Anthony Fauci: “No more excuses. We have all the tools to end the HIV/AIDS pandemic”

The conference on retroviruses and opportunistic infections (CROI 2019), launched March 4 in Seattle (TROI 2019), the director of the US National Institute of Allergy and Infectious Diseases, Anthony Fauci, presented a report on the implementation of the plan announced in February by Donald Trump to eliminate HIV in the US by 2030.

Earlier, in his address to the Congress on February 5, 2019, the head of state announced his intention to put an end to the HIV / AIDS pandemic in the USA within 10 years. To achieve this goal, the head of state asked both Republicans and Democrats to support the initiative.

According to him, while the tremendous advances in biomedical research have led to the development of a significant number of effective HIV treatment regimens, prevention and care strategies, the HIV pandemic is still a public health crisis in the United States and around the world.

As a result of the AIDS epidemic in the United States, more than 700 thousand people died, and according to the Centers for Disease Control and Prevention (CDC), over 1.1 million citizens of the country are currently living with HIV, and 15% of them are not aware of their status.

In 2017, HIV was diagnosed in more than 38 thousand people in the United States. Most of them are young African Americans and Hispanics who have sex with men (MSM). In addition to these, the level of infection prevalence is also extremely high among transgender people, people who have risky sexual behavior and injecting drugs.

According to specialists, more than half of all new HIV cases have been registered in the southern states of the United States, Washington (DC) and Puerto Rico. Of the slightly more than 3,000 counties in America, half of the diagnoses fell on 48 "hot spots."

In response to the ongoing crisis, the US Department of Health and Human Services (HHS) proposed a new initiative aimed at reducing the number of new infections by 75% in 5 years and 90% in 10 years.

This initiative will combine critical scientific advances in prevention, diagnosis, treatment and care, while simultaneously coordinating highly successful programs, resources, and the infrastructure of the CDC, the National Institutes of Health (NIH), the United States Office of Health Care Resources and Services (HRSA), and substance abuse and mental health (SAMHSA).

The first phase, coordinated by the Office of the Assistant Secretary of Health for HHS, will focus on geographic and demographic locations in 19 states, Washington and Puerto Rico, where most of the new HIV cases are recorded, as well as in 7 southern states with prevalent HIV in rural areas.

According to Dr. Fauci, the strategy to combat HIV infection will include 4 key points:

• Diagnose all people with HIV as early as possible after infection;
• Prompt and effective HIV treatment to achieve a sustained virological response (no-load);
• Preventing new cases of HIV transmission: extensive use of pre-exposure prophylaxis (PrEP);
• The rapid identification and rapid response to emerging foci of HIV infection.

A key component of the success of the proposed initiative is the close cooperation of city, county and federal authorities, local and regional clinics and medical institutions, clinicians, pharmaceutical companies and distributors, as well as the public and religious organizations.

Implementing the latest advances in HIV research will also be crucial to the initiative.

Among them, the thesis “undetectable = not transmitting” (U = U), proved by the five largest clinical studies, has broad implications for public health, prevention and treatment of HIV.

U = U means that people with HIV who are on antiretroviral therapy (ART) and who maintain an undetectable viral load are unable to sexually transmit HIV. This thesis is invaluable in countering stigma and discrimination related to HIV.

However, despite the unconditional importance of this, it is still drug therapy that will become the basis for defeating the virus.

Numerous studies conducted in the study of anti-HIV drugs have led to tremendous success today: a person living with a virus and following a doctor's advice has a healthy immune system and lives a full life.

Behind all this, there is a whole group of combinations of antiviral drugs (about 30), as well as pre-contact (PrEP) and post-exposure prophylaxis used among HIV-negative representatives of risk groups.

“Theoretically, if we give ARV therapy to all patients and provide the rest with pre-contact prophylaxis (PrEP), we will be able to stop the HIV epidemic right now,” says Fauci.

“Experts have prepared an absolutely feasible plan, which should focus on“ hot ”demographic and geographic points. Lessons learned from the implementation of the strategy will eventually be used 

To reduce HIV prevalence across the country through federal, regional and local health departments and nongovernmental organizations. ”

The coordinated work of the HHS institutions will ensure the effectiveness of the implementation plan.

Ryan White’s HRSA program on HIV / AIDS (RWHAP) has made significant progress in implementing quality treatment and care for PLHIV. In 2017, 85% of people who participated in the program reached an undetectable viral load, which is much higher than the national average among 60% of HIV-infected adults and adolescents. RWHAP also significantly raised the level of treatment in key groups, including women, transgender people, African Americans, adolescents and the homeless.

Using this experience, HRSA, in collaboration with federal and regional health departments, as well as community and religious organizations, will make the necessary efforts to achieve the goals of the HHS initiative to end the HIV epidemic in the United States.

The CDC will also participate in the implementation of the plan, using all existing programs and working with the communities along with federal and local health authorities. The main goal is to make HIV testing accessible to all who need it, diagnose infections as early as possible, conduct epidemiological studies of new foci of the virus, and facilitate rapid communication with comprehensive care in RWHAP.

The HRSA Health Centers program will provide PrEP services to people at risk, as well as care for PLHIV.

IHS will focus on developing programs and services in urban and rural communities as part of achieving the four objectives. In order to expand access to treatment, IHS has already published PrEP guidelines, and also developed electronic references with clinical reminders for medical staff.

NIH centers will inform HHS partners about current biomedical research results, collecting and disseminating data on the effectiveness of approaches to maximize the effectiveness of the initiative.

Finally, in addition to the programs described, it is also crucial to ensure free access to FDA-approved drug treatment of substance use disorders in combination with counseling / behavioral services. SAMHSA's efforts to increase the number of providers of this treatment, especially in hot spots, will help control the spread of HIV.

“For the first time in US history, all institutions united under the leadership of HHS to defeat an epidemic,” Dr. Fauci summarized the CROI data, “No more excuses. We have all the tools to end the HIV / AIDS pandemic. ”