Evaluating progress on the prevention, treatment and cure of HIV infection: Week 1 of the PLOS Medicine Special Issue on HIV/AIDS

Senior Editor Richard Turner discusses the content published in week 1 of the PLOS Medicine Special Issue on HIV/AIDS.

This week, PLOS Medicine begins publication of a Special Issue on Advances in HIV Prevention, Treatment and Cure, advised by Guest Editors Linda-Gail Bekker, Steven Deeks and Sharon Lewin of the Desmond Tutu HIV Centre, University of Cape Town, South Africa; the University of California, San Francisco, USA; and the Peter Doherty Institute of Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Australia, respectively. The issue will feature research and discussion content addressing one of the world’s most critical health challenges.

Developing scientific and societal solutions to control the spread of the HIV epidemic has been a long struggle, drawing on commitment and advocacy from many quarters, including researchers, donors, activists and patients, including many in low- and middle-income countries. Today, potent methods for prevention and treatment of HIV infection are widely available, but the wide geographic spread of the virus and its prevalence within vulnerable population groups mean that the scale of the epidemic remains a serious problem—in 2016, there were an estimated 1.8 million new HIV infections and 1 million deaths from AIDS-related illnesses, a large proportion in low- and middle-income countries.

In a Research Article in PLOS Medicine, Tonia Poteat and colleagues address the situation of a key population at risk of HIV/AIDS—transgender women and men who have sex with men (MSM) in Africa. In an analysis of survey data on more than 4,500 participants from 8 countries, Poteat and colleagues document a greater risk of HIV infection for transgender women as compared with other MSM, and report on behavioural risk factors associated with HIV infection and on participants’ experiences of stigma and violence. Such findings should be valuable in guiding the design of programmes to engage with, and address the challenges around provision of prevention and care for, this at-risk group.

With the goal of ending the HIV epidemic in mind, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set demanding targets for achieving high coverage of HIV testing, as well as effective and sustained treatment of people who are infected, across all countries. As an example of the issues of engaging and retaining patients in care, Samantha Kaplan and colleagues report in their Research Article on a longstanding programme for provision of HIV therapy in Khayelitsha township in South Africa. The authors estimate that around 25% of patients disengaged from care over 2 years, although a proportion of these patients were found to have subsequently re-engaged in care. These findings indicate the difficulties of providing effective therapy for a mobile population in such settings.

In a further Research Article, Margaret McNairy and colleagues report the findings of Link4Health, a cluster-randomized trial carried out in Swaziland. With an aim of improving the engagement of and retention in care of people with HIV, the authors tested a combination intervention including prompt HIV testing and initiation of antiretroviral therapy, together with other approaches to support provision of care. Substantial benefits in engagement and retention in care up to 1 year are reported, indicating the promise of combined approaches to increase population coverage with effective treatment. In a Perspective entitled “Reaching global HIV/AIDS goals: What got us here, won’t get us there”, Wafaa El-Sadr and coauthors discuss the importance of tailoring HIV therapy and care to specific settings and population groups.

The ultimate solution to the HIV/AIDS epidemic would be to develop a reliable method to cure HIV infection, but to date this has been achieved very rarely. Timothy Henrich and colleagues address this topic in a Research Article, in which they describe detailed studies carried out on two people participating in pre-exposure prophylaxis programmes. These individuals started antiretroviral treatment a few days after HIV infection, and one patient subsequently underwent an analytical treatment interruption; Henrich and colleagues studied the characteristics and distribution of the viral reservoir for more than two years. Although cure was not achieved in either of these patients, such analyses should be able to inform future strategies intended to eradicate HIV from people with the infection.

Effective antiretroviral therapy means that people are now living with HIV for many years, and large population studies such as D:A:D (Data collection on Adverse events of Anti-HIV Drugs) are important to monitor the long-term effects of HIV infection on the immune system and associated disease sequelae, and on the adverse effects of antiretroviral drugs. Mark Boyd and colleagues, in their Research Article, study patients at elevated risk of cardiovascular and renal disease among more than 27,000 participants in the D:A:D study, and report a multiplicative increase in the risk of events in those patients judged to be at risk of both types of disease.

The issue will continue for the next several weeks with further research and commentary papers—to view the papers, visit the Special Issue Collection.

Feature image: US Marine Corps, Wikimedia, Public Domain