Preventing acquisition of HIV is the only path to an AIDS-free generation

Abstract

The article by Medlock et al. (1) reminds us that HIV infection is still the epidemic of our times. Currently, 36.7 million persons are living with HIV, and annual deaths from HIV are still upward of 1 million persons per year (aidsinfo.unaids.org). Because a wide variety of studies have demonstrated enhanced survival and quality of life with the early detection of HIV and the timely initiation of antiretroviral therapy (ART) (2, 3), much of this continuing global morbidity and mortality is due to the inability of our health care systems to scale up these interventions. Among countries that have steadily increased access to antiretrovirals, we have at last seen a “bending of the curve,” as life expectancy increases in adults and HIV infections are averted in infants (Fig. 1 A ). The reversal of mortality rates from the early years of the epidemic when ART was not readily available has given both hope and impetus to try and “end AIDS.” In 2014, the Joint United Nations Program on HIV and AIDS (UNAIDS) outlined a three-part program entitled “90-90-90” as a commitment to improve access to ART as a life-saving intervention, a transmission prevention measure, and a human rights endeavor (4). These targets include ( i ) successfully diagnosing 90% of all HIV-positive people, ( ii ) delivering ART to 90% of those people diagnosed, and ( iii ) achieving viral suppression for 90% of those people on treatment. The goal of this program is to markedly reduce the global morbidity and mortality due to HIV-related causes by 2020 as a first step in the global control of the epidemic. Fig. 1. ( A ) Mortality rates in South Africa 1997–2012. HIV-related deaths dropped from 300,000 in 2006 to 153,000 in 2012 coincident with large-scale roll-out of ART (14). ( B ) Association between new HIV acquisitions and ART coverage. The number of new … [↵][1]1To whom correspondence should be addressed. Email: lcorey{at}fredhutch.org. [1]: #xref-corresp-1-1