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The art of HIV elimination: past and present science

The art of HIV elimination: past and present science
The art of HIV elimination: past and present science
Introduction: Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges.

Discussion: In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another. More recently, it has become clear that combination prevention strategies targeted to high transmission geographies and people at most risk of infections are required to achieve epidemic control. Biomedical strategies such as male medical circumcision and antiretroviral therapy for treatment in HIV-positive individuals and as preexposure prophylaxis in HIV-negative individuals provide immense promise for the future of HIV control. In resourcerich settings, the threat of HIV treatment optimism resulting in increased sexual risk taking has been observed and there are concerns that as ART roll-out matures in resource-poor settings and the benefits of ART become clearly visible, behavioural disinhibition may also become a challenge in those settings. Unfortunately, an efficacious vaccine, a strategy which could potentially halt the HIV epidemic, remains elusive.

Conclusion: Combination HIV prevention offers a logical approach to HIV control, although what and how the available options should be combined is contextual. Therefore, knowledge of the local or national drivers of HIV infection is paramount. Problems with the HIV care continuum remain of concern, hindering progress towards the UNAIDS target of 90-90-90 by 2020. Research is needed on combination interventions that address all the steps of the cascade as the steps are not independent of each other. Until these issues are addressed, HIV elimination may remain an unattainable goal.
2155-6133
1-10
Lwuji, C.C.
c62997f8-9fde-43e2-9512-1e2308f7be65
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
de Oliveira, T.
c657f813-01c5-4700-bc81-f34b163b8003
Porter, K.
461d2468-38d4-4d20-ae03-ddc0d62ca834
Pillay, D.
f5be10ef-edf2-46b9-9c80-61d6a6ed7ce4
Fisher, M.
1ba6a9e9-9021-4c95-8423-4f04c52b6f9e
Newport, M.
f6dce245-f7a4-4a00-9336-79bd12f372df
Newell, M.-L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Lwuji, C.C.
c62997f8-9fde-43e2-9512-1e2308f7be65
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
de Oliveira, T.
c657f813-01c5-4700-bc81-f34b163b8003
Porter, K.
461d2468-38d4-4d20-ae03-ddc0d62ca834
Pillay, D.
f5be10ef-edf2-46b9-9c80-61d6a6ed7ce4
Fisher, M.
1ba6a9e9-9021-4c95-8423-4f04c52b6f9e
Newport, M.
f6dce245-f7a4-4a00-9336-79bd12f372df
Newell, M.-L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3

Lwuji, C.C., McGrath, N., de Oliveira, T., Porter, K., Pillay, D., Fisher, M., Newport, M. and Newell, M.-L. (2015) The art of HIV elimination: past and present science. Journal of Aids and Clinical Research, 6 (11), 1-10. (doi:10.4172/2155-6113.1000525).

Record type: Article

Abstract

Introduction: Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges.

Discussion: In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another. More recently, it has become clear that combination prevention strategies targeted to high transmission geographies and people at most risk of infections are required to achieve epidemic control. Biomedical strategies such as male medical circumcision and antiretroviral therapy for treatment in HIV-positive individuals and as preexposure prophylaxis in HIV-negative individuals provide immense promise for the future of HIV control. In resourcerich settings, the threat of HIV treatment optimism resulting in increased sexual risk taking has been observed and there are concerns that as ART roll-out matures in resource-poor settings and the benefits of ART become clearly visible, behavioural disinhibition may also become a challenge in those settings. Unfortunately, an efficacious vaccine, a strategy which could potentially halt the HIV epidemic, remains elusive.

Conclusion: Combination HIV prevention offers a logical approach to HIV control, although what and how the available options should be combined is contextual. Therefore, knowledge of the local or national drivers of HIV infection is paramount. Problems with the HIV care continuum remain of concern, hindering progress towards the UNAIDS target of 90-90-90 by 2020. Research is needed on combination interventions that address all the steps of the cascade as the steps are not independent of each other. Until these issues are addressed, HIV elimination may remain an unattainable goal.

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Accepted/In Press date: 25 November 2015
Published date: 30 November 2015
Organisations: Faculty of Medicine

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Local EPrints ID: 386057
URI: http://eprints.soton.ac.uk/id/eprint/386057
ISSN: 2155-6133
PURE UUID: e0e08c07-a7bc-4e5c-8900-94d09a9a7b4f
ORCID for N. McGrath: ORCID iD orcid.org/0000-0002-1039-0159
ORCID for M.-L. Newell: ORCID iD orcid.org/0000-0002-1074-7699

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Date deposited: 27 Jan 2016 16:37
Last modified: 18 Feb 2021 17:22

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Contributors

Author: C.C. Lwuji
Author: N. McGrath ORCID iD
Author: T. de Oliveira
Author: K. Porter
Author: D. Pillay
Author: M. Fisher
Author: M. Newport
Author: M.-L. Newell ORCID iD

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