HIV Today: Between Treatment and Prevention
Advocacy Since the early challenges in the 1980s, treatment and awareness for HIV has developed in front of these leading voices from the industry. We checked in with them to better understand the latest in managing risk and the disease itself.
Mediaplanet: What have been some key breakthroughs in our understanding of the disease?
Carole Treston: The contribution that HIV/AIDS research has made to our overall understanding of the immune system, viruses and viral treatment strategies is tremendous. This progress has not only advanced HIV/AIDS treatment, but has advanced the understanding, treatments and cure for other diseases, such as hepatitis.
Gerald Schochetman: The introduction of the world’s first test to detect HIV-antibody, developed by Abbott, marked a pivotal turn in the battle against the disease. In just one short year after its U.S. Food and Drug Administration (FDA) approval, the test safeguarded the nation’s blood supply, reduced new HIV infections and drove “know your status” campaigns worldwide. Following the test’s approval, the chances of getting HIV from infected blood in some U.S. cities went from 1-in-90 in 1985, to 1-in-40,000 in 1986, and today it’s extremely rare. This milestone also laid the foundation for the development of new and lifesaving therapies.
MP: What do you think has been the biggest breakthrough toward unlocking the cure?
CT: Knowledge about reducing the amount of HIV in the blood to nearly zero and a better understanding of where and how the virus hides in the body despite highly effective treatment have been tremendous breakthroughs. What was unthinkable not too long ago—a cure—now seems possible but will still require significant work and resources.
"Early diagnosis allows people to start on treatment, preserving their health and greatly reducing the risk of transmitting to others through sexual contact."
GS: During the last thirty years, the health community has come to understand that two factors are instrumental in preventing and reducing the spread of HIV: Knowing one’s HIV status and starting treatment early. Testing is an integral part of both steps. Today, testing advances make it possible to determine the viral load of those who are HIV positive and to monitor how effective their treatments are so that adjustments may be made as necessary.
MP: How has HIV care evolved to better help individuals manage their disease?
CT: Today, people with HIV on effective treatment can live long and healthy lives and when on treatment, their risk of infecting someone else is significantly and substantially reduced. HIV is a treatable chronic disease, like so many other diseases. Yet the stigma, shame and fear about HIV persists and we need to end that.
GS: The earlier people get tested and know their status, the sooner they can begin treatment. Early treatment is key in fighting this disease. In May 2015, the National Institutes of Health (NIH) came out with the first study that clearly shows that those with HIV who received immediate treatment significantly reduced their risk of serious, adverse health outcomes. More recently, the WHO issued new HIV treatment and prevention guidelines that also encourage anyone with HIV to begin antiretroviral therapy (ART) immediately after diagnosis to keep them healthier and reduce the risk of transmitting the virus to others.
MP: How has HIV testing helped prevent the spread of this disease?
CT: Screening for HIV is now recommended as part of routine medical care. Early diagnosis allows people to start on treatment, preserving their health and greatly reducing the risk of transmitting to others through sexual contact. People who test negative but are at risk for HIV can start PrEP, an extremely effective approach to HIV prevention for those at highest risk.
GS: The first crucial step to an AIDS-free generation is testing. But, simply getting tested is not enough. Five years ago, the U.S. Food and Drug Administration (FDA) approved the first HIV Combo test in the U.S.—the ARCHITECT HIV Ag/Ab Combo test—developed by Abbott. Called fourth-generation tests, these tests can screen for both antibodies to the virus and antigen (a part of the HIV virus), and can detect HIV infection earlier than antibody-only tests.
By requesting an HIV Combo test, HIV may be detected earlier than with antibody-only tests, allowing those who have been infected to get started on treatment earlier and reducing the risk that the virus will be transmitted to others.
MP: In regards to funding, what do you think should be a top priority in stopping the spread of this disease?
CT: Better education to help end the fear and stigma about what is now a chronic, treatable disease will help. Normalizing HIV testing and making it easier to get into and to stay in treatment is important. Recognizing and addressing the social and economic factors that allow HIV to flourish in some communities is critical.
GS: The Affordable Care Act made HIV testing even more accessible by including it as an essential preventive service—similar to mammograms, immunizations and blood pressure—and health insurance providers must cover them. Last year, the CDC recommended laboratories and testing facilities begin using HIV Combo testing technology to help identify early cases of HIV.
Despite this guidance, many facilities in the United States do not yet offer HIV Combo tests. Until the majority of facilities are using these tests, it’s important for people to talk to your doctor to understand if you should get an HIV Combo test.