Lessons from the 9th IAS confab 2017

In Ghana, according to the 2015 estimates by The Joint United Nations Programme on HIV and AIDS (UNAIDS), there are about 270,000 people living with the Human Immunodeficiency Virus (HIV), with the prevalence rate of the infection being 1.6 per cent in those aged 15 to 49 years.

While these figures may not be staggering, in comparison to other countries in Sub-Saharan Africa, HIV/AIDS is still a relevant topic to address in Ghana because there has been an increase in these figures since 2012 (when prevalence rate was 0.9 per cent and 200,000 people lived with the infection).

To further highlight the current status at the time of writing this article in my small practice this week, I diagnosed three new patients with HIV. It is a sharp reminder to everyone that HIV/AIDS is still real and pertinent in our country (and globally) today.

I had the privilege of attending the 9th International Conference on HIV science, organised by the International AIDS Society (IAS), in Paris recently. This biennial event, one of the biggest and renowned scientific gatherings to deliberate on HIV/AIDS globally, was well attended and insightful.
This year’s conference brought together researchers, medical practitioners, HIV/AIDS professionals, advocates, people living with AIDS (PLWA), pharmaceutical companies and other stakeholders. One of the key objectives of the conference was to highlight the fact that ‘HIV science matters’, with the focus on ‘implementation – moving scientific advances into practice’.

The well-organised conference featured several sessions and workshops over four days. Key lessons learnt were:

•New guidelines on the management of HIV drug resistance by The World Health Organisation (WHO).

Drug resistance has been identified with some antiviral drugs, particularly Nevirapine and Efavirenz, which are in a class of drugs referred to as non-nucleoside reverse transcriptase inhibitors (NNRTI).

In most countries, they tend to be the first line drugs prescribed. According to the WHO HIV Drug Resistance Report this year, resistant HIV strains were identified in naive patients.

These patients, reported in parts of Asia, Africa and Latin America, were more than 10 per cent, making it expedient that such countries consider revising their HIV treatment plan. The recommendations included the use of Dolutegravir, which belongs to a class known as Integrase Inhibitors, as first line treatment in such countries. It was advocated that drug resistance surveillance be implemented globally, along with increasing viral load testing, where feasible, so as to pick up resistant cases quickly and treat them accordingly.

•There was commitment by the HIV/AIDS community to the 90-90-90 target set by the United Nations Programme on HIV/AIDS. It is the aim that ‘‘90 per cent of all people living with HIV will know their status; 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90 per cent of all people receiving antiretroviral therapy will have viral suppression’’ by 2020 In order to achieve this, it was the society’s advocacy for research into the science of HIV, novel drug formulation, vaccine development, support for people living with HIV, accessible prevention measures and continuous funding opportunities.

• Affordable drugs for all was a recurring theme in many sessions. There was a call for more drug research, development and availability of affordable generic drugs for HIV; as well as for co-infections such as hepatitis C, which are currently very expensive.

•Key strategies for the prevention of mother-to-child infection transmission (with research findings supporting the use of Raltegravir); intensifying advocacy for preventive measures and pre-exposure prophylaxis; surveillance and treatment of concomitant sexually transmitted illnesses, were also addressed.

• Presentations on various research findings on multiple co-infections and co-morbidities were made. These included tuberculosis, hepatitis B and C. Consideration, early detection and management of these conditions, including non-communicable diseases and malignancies, were advised to enhance the quality of life of People Living With Aids.

•Active participation and testimonies of PLWA brought to bear the continuous social issues of discrimination and stigmatisation associated with HIV/AIDS. Multifaceted strategies need to be considered in addressing these issues. These include education, focusing on at-risk populations, need for political involvement and fostering international partnerships.

Despite the challenges facing this sphere of medicine, it was encouraging to learn that last year, out of the 36.7 million people with HIV globally, more than half (19.5 million) were on medication. Additionally, mortality associated with the infection has reduced by 48 per cent.

Nevertheless, the global community must not rest on its oars and for that matter, Ghana. There is still a lot to be done to combat HIV infection. Education on the condition, stress on prevention, voluntary testing/early detection, prompt treatment for ALL, further research, affordable and sustainable supply of drugs and continuous monitoring, would go a long way in helping to achieve the 90-90-90 goal.

We should also be mindful of the social aspects of HIV/AIDS, particularly stigmatisation, and treat people with the dignity and respect they deserve, just as we do. We are all one.