The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs in an attempt to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same sex and opposite sex partners so long as the HIV-positive partner maintains an undetectable viral load.
In the context of high risk populations, male circumcision has been shown to reduce the risk of human immunodeficiency virus (HIV) transmission from HIV+ women to men. In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions. Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections (STIs) from an infected female partner through vaginal sex.
HIV/AIDS, or human immunodeficiency virus, is considered by some authors a global pandemic. However, the WHO currently uses the term 'global epidemic' to describe HIV. As of 2018, approximately 37.9 million people are infected with HIV globally. There were about 770,000 deaths from AIDS in 2018. The 2015 Global Burden of Disease Study, in a report published in The Lancet, estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year, but remained stable from 2005 to 2015.
HIV/AIDS in India is an epidemic. The National AIDS Control Organisation (NACO) estimated that 2.14 million people lived with HIV/AIDS in India in 2017. Despite being home to the world's third-largest population of persons with HIV/AIDS, the AIDS prevalence rate in India is lower than that of many other countries. In 2016, India's AIDS prevalence rate stood at approximately 0.30%—the 80th highest in the world. Treatment of HIV/AIDS is primarily via a "drug cocktail" of antiretroviral drugs and education programs to help people avoid infection.
Pre-exposure prophylaxis (PrEP) is the use of medications used to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent, usually a virus. The term typically refers to the specific use of antiviral drugs as a strategy for HIV/AIDS prevention. PrEP is one of a number of HIV prevention strategies for people who are HIV negative but who also have a higher risk of acquiring HIV, including sexually active adults at increased risk of HIV, people who engage in injection drug use, and serodiscordant sexually active couples.
Gregg Gonsalves is a global health activist, an epidemiologist, an associate professor at Yale School of Public Health and an associate professor (adjunct) at Yale Law School.
HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).
HIV and AIDS is a major public health issue in Zimbabwe. The country is reported to hold one of the largest recorded numbers of cases in Sub-Saharan Africa. According to reports, the virus has been present in the country since roughly 40 years ago. However, evidence suggests that the spread of the virus may have occurred earlier. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.
Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people afflicted with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.
The San Francisco AIDS Foundation (SFAF) is a nonprofit organization dedicated to providing services for people with HIV/AIDS, with a mission to end the AIDS epidemic in the United States. They were founded in 1982, at the beginning of the AIDS epidemic. SFAF is one of the largest and oldest community-based AIDS service organizations in the United States. SFAF has an 87.67% overall rating, and a 97% accountability & transparency rating, at Charity Navigator.
Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, death and transmission was first proposed in 2000 by Garnett et al. The term is often used to talk about treating people that are currently living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) to prevent illness, death and transmission. Although some experts narrow this to only include preventing infections, treatment prevents illnesses such as tuberculosis and has been shown to prevent death. The dual impact on well being and its 100% effectiveness in reducing transmission makes TasP the most important element in the HIV prevention toolkit. In relation to HIV, antiretroviral therapy (ART) is a three or more drug combination therapy that is used to decrease the viral load, or the measured amount of virus, in an infected individual. Such medications are used as a preventative for infected individuals to not only spread the HIV virus to their negative partners but also improve their current health to increase their lifespans. Other names for ART include highly active antiretroviral therapy (HAART), combination antiretroviral therapy (cART), triple therapy and triple drug cocktail. When taken correctly, ART is able to diminish the presence of the HIV virus in the bodily fluids of an infected person to a level of undetectability. Undetectability ensures that infection does not necessarily have an effect on a person's general health, and that there is no longer a risk of passing along HIV to others. Consistent adherence to an ARV regimen, monitoring, and testing are essential for continued confirmed viral suppression. Treatment as prevention rose to great prominence in 2011, as part of the HPTN 052 study, which shed light on the benefits of early treatment for HIV positive individuals.
Suniti Solomon was an Indian physician and microbiologist who pioneered AIDS research and prevention in India after having diagnosed the first Indian AIDS cases among the Chennai sex workers in 1986 along with her student Sellappan Nirmala. She founded the Y R Gaitonde Centre for AIDS Research and Education in Chennai. The Indian government conferred the National Women Bio-scientist Award on her. On 25 January 2017, the Government of India awarded her the Padma Shri for medicine for her contributions towards diagnosis and treatment of HIV.
David DuPuy Celentano is a noted epidemiologist and professor who has contributed significantly to the promotion of research on HIV/AIDS and other sexually transmitted infections (STIs). He is the Charles Armstrong chair of the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. He holds joint appointments with the school’s departments of Health Policy and Management, Health Behavior and Society, and International Health, and the Johns Hopkins University School of Medicine’s Division of Infectious Diseases.
Bictegravir is a second-generation integrase inhibitor (INSTI) class that was structurally derived from an earlier compound dolutegravir by scientists at Gilead Sciences; in vitro and clinical results were presented by Gilead in the summer of 2016. In 2016, bictegravir was in a Phase 3 trial as part of a single tablet regimen in combination with tenofovir alafenamide (TAF) and emtricitabine (FTC) for the treatment of HIV-1 infection and the combination drug bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) was approved for use in the United States in 2018.
Sharon Ruth Lewin, FRACP, FAHMS is the inaugural Director of the Peter Doherty Institute for Infection and Immunity. She is also a Professor of Medicine at The University of Melbourne and a National Health and Medical Research Council (NHMRC) Practitioner Fellow. As an infectious diseases physician and basic scientist, her laboratory focuses on basic, translational and clinical research aimed at finding a cure for HIV and understanding the interaction between HIV and hepatitis B virus. Her laboratory is funded by the NHMRC, the National Institutes of Health, The Wellcome Trust, the American Foundation for AIDS Research and multiple commercial partnerships. She is also the Chief Investigator of a NHMRC Centre of Research Excellence (CRE), The Australian Partnership for Preparedness Research on Infectious Diseases Emergencies (APPRISE) that aims to bring together Australia’s leading experts in clinical, laboratory and public health research to address the key components required for a rapid and effective emergency response to infectious diseases.
YR Gaitonde Centre for AIDS Research and Education is a non-profit organisation in India working in the domain of HIV/AIDS. The organisation was founded by Dr Suniti Solomon in 1993. As reported in 2018, YRG Care had provided HIV prevention and treatment related services to about 21,000 people in India who were infected by HIV. After Dr Suniti Solomon died, Dr Sunil Solomon leads YRG Care.
Chloe Meave Orkin is a British physician and Professor of HIV/AIDS medicine at Queen Mary University of London. She works as a consultant at the Royal London Hospital, Barts Health NHS Trust. She is an internationally renowned expert in HIV therapeutics and led the first phase III clinical trial of injectable anti-retrovirals. She is immediate past Chair of the British HIV Association, where she championed the Undetectable=Untransmittable (U=U) campaign within the United Kingdom. She is president elect of the Medical Women's Federation. Orkin is openly gay and was on the Top 100 Lesbian influencer lists in both the UK and in the US in 2020. She considers herself a medical activist and much of her work focuses on inequalities in healthcare and in Medicine.
Michel Alary is a Canadian academic, doctor of preventive medicine and a health researcher. He is a Professor of Social and Preventive Medicine at Université Laval and the director of population health research at the Research Centre of the CHU de Quebec – Université Laval. He also serves as a Medical Consultant at the Institut national de santé publique du Québec. Alary has published over 260 research papers and has produced major reports for the World Bank and UNAIDS about HIV in sub-Saharan Africa. He also evaluated the Bill & Melinda Gates Foundation's India AIDS Initiative for which his project received the Avahan Recognition Award. He has conducted epidemiological and preventive research on blood-borne infections, HIV and other Sexually Transmitted Diseases (STD) among the most vulnerable populations in developed and developing countries.
Etheldreda Nakimuli-Mpungu is a professor, researcher, epidemiologist and psychiatrist at the Department of Psychiatry in the Faculty of Medicine, Makerere University in Uganda. Her research is particularly focused on supportive group psychotherapy as a first-line treatment for depression in people with HIV. She is one of only five recipients of the Elsevier Foundation Award for Early Career Women Scientists in the Developing World in Biological Sciences, as well as listed at one of the BBC's 100 Women in 2020.
Steven Grinspoon (M.D.) is a Professor of Medicine at Harvard Medical School, Chief of the Massachusetts General Hospital (MGH) Metabolism Unit, and Director of the Nutrition Obesity Research Center at Harvard. In addition, he is the MGH Endowed Chair in Neuroendocrinology and Metabolism. His work investigates the neuroendocrine regulation of body composition, and physiologic consequences of fat distribution on cardiovascular disease and inflammation. He has investigated the effects of reduced growth hormone on metabolic dysregulation in obesity and was the first to propose the use of a Growth Hormone-releasing Hormone (GHRH) analogue to increase endogenous GH secretion on lipodystrophy and generalized obesity, which led to the FDA approval of Tesamorelin for excess visceral fat accumulation in HIV-infected patients. This work has now been extended to show robust effects on Non-alcoholic fatty liver disease (NAFLD). More recently, his research focuses on the inflammatory mechanisms by which ectopic fat and other metabolic perturbations contribute to HIV-Cardiovascular disease (CVD), and in this regard, he led the AHA State of the Science Conference on CVD in HIV. Additionally, he is leading the large multicenter REPRIEVE study, the first study of a primary prevention strategy for CVD in HIV. He has also investigated increased Renin-Angiotensin-Aldosterone System (RAAS) activation and immune activation in relationship to visceral fat accumulation, and the mechanisms of subcutaneous adipose dysfunction involving DICER. Dr. Grinspoon has served on the Harvard faculty since 1995 and has been selected to the American Society for Clinical Investigation and the Association of American Physicians for his scientific contributions. He received the American Federation of Medical Research Investigator of the Year Award in 2005 and the Edward H. Ahrens Jr. Award for Patient Oriented Research in 2014 as well as the Endocrine Society Laureate Award for Translational Research in 2016. He has published over 330 articles and mentored over 40 trainees in his career. He was elected as a Member of the American Clinical and Climatological Association for his achievements in 2017. His work demonstrating effects of Tesamorelin to reduce hepatic fat and fibrosis progression in NAFLD, published in Lancet HIV, was a finalist for the Clinical Research Forum’s top 10 Clinical Research Achievement Awards in 2020. In 2015, he became the Principal Investigator of the NIH funded Nutrition Obesity Research Center at Harvard.
