Forty years after the discovery of the AIDS virus, the advances are immense, but can we go further?
Absolutely, since there are just over 38 million people living with HIV in the world and more than 650,000 more people die of AIDS each year.
It means that we have not yet eradicated the disease, yet we have to get there since we know that with the treatments, people do not develop the disease. If we manage to treat 100% of infected people, they will no longer develop AIDS.
But a quarter of people living with HIV still do not have access to treatment for various reasons, including insufficient testing.
We must continue to develop access to treatment and care, and improve screening.
In 2021, in France, 30% of people who discovered their HIV status were at an advanced stage of infection. However, the faster you are treated, the more the life expectancy is the same as that of a person not infected with HIV, and the less you infect others. The messages obviously did not go over very well.
Stigmatization and discrimination remain present and can constitute obstacles to screening.
The Covid crisis also brought a halt to activity, which fell in 2020 by 14% compared to 2019, and only increased again by 8% in 2021.
In recent years, several cases of “cure” of HIV have been reported in patients after a bone marrow transplant to treat a tumor. Is it hope?
These are important advances for research because, thanks to these cases, we can learn which treatments to initiate to control the infection.
But we certainly cannot develop them on a large scale. These are extremely heavy treatments, offered to patients who had developed cancer. It was necessary to combine the transplant with immunosuppressive treatments (which reduce the action of the immune system, editor’s note)…
We can still learn a lot from these patients. This is why research is focusing on these cases as on “HIV controller” patients: rare HIV-positive people who were treated extremely soon after their infection and who manage to maintain a viral load low enough to be able to do without treatment.
Everything that we understand from these cases is extremely important for defining new therapeutic strategies. It will not be possible to eradicate HIV because this virus remains present in the body, including under treatment. But one of the main research priorities is that soon patients can take treatment for a certain time, stop it and that when treatment is stopped, the virus remains under control.
What about a possible vaccine?
For the moment, we have no candidate vaccine that has shown its effectiveness. This does not mean that research on this subject stops. There are RNA vaccine candidates being studied at the moment, but we are not in the same context as Covid: we are facing a much more complicated virus which attacks immune defense cells. Research is progressing, I’m just a little worried to see that fewer and fewer young people are interested in HIV research, in science at all.
For AIDS, we are lucky to have treatments but also prevention, pre-exposure prophylaxis (PreP) which works very well and which needs to be developed while waiting for the vaccines of the future.