HIV epidemiology and breakthroughs in prevention 30 years into the AIDS epidemic

Susan P Buchbinder1

  • 1University of California San Francisco, San Francisco, CA, USA.

Insights

The HIV epidemic disproportionately affects men who have sex with men (MSM) globally. Advances in antiretroviral therapy and prevention strategies like pre-exposure prophylaxis (PrEP) offer hope, alongside managing herpes simplex virus type 2 (HSV-2) co-infections.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • The Human Immunodeficiency Virus (HIV) epidemic, thirty years post-initial reports, remains concentrated among men who have sex with men (MSM) in the United States.
  • Global HIV impact varies, with MSM predominant in the Americas/Western Europe, heterosexuals in sub-Saharan Africa, and injection drug users in Eastern Europe/Southeast Asia.
  • Disparities persist in the U.S., with Black and Latino populations disproportionately affected despite improved HIV testing and care.

Framework:

  • The 2011 Conference on Retroviruses and Opportunistic Infections highlighted key populations: adolescents, women, MSM, and serodiscordant couples.
  • A significant focus was the interplay between herpes simplex virus type 2 (HSV-2) and HIV-1, noting HSV-2's potential to substantially impact HIV rates due to its prevalence and persistence.
  • Advances in antiretroviral drugs for both HIV prevention (oral pre-exposure prophylaxis, topical microbicides) and treatment (antiretroviral therapy) were celebrated.

Implementation:

  • Ongoing evaluation of prevention strategies including male condoms, male circumcision, and HIV testing with linkage to care.
  • Emphasis on comprehensive approaches addressing co-infections like HSV-2 to curb HIV transmission.
  • Leveraging advancements in antiretroviral therapy (ART) for both treatment and prevention (TasP).

Implications:

  • Effective prevention and treatment of HSV-2 could significantly reduce HIV-1 incidence.
  • Continued focus on high-risk populations and tailored interventions is crucial for global HIV control.
  • The integration of biomedical and behavioral prevention strategies is essential for comprehensive HIV/AIDS management.

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