

– WHO has recommended since 2015 that people with HIV start antiretroviral therapy as soon as possible

• Improves individual health and reduces transmission

Ongoing Challenges…the road ahead

• Ability to achieve treatment success

– Goal is undetectable viral load‐ requires high level

• f treatment adherence

– Addictions, mental health, stigma, poverty, access to care and treatment impact ability to achieve treatment success

“We live in a completely interdependent world, which simply means we can not escape each other. How we respond to AIDS depends, in part, on whether we understand this interdependence. It is not someone else's problem. This is everybody's problem.” ― Bill Clinton

THANK YOU FOR THE IMPORTANT WORK THAT YOU DO!