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New WHO guidelines on HIV control and scientific updates published at IAS 2023.
The World Health Organization (WHO) publishes new scientific and normative guidelines on HIV 12th International IAS (International AIDS Society) Conference on HIV Science.
New WHO guidelines and accompanying Lancet systematic review published today describe the role HIV viral suppression and unmeasurable viral levels in improving individual health and stopping further transmission of HIV. The guidelines describe key HIV viral load thresholds and approaches to measuring viral levels against these thresholds; for example, people living with HIV who achieve undiscovered level of the virus through consistent use of antiretroviral therapy, do not transmit HIV to their sexual partners and have a low risk of vertical transmission of HIV to their children. Evidence also shows that there is negligible, or almost zero, risk of HIV transmission when a person has an HIV viral load of less than or equal to 1000 copies per ml, also commonly referred to as having repressed viral load.
Antiretroviral therapy continues to change the lives of people living with HIV. People living with HIV who are diagnosed and treated early and take their medications as prescribed can expect to have the same health and life expectancy as their HIV-negative counterparts.
“For more than 20 years, countries around the world have relied on WHO’s evidence-based guidelines for the prevention, testing and treatment of HIV infection,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The new guidelines we are announcing today will help countries use powerful tools that have the potential to change the lives of millions of people living with HIV or at risk of HIV.”
At the end of 2022, 29.8 million of the 39 million people living with HIV were taking antiretroviral treatment (meaning 76% of all people living with HIV), and almost three-quarters of them (71%) were living with suppressed HIV. This means that for those who are virally suppressed, their health is well protected and they are not at risk of transmitting HIV to other people. While this is a very positive development for adults living with HIV, viral load suppression in children living with HIV is only 46% – a reality that needs urgent attention.
Here is an overview of other key scientific and normative updates that WHO announced at the IAS 2023 conference:
HIV and measles
An analysis of global surveillance data reported to WHO during measles outbreaks in multiple countries found that among more than 82,000 measles cases, about 32,000 cases had information on HIV status. Among them, 52% were living with HIV, the majority were men who have sex with men (MSM); and more than 80% indicated sexual intercourse as the most likely way of contracting the mpox.
Among the 16,000 people diagnosed with mpox and living with HIV, about one quarter (25%) had advanced HIV disease or immunosuppression – leading to an increased risk of hospitalization and death. People living with HIV who were on HIV treatment and with good immunity had similar hospitalizations and deaths as those who were HIV negative.
In light of these findings, WHO recommends that countries integrate measles detection, prevention and care with existing and innovative programs for the prevention and control of HIV and sexually transmitted infections.
To understand how to better prepare for and respond to future increases in mppox transmission, WHO conducted a rapid electronic survey in May 2023 to assess community experiences of the mppox outbreak in Europe and the Americas in 2022-2023.
More than 24,000 people took part in the survey, which focused on men who have sex with men and trans and gender diverse people, with 16,875 individuals completing the survey. Almost 51% changed their sexual behavior (such as reducing the number of sexual partners), and 35% maintained these changes a year later. Findings from this survey provide valuable insight into the experiences and needs of affected communities and highlight the importance of increasing access to measles vaccination and diagnostics globally.
HIV and COVID-19
Updated analysis from WHO Global Clinical Platform for COVID-19 to May 2023 found a consistently high risk of death in people living with HIV hospitalized for COVID-19 in the pre-Delta, Delta, and Omicron variant waves, with an overall in-hospital mortality rate of 20%-24%. For people without HIV, the risk of death fell during the Omicron variant wave by 53%—55% compared with the pre-Delta and Delta variant waves; but for people living with HIV, the percentage decline in mortality during the Omicron wave period compared to other waves was modest (16%–19%). This difference resulted in a 142-fold higher risk of death among people living with HIV compared to people without HIV during the Omicron wave period.
Risk factors for in-hospital death that were common across all variant waves of the pandemic were low CD4 counts (less than 200 cells per m3) and severe or critical COVID-19 disease at hospital admission.
“Uncontrolled HIV remains a risk factor for poor outcomes and death in the measles outbreak and the COVID-19 pandemic,” said Dr Meg Doherty, Director of WHO’s Global Programs on HIV, Hepatitis and Sexually Transmitted Infections. “We must ensure the integration of HIV considerations into pandemic preparedness and response. Protecting people living with HIV from future pandemics is vital and reinforces the need to ensure access to HIV testing and treatment and preventive vaccines for mpox and COVID-19 to save lives; community-led responses that work on HIV will also be useful to address future pandemics.”
Optimizing HIV testing services through expanded testing options and simplified service delivery
WITH new recommendations on HIV testingWHO urges countries to expand the use of HIV self-testing and promote testing through sexual and social networks to increase testing coverage and strengthen uptake of HIV prevention and treatment services in high-burden settings and in regions with the greatest gaps in testing coverage.
The recommendation comes at a crucial time, in which self-care and self-testing are increasingly recognized as ways to increase access, efficiency, effectiveness and acceptability of health care in many areas of different diseases, including HIV.
Primary health care and HIV
AND a new policy framework on primary health care (PHC) and HIV will help decision-makers optimize ongoing work and collaboration to improve primary care and disease-specific responses, including HIV. In the second year of implementation, Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for 2022-2030. actively advocate for synergies within general health care and primary health care.
“Eradicating AIDS is impossible without optimizing opportunities in and within health systems, including communities and in the context of primary health care,” said Dr Jérôme Salomon, WHO Assistant Director-General, Universal Health Coverage, Communicable and Noncommunicable Diseases.
This latest research and guidance comes at a time when progress toward ending the global AIDS epidemic has lagged, following the COVID-19 pandemic; but the response is quickly catching up, and some countries are now recording a the road to the end of AIDSincluding Australia, Botswana, Eswatini, Rwanda, the United Republic of Tanzania and Zimbabwe and 16 other countries that are close to achieving the 95-95-95 global targets, which aim for 95% of people living with HIV to know their status, 95% of those diagnosed with ART and 95% of those on treatment to have a reduced viral load.
Note to the editor:
12th IAS Conference on HIV Science
IAS 2023, 12th IAS Conference on HIV Science will be held in Brisbane from 23-26 July 2023. This biennial conference presents critical advances in basic, clinical and operational HIV research that move science into policy and practice.
For more detailed information about WHO at the conference, visit: https://who.int/news-room/events/detail/2023/07/23/default-calendar/who-at-ias-conference-2023
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