World AIDS Day

Today is World AIDS Day, which has taken place on 1st December every year since 1988. This year is particularly poignant given that 5th June 2022 marked the 40th anniversary of the first-reported case of AIDS in the United States. The advanced stage of human immunodeficiency virus (HIV) infection has since claimed the lives of more than 32 million people globally. While there remains no cure for this devastating illness, HIV is no longer the death sentence it once was thanks to medical advances that have drastically improved patient prognosis.

Effective therapies first became available in the late 1980s. In March 1987, the US Food and Drug Administration approved the antiretroviral drug azidothymidine (AZT) to treat HIV infection. While AZT and other early drugs provided hope to thousands of people living with HIV, these initial HIV treatments were plagued by issues of drug resistance. In 1996, the first of a different antiretroviral drug class called protease inhibitors was approved, heralding the era of highly active antiretroviral therapy (HAART). Three-drug regimens subsequently transformed HIV from a fatal diagnosis to a controllable condition, with infected patients experiencing a dramatic increase in life expectancy.

Today, treatment has progressed to novel 2-drug regimens, and many individuals are able to control their HIV with just one pill a day. The 2012 approval of pre-exposure prophylaxis (PrEP) for adults at high risk of HIV infection was a significant milestone – daily PrEP taken according to guidelines can lower the risk of catching HIV to almost zero. Recently approved long-acting injectables are administered every one or two months, potentially overcoming some of the issues people can experience with pill-based antiretroviral regimens, such as fear of disclosing their HIV positive status.

Despite the progress made in the last four decades, as we look ahead to 2023 there are several unmet needs still to address. The need for more convenient regimens is ongoing, as are issues of tolerability, drug interactions and drug resistance. Given the success of antiretroviral therapy, the proportion of older people with HIV is increasing, bringing about its own unique challenges. There are also disparities in access to treatment, with Black and Hispanic populations disproportionately affected by HIV. We have come far in the fight against HIV since the 1980s, but still have a way to go.