Eliminating New HIV Infections by 2030

Eliminating New HIV Infections by 2030
COMMENTARY
December 1, 2020
Senior Vice President, CVS Health and Chief Medical Officer, CVS Caremark

The ‘Ending the HIV Epidemic: A Plan for America’ (EHE) initiative by the U.S. Department of Health and Human Services (HHS) aims to reduce new HIV infections by 75 percent by the middle of this decade and at least 90 percent by 2030, with the goal of ending the HIV epidemic in the U.S.https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview.

That’s a worthy goal we should all work together to achieve. For far too long, the HIV/AIDS epidemic has claimed the lives of hundreds of thousands of people in America, and around the globe. More than 700,000 Americans have died of HIV/AIDS since 1981 and more than 1.1 million are known to be living with it now.https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Many more continue to be at risk.

Education, additional treatment options and a great deal of outreach helped make significant progress in bringing down the number of new HIV infections each year, but that progress has stalled. An estimated 400,000 are expected to be diagnosed with the virus over the next decade and many more may acquire it without being aware of their positive status.https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview According to HIV.gov, a coalition of agencies across HHS leading the EHE initiative, there is a real risk of the epidemic resurging because of “trends in injection drug use; HIV-related stigma; homophobia; lack of access to HIV prevention, testing, and treatment; and a lack of awareness that HIV remains a significant public health threat.”

Ending the epidemic will not be easy, but it is achievable. Three factors will play a key role:

Pictogram of extended hand Education and awareness Pictogram of pill bottle Access to pre- and post-exposure preventive treatments Pictogram of a calendar and a pill bottle Widespread testing and timely treatment
Education and awareness
Pictogram of a calendar and a pill bottle Access to pre- and post-exposure preventive treatments
Pictogram of a calendar and a pill bottle Widespread testing and timely treatment

Education and Awareness

Education about HIV/AIDS should include building awareness about its prevalence and its deadly nature if left untreated. However, it is equally important to help those affected by the disease, and those at risk understand “harm reduction.” Approximately 80 percent of new HIV transmissions are from persons who do not know they have HIV infection or are not receiving regular care.. https://www.cdc.gov/mmwr/volumes/68/wr/mm6811e1.htm?s_cid=mm6811e1_w. Education can not only help those at-risk develop and maintain safer behaviors, but also help reduce stigma and discrimination toward those affected by, and living with, HIV.https://www.unaids.org/en/resources/presscentre/featurestories/2014/april/20140401unesco

Harm reduction strategies aim to help reduce behaviors such as injected drug use and risky sexual practices.https://www.niaid.nih.gov/diseases-conditions/harm-reduction. These include:

Checkmark Awareness about sexually transmitted diseases
Checkmark Education about safe sex practices
Checkmark Peer-based education about risks of shared needle use
Checkmark Awareness of pre- and post-exposure treatments

It is important to note that the HIV epidemic disproportionately affects communities of color and younger populations. In 2018, Black Americans and African Americans accounted for 45.4 percent of 37,968 people who received an HIV diagnosis, while Hispanics/Latinos made up 22.4 percent.https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics. By age group, 31.5 percent of annual infections were among those aged 25-34, and 16.9 percent among those aged 35-44. Awareness efforts should be culturally competent. Educational efforts will need to speak to the unique needs and issues facing these communities.

Prevention

Prevention is possibly the single-most important component of ending the HIV epidemic. A variety of strategies can be brought to bear, including providing convenient access to supplies for safe sex and needle exchange programs. Anti-retroviral therapies (ART) can also help prevent transmission both from someone who has been diagnosed with HIV to another person, as well as from mother to child among pregnant women.

Relatively recent breakthroughs mean we now have preventive treatments — medications that can help prevent someone from contracting HIV. Prophylaxis can be pre-exposure — also known as PrEP — or post-exposure — also known as PEP. PrEP medications are oral medications taken daily. The goal of prophylactic treatment is to prevent the virus from taking hold and spreading through the body. The Centers for Disease Control and Prevention (CDC) recommends only using PEP in emergency situations and within 72 hours of exposure.https://www.cdc.gov/hiv/basics/pep.html.

Daily prescription pill container pictogram

Reduction in risk of contracting HIV with PrEP:https://www.cdc.gov/hiv/basics/prep.html.

99%
from sexual contact

74%
from injected drugs

Reduction in risk of contracting HIV with PrEP:9
Pictogram of a calendar and a pill bottle 99%
from sexual contact
Pictogram of a calendar and a pill bottle 74%
from injected drugs

PrEP can reduce the risk of contracting HIV from sexual contact by approximately 99 percent, and from injected drugs by at least 74 percent, according to the CDC.https://www.cdc.gov/hiv/basics/prep.html. Currently, available daily PrEP medications include Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine and tenofovir alafenamide). Options for prophylactic treatments continue to expand with the launch of a U.S. Food and Drug Administration-approved generic PrEP therapy.https://www.tevapharm.com/news-and-media/latest-news/teva-launches-first-generic-versions-of-hiv-1-treatments-truvada-emtricitabine-200-mgtenofovir-disopro/.

The World Health Organization has stated, that while PrEP treatments are highly effective, adherence has been a challenge and inconsistent use reduces the prevention effect. Another potential preventive treatment in the pipeline has shown promising results in clinical trials and could become the first long-acting treatment that could help mitigate the risks of non-adherence. Cabotegravir, an injectable currently approved as a long-lasting ART, was significantly more effective in preventing HIV transmission than a daily oral regimen.https://www.nih.gov/news-events/news-releases/long-acting-injectable-form-hiv-prevention-outperforms-daily-pill-nih-study. If approved for prevention, it could help improve prevention efforts without requiring adherence to a daily oral regimen, and also increase treatment options.

HIV Testing and Treatment

One in seven people living with HIV in the U.S. is unaware of their positive status.https://www.cdc.gov/std/sam/gyt/.

For the best possible outcomes, early diagnosis is critical. And yet, 14 percent of those living with HIV in the U.S. — one in seven people — including nearly 45 percent of those aged 13-24, do not know about their positive status, according to the CDC.https://www.cdc.gov/std/sam/gyt/.

Getting tested for HIV is the only way to know for sure if someone has HIV. The agency recommends that everyone aged 13-64 should get tested at least once, and those at higher risk of exposure — or acquiring HIV — should be tested at least annually or more frequently. Getting tested not only helps ensure that anyone infected can get proper treatment. If someone has their viral load under control through treatment, they are less likely to transmit the infection to someone else. Most health care providers offer HIV testing. People can also get tested at health, family planning and sexual health clinics, community health centers, local health departments, substance abuse prevention or treatment programs, or veterans’ affairs medical centers. Many pharmacies also offer HIV testing.

In addition to helping prevent transmission, ART regimens have helped dramatically reduce morbidity and mortality, as well as AIDS- and non AIDS-related complications. These treatments have helped bring life expectancy for those with HIV to nearly at par with the general population.

Since the introduction of ARTs, treatment options have expanded significantly and newer agents are more potent, better tolerated and often display less toxicity compared with earlier therapy options.https://www.uptodate.com/contents/when-to-initiate-antiretroviral-therapy-in-persons-with-hiv?search=antiretroviral%20therapy&topicRef=13978&source=see_link#H84590753. Treatment regimens today are also more simplified, which has helped improve adherence and lessen the risk of developing virologic failure with drug-resistant virus.

What Employers/Businesses Can Do

Employers can help support the fight against HIV/AIDS.

Do you want to learn how we can end new HIV infections by 2030? Ask Us
COMMENTARY
December 1, 2020
Senior Vice President, CVS Health and Chief Medical Officer, CVS Caremark
THIS INSIGHT ADDRESSES

CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.

Image source: Licensed from Getty Images, 2020.

©2020 CVS Health. All rights reserved.