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Editorial
. 2016 Jun 22;14(1):94.
doi: 10.1186/s12916-016-0640-4.

Beyond viral suppression of HIV - the new quality of life frontier

Jeffrey V Lazarus  1   2 , Kelly Safreed-Harmon  3 , Simon E Barton  4 , Dominique Costagliola  5 , Nikos Dedes  6 , Julia Del Amo Valero  7 , Jose M Gatell  8 , Ricardo Baptista-Leite  9   10 , Luís Mendão  6 , Kholoud Porter  11 , Stefano Vella  12 , Jürgen Kurt Rockstroh  13
Affiliations
Editorial

Beyond viral suppression of HIV - the new quality of life frontier

Jeffrey V Lazarus et al. BMC Med. .

Abstract

Background: In 2016, the World Health Organization (WHO) adopted a new Global Health Sector Strategy on HIV for 2016-2021. It establishes 15 ambitious targets, including the '90-90-90' target calling on health systems to reduce under-diagnosis of HIV, treat a greater number of those diagnosed, and ensure that those being treated achieve viral suppression.

Discussion: The WHO strategy calls for person-centered chronic care for people living with HIV (PLHIV), implicitly acknowledging that viral suppression is not the ultimate goal of treatment. However, it stops short of providing an explicit target for health-related quality of life. It thus fails to take into account the needs of PLHIV who have achieved viral suppression but still must contend with other intense challenges such as serious non-communicable diseases, depression, anxiety, financial stress, and experiences of or apprehension about HIV-related discrimination. We propose adding a 'fourth 90' to the testing and treatment target: ensure that 90 % of people with viral load suppression have good health-related quality of life. The new target would expand the continuum-of-services paradigm beyond the existing endpoint of viral suppression. Good health-related quality of life for PLHIV entails attention to two domains: comorbidities and self-perceived quality of life.

Conclusions: Health systems everywhere need to become more integrated and more people-centered to successfully meet the needs of virally suppressed PLHIV. By doing so, these systems can better meet the needs of all of their constituents - regardless of HIV status - in an era when many populations worldwide are living much longer with multiple comorbidities.

Keywords: AIDS; HIV; Health policy; Health systems.

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Figures

Fig. 1
Fig. 1
The ‘fourth 90’: proposed revision to the UNAIDS 90-90-90 targets*
Fig. 2
Fig. 2
Expanding the HIV continuum of care cascade: an example using data from Vietnam*
Fig. 3
Fig. 3
Expanding the HIV continuum of care cascade: an example using data from Switzerland*
See this image and copyright information in PMC

References

    1. World Health Organization. Draft global health sector strategy on HIV, 2016–2021 [Draft 01.12.2015]. 2015. http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_31-en.pdf?ua=1. Accessed 25 April 2016.
    1. UNAIDS. 90–90–90: an ambitious treatment target to help end the AIDS epidemic. 2014. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Accessed 25 April 2016.
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