South Africa has the highest HIV epidemic in the world, with 7.97 million people living with HIV. The UNAIDS reports that in 2018, 240 000 people were newly infected with HIV in our country and 71 000 people died from an AIDS-related illness.
But while the figures may seem bleak, the number of new HIV infections fell from 390 000 to 240 000 within the same period.
Ahead of World Aids Day, experts within the field of HIV/Aids spoke at the Cipla HIV/Aids press workshop and answered some pivotal questions. Health24 also spoke to Professor Ian Sanne, Divisional Head at the Clinical HIV Research Unit (CHRU) and CEO of Right to Care, on how close we are to combatting the demon of HIV.
Searching for a cure: how far away are we?
While HIV prevention and treatment have come a long way within recent years, a cure for the HIV-positive population is still many miles away, say experts.
“There’s a glimmer of hope, but we’re not there yet. And we can’t give people false hope,” said Dr Sindi van Zyl, a specialist in the HIV and Aids field, at the Cipla HIV/Aids press workshop this week.
“One day we will have a cure, but for now, we applaud the scientists for their ongoing research and we look forward to that cure.”
What about a vaccine?
With vaccines being trialled around the world and results said to be expected around 2023, we asked Professor Sanne whether this is realistic.
“Vaccine development is well underway, and full protection against HIV would probably include a combination of monoclonal antibodies and a vaccine, but we are hoping that the current studies that are underway will generate at least partial immunity to HIV.
“Clinical trials are currently being conducted, and they are powered on the new cases that are identified. Should the vaccine arm do better than the control arm, then the Data and Safety Monitoring Board (DSMB) will look at the data for six months in a blinded fashion.
“If they see a significant difference, they will stop the study and announce the results, and it could happen earlier than 2023, but I’m not allowed to say more,” adds Sanne.
Dolutegravir: New ARV shows promising results, but we should tread lightly
South African Health Minister Zweli Mkhize announced on 27 November the launch of a new three-in-one pill for HIV that could help people suffer fewer side effects than the older drugs and accelerate viral suppression (so those living with HIV may not be able to transmit the virus) in those living with HIV throughout the country.
The new pill is a combination of tenofovir, lamivudine and dolutegravir and will replace efavirenz, an older medicine. However, we should note a few things, says Dr Michelle Moorhouse, co-principal investigator of ADVANCE and Head of treatment strategies at Ezintsha.
“Dolutegravir was just launched, and although the efficacy and safety profile appears to yield positive results, clinical trials based on this drug are very different from the real world of medical practice and care, and we should remember that no drug is safe and effective for everybody,” she explained, adding:
“When drugs are approved there are many data gaps. Registrational studies do not enroll populations representative of the demographics of the HIV portfolio and many important populations are excluded from the Randomised Controlled Trials (RCTs).
Moorhouse also explained that ADVANCE, an ongoing 96-week study being conducted in inner city Johannesburg in South Africa, has highlighted the importance of studying newer ARVs in African populations, and has shown that efavirenz does perform well for some people, and says that we shouldn’t be quick to vilify older drugs as they may still have a role in ART.
What happens if patients develop resistance to the new pill?
“If this happens, we would definitely be willing to switch people back to efavirenz, but we anticipate that more than 90% of people will do well on dolutegravir,” says Sanne.
The UN’s 90-90-90 target
The United Nations announced an ambitious treatment target in 2013 to help end the HIV/Aids epidemic in countries around the world, and they include the following:
- By 2020, 90% of all people living with HIV will know their HIV status.
- By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
- By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
This target setting was ambitious, and correctly so, says Sanne.
“It [target] has honed the health system to actually increase the activities in the most under-served communities, and with that we are rapidly progressing with the number of patients that are coming forward for testing and are being put onto treatment,” he adds.
However, out of South Africa’s total population of 7.97 million living with HIV, 3 million people are still not on treatment. The key to reaching these targets are testing, counselling and ensuring that there is an ongoing and reliable source of ARVs, says Dr Moeketsi Mathe, Board member of the Southern African HIV Clinicians Society.
“We need to offer HIV testing broadly, start healthy HIV-positive people on lifelong treatment, and provide counselling to explain the benefits of treatment,” says Mathe.
To achieve the third target, drug adherence plays a key role.
“We need to ensure that patients actually swallow their pills, and for this to happen, there needs to be access to effective, tolerable and cost-effective drugs.
“If you’re unable to swallow a pill because of the size of it, for example, it doesn’t matter how great it is – you’re not going to take it. And if it makes you feel horrible, however good that pill is, you’re just not going to take it.
“The biggest determinant of whether a person will swallow a pill is the tolerance of it. So the two important questions are: can they take it, and how does it make them feel?”
*World Aids Day has been taking place on 1 December every year since 1988, and is dedicated to raising awareness of the Aids pandemic, caused by the spread of HIV infection, and mourning those who have died of the disease.