Laura Waters
Chair, BHIVA
Since it first emerged as a global health issue in the 1980s, the outlook for people living with HIV has been transformed from a terminal illness to a long-term condition, thanks to better testing and effective treatment.
Untreated HIV damages the immune system, leaving people at risk of infections and cancer. However, medication allows immune recovery, by stopping the virus from reproducing, and suppressing it to undetectable levels in the blood.
People with HIV in the UK who are on effective treatment can therefore expect a normal lifespan and cannot pass the virus on to their sexual partners. One of the most prominent HIV messages in recent years is ‘Undetectable = Untransmittable’ (or U=U).
Risks of late diagnosis
All this good news does not, however, mean our work is done. In the UK we know that about one in 12 people with HIV do not know they have it – people with undiagnosed HIV may end up being diagnosed late and can pass HIV on to their sexual partners. Late diagnosis means that their immune system may already be damaged and result in an eight times higher risk of death in the first year after diagnosis.
Testing in line with recommendations is not only cost-effective but essential. Barriers to adoption include medical staff being reluctant to discuss testing, as well as perceived cost, although HIV testing does not require special counselling.
Reduced access to sexual health and other services as a result of the COVID-19 pandemic has undoubtedly had an impact on testing. But it may also have improved availability in some hospitals that are offering HIV tests to people presenting COVID-19 symptoms.
People with HIV in the UK who are on effective treatment can therefore expect a normal lifespan and cannot pass the virus on to their sexual partners. One of the most prominent HIV messages in recent years is ‘Undetectable = Untransmittable’ (or U=U).
Finding the best treatment options
HIV treatment can be challenging for some patients in terms of side effects and taking pills every day. This is where new research is crucial; longer lasting injectable treatment is now on the horizon and is much preferred by patients in trials.
Other long-acting options, such as pills taken once a week, once a month, implants and patches, are in development. This means people living with HIV can look forward to a choice of treatment delivery options in the future.
Prioritising crucial research
Despite a normal life expectancy, people with HIV remain at greater risk of some age-related illnesses like heart, kidney and bone disease. Some of this may be down to HIV drugs, so studies to understand the long-term side effects, and how to prevent them, are crucial.
Inevitably the necessary priority given to COVID-19 research has had a massive impact on research for conditions like HIV. Co-ordinated planning, prioritisation and the streamlining of trial design, will be key to making the most of our research opportunities in the aftermath of the pandemic.
Implementing integrated care
For three successive years HIV care in the UK has achieved excellent outcomes, surpassing UNAIDS 90:90:90 targets (90% of people with HIV diagnosed, 90% of diagnosed people on treatment, and 90% of people on treatment undetectable).
Last year 97% of all people on treatment in the UK were in fact undetectable. Although numbers of new HIV diagnoses continue to plummet in gay and bisexual men, through better testing and prevention we must ensure that this is replicated in all others.
To succeed we must banish the still prevalent spectre of stigma, provide integrated HIV care and ensure that people with HIV can access the broad range of medical, psychological and social care they may need as they grow older.