The World Health Organization (WHO) publishes new scientific and normative guidance on HIV. 12th International IAS (International AIDS Society) HIV Science Conference.
New WHO guidance and accompanying guidelines A systematic review of the Lancet Released today, explain the role of HIV viral suppression It uses undetectable levels of the virus to improve an individual’s health and halt the progression of HIV infection. This guidance describes key HIV viral load thresholds and approaches for measuring viral levels relative to these thresholds. For example, living with HIV, undetectable Consistent use of antiretroviral therapy reduces viral levels, does not transmit HIV to sexual partners, and reduces the risk of vertically transmitting HIV to children. Evidence also indicates that if a person has an HIV viral load measurement of 1000 copies per mL or less, the risk of HIV infection is negligible or nearly zero. restrained viral load.
Antiretroviral therapy continues to transform the lives of people living with HIV. People living with HIV can expect the same health and life expectancy as HIV-negative people if they are diagnosed early, treated and take their medicines as prescribed.
“For more than two decades, countries around the world have relied on WHO’s evidence-based guidelines for the prevention, testing and treatment of HIV infection,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The new guidelines we are announcing today will help countries use powerful tools with the potential to transform the lives of millions of people living with or at risk of HIV.”
By the end of 2022, 29.8 million of the 39 million people living with HIV were on antiretroviral therapy (meaning 76% of all people living with HIV), and nearly three-quarters (71%) of them were living HIV-suppressed. This means that the health of the person who is virally suppressed is well protected and there is no risk of transmitting her HIV to others. While this is very positive progress for adults living with HIV, it is a reality that requires urgent action as only 46% of children living with HIV are virally suppressed.
Below is a summary of other important scientific and normative updates to be presented by WHO at the IAS 2023 conference.
HIV and mpox
Analysis of global surveillance data reported to WHO during multinational outbreaks of mpox found that of more than 82,000 mpox cases, approximately 32,000 had information on HIV status. Of these, 52% were living with HIV, mostly men who have sex with men (MSM). And more than 80% reported sex as the most likely route of contracting mpox.
Of the 16,000 people diagnosed with mpox and living with HIV, about a quarter (25%) have advanced HIV disease or immunosuppression, increasing the risk of hospitalization and death. HIV-infected persons with good immunity who were on HIV treatment had hospitalization and death outcomes similar to those of HIV-negative persons.
Based on these findings, WHO recommends that countries integrate mpox detection, prevention and care into existing innovative HIV and STI prevention and control programmes.
To understand how to better prepare for and respond to future increases in mpox transmission, WHO led a rapid electronic survey in May 2023 to assess community experiences of mpox outbreaks in Europe and the Americas in 2022–2023.
More than 24,000 people participated in the survey, which focused on men who have sex with men, transgender and gender-diverse people, with a target audience of 16,875 responding to the survey. Nearly 51% changed their sexual behavior (such as reducing the number of sexual partners), and 35% maintained that change after one year. The findings of this study provide valuable insight into the experiences and needs of affected communities and highlight the importance of increasing access to mpox vaccination and diagnostics globally.
HIV and COVID-19
Latest analysis results The WHO global COVID-19 clinical platform to May 2023 found a persistently elevated risk of mortality among HIV-infected persons hospitalized with COVID-19 across predelta, delta, and omicron mutational waves, with an overall in-hospital mortality rate of 20%–24%. Mortality risk among HIV-uninfected persons was reduced by 53% to 55% during the Omicron variant wave compared to pre- and delta variant waves. However, for people living with HIV, the percentage reduction in mortality during the Omicron wave was modest compared to other waves (16% to 19%). This difference resulted in a 142-fold increased risk of death in her HIV-infected relatives during the Omicron wave period.
Common risk factors for in-hospital mortality across all variant waves of the pandemic were low CD4 counts (<200 cells/m3) and severe or severe COVID-19 illness on admission.
“Uncontrolled HIV remains a risk factor for poor prognosis and mortality in the mpox epidemic and COVID-19 pandemic,” said Dr Meg Doherty, Director of the WHO Global HIV, Hepatitis and STIs Programme. “We must ensure that HIV considerations are built into pandemic preparedness and response. Protecting people living with HIV from future pandemics is critical and reinforces the need to ensure access to life-saving HIV testing and treatment, mpox and preventive vaccines against COVID-19. A community-led response that is effective against HIV will also benefit future pandemics.”
Optimize HIV testing services by expanding testing options and simplifying service delivery
With its new recommendations on HIV testing, WHO calls on countries to increase access to HIV self-testing, facilitate testing through sexual and social networks to expand testing coverage, and strengthen access to HIV prevention and treatment services in high-burden settings and areas with the greatest disparities in testing coverage.
This recommendation comes at a pivotal time when self-care and self-testing are increasingly recognized as ways to increase access, efficiency, effectiveness and acceptability of healthcare across a range of disease areas, including HIV.
Primary health care and HIV
a A New Policy Framework on Primary Health Care (PHC) and HIV This will help decision makers optimize ongoing work and collaboration to advance primary health care and disease-specific responses, including HIV. In the second year of introduction, Global Health Sector Strategy on HIV, Viral Hepatitis and Sexually Transmitted Diseases 2022-2030 We actively advocate synergies within the framework of universal health coverage and primary health care.
“It is impossible to end AIDS without optimizing opportunities across and within health systems, including communities and primary health care settings,” said Dr. Jerome Salomon, Assistant Director-General for Universal Health Coverage, Communicable and Non-Communicable Diseases, WHO.
This latest research and guidance comes amid slow progress towards ending the global AIDS epidemic following the COVID-19 pandemic. But the reaction has caught up quickly, and some countries are now The road to AIDS eradicationIncludes Australia, Botswana, Eswatini, Rwanda, United Republic of Tanzania, Zimbabwe and 16 other countries that are close to reaching the 95-95-95 global goal of 95% of people living with HIV knowing their status, 95% of those diagnosed receiving ART, and 95% on treatment achieving viral load suppression.
Note to editors:
12th IAS HIV Science Conference
IAS 2023, 12th IAS HIV Science Conference It will take place in Brisbane from 23rd to 26th July 2023. This biennial conference will showcase important advances in basic, clinical and practical HIV research that translate science into policy and practice.
Find out more about WHO at the conference below. https://who.int/news-room/events/detail/2023/07/23/default-calendar/who-at-ias-conference-2023
