Slow progress in the fight against HIV and AIDS

Global reduction in infections and deaths, prevention and effective treatment… The fight against HIV and AIDS is moving forward, although ending the epidemic remains a distant goal.

This is a panorama on the eve of World AIDS Day, which is celebrated this Sunday.

– The disease is receding –

The number of human immunodeficiency virus (HIV) infections fell in 2023 to its lowest historical level of between 1 million and 1.7 million, according to an annual report released Tuesday by UNAIDS.

The number of new infections worldwide fell by one-fifth in the 2010s, according to The Lancet HIV.

Deaths, usually caused by opportunistic diseases when AIDS appears in the final stages of infection, fell by about 40% to clearly fall to less than one million people a year.

This trend is driven mainly by marked improvements in sub-Saharan Africa, the region of the world hardest hit by the AIDS epidemic.

However, the picture remains mixed, with cases rising in other regions such as the Middle East or Eastern Europe. We are still far from the UN goals, which aim to almost completely eradicate the epidemic by 2030.

– Effective tools –

HIV experts agree on the importance of preventive treatment, known as PrEP (pre-exposure prophylaxis), which has become a crucial tool in the fight against the epidemic.

These treatments, taken by people who are not infected but whose behavior is considered risky, are very effective in preventing infection.

For this reason, experts advocate its expansion. In France, for example, health authorities have included PrEP as a central pillar of their new recommendations: it should no longer be used exclusively by men in homosexual relationships.

For people already infected, treatment is becoming increasingly effective and convenient, especially because it needs to be taken less frequently.

– Obstacles remain –

Despite advances, the implementation of treatments, both preventive and curative, faces numerous challenges. This is the case in poor countries, such as those on the African continent, where the cost of medicine continues to be a problem.

The controversial case has sparked controversy in recent months.

Gilead’s laboratory has developed lenacapavir, which promises unprecedented effectiveness in both prevention and treatment. Experts believe this could represent a revolutionary change, but the cost is astronomical: $40,000 per person per year.

Under pressure from AIDS groups, Gilead announced in early October that it would allow low-cost generic versions of the drug to be produced in poorer countries.

However, barriers are not only financial, especially in the case of preventive treatment. It is also crucial to combat the stigma associated with its use in countries where, for example, homosexuality is still unacceptable.

“Introducing PrEP in Africa faces a major challenge: getting high-risk people to recognize that they are at risk,” an article in The Lancet Global Health summarized in 2021.

The same problem applies to diagnosis, which is especially important since many infections are detected at an advanced stage, which makes their treatment difficult.

– What about vaccines? –

Some aspects attract media attention that may be disproportionate. This is the case with vaccine studies, which have so far not yielded conclusive results.

As for the effectiveness of preventive treatments, “don’t we already have a vaccine?” asked infectious disease specialist Yazdan Yazdanpan, director of ANRS, a pioneering French institute in the fight against viruses, during a press conference in October. AIDS.

However, this expert acknowledged that “vaccine research must not stop.”

Another achievement that should not be exaggerated is the few cases of remission observed in recent years: less than ten in total. While impressive, they are the result of stem cell transplants, risky operations that are only possible in very specific cases.

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