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Review
. 2024 Jul;11(7):e489-e494.
doi: 10.1016/S2352-3018(24)00098-5.

Is HIV epidemic control by 2030 realistic?

Chris Beyrer  1 , Georgia D Tomaras  2 , Huub C Gelderblom  3 , Glenda E Gray  4 , Holly E Janes  3 , Linda-Gail Bekker  5 , Gregorio Millett  6 , Giuseppe Pantaleo  7 , Susan Buchbinder  8 , Lawrence Corey  3
Affiliations
Review

Is HIV epidemic control by 2030 realistic?

Chris Beyrer et al. Lancet HIV. 2024 Jul.

Abstract

Rates of new HIV acquisition remain unacceptably high in most populations in low-income, middle-income, and high-income settings despite advances in treatment and prevention strategies. Although biomedical advances in primary prevention of new infections exist, systematic scale-up of these interventions has not occurred at the pace required to end AIDS by 2030. Low population coverage, adherence to oral pre-exposure prophylaxis in settings with high rates of HIV acquisition, and the fact that a significant proportion of new HIV infections occurs in populations not identified as high risk and are hence not targeted for prevention approaches impedes current prevention strategies. Although long-acting injectables and monoclonal antibodies are promising approaches to help reduce incidence, high cost and the need for high coverage rates mean that a vaccine or vaccine-like intervention still remains the most likely scenario to produce a population-level impact on HIV incidence, especially in countries with generalised epidemics. Current global efforts are not sufficient to meet 2030 HIV epidemic goals; acknowledgment of this issue is required to ensure persistent advocacy for population-based control of the ongoing HIV pandemic.

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Conflict of interest statement

Declaration of interests SB receives grants paid to institution from Gilead, ViiV, GSK, and Merck. LC reports grants from the National Institute of Allergy and Infectious Diseases and National Institutes of Health paid to institution. GDT reports grants from National Institutes of Health paid to institution and contracts from Janssen, Regeneron, BioNTech, and Sanofi and honorariums for scientific advisory boards from Michelson Prizes, Gilead Scholars, University of Alabama, University of North Carolina, Emory University, and NIH Vaccine Research Center. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.. HIV-1 incidence estimates among female placebo recipients in recent HIV prevention efficacy trials in sub-Saharan Africa (A) and South Africa (B).
Figure 2.
Figure 2.. HIV-1 incidence estimates among MSM/transgender persons placebos worldwide (A) and in US (B).
Figure 3.
Figure 3.. Number needed to treat to prevent HIV infections using PrEP among high likelihood (HIV incidence > 3%/YR and medium to low likelihood (HIV incidence < 3%/YR) persons in sub-Saharan Africa.
In this example, 20% of the population is considered at high likelihood of HIV acquisition (HIV incidence ≥ 3%, with 6 HIV infections among 200 persons, i.e., 1 in 33 acquire HIV), and 80% of the population is considered at low or medium likelihood of HIV acquisition (HIV incidence < 3%, with 4 HIV infections among 800 persons, i.e., 1 in 200 acquire HIV). The number needed to treat (NNT) to prevent 1 HIV acquisition is 200 / 6 = 33 in the high- likelihood category, and 800 / 4 = 200 in the low-medium likelihood category, and 1000 / 10 = 100 for the entire population.
See this image and copyright information in PMC

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