Understanding Hiv/aids

GLOBAL STATISTICS
17 million people were accessing antiretroviral therapy
36.7 million [34.0 million–39.8 million] people globally were living with HIV
2.1 million [1.8 million–2.4 million] people became newly infected with HIV
1.1 million [940 000–1.3 million] people died from AIDS-related illnesses
78 million [69.5 million–87.6 million] people have become infected with HIV since the start of the epidemic
35 million [29.6 million–40.8 million] people have died from AIDS-related illnesses since the start of the epidemic
People living with HIV
In 2015, there were 36.7 million [34.0 million–39.8 million] people living with HIV.
People living with HIV accessing antiretroviral therapy
As of December 2015, 17 million people living with HIV were accessing antiretroviral therapy, up from 15.8 million in June 2015 and 7.5 million in 2010.
46% [43–50%] of all adults living with HIV were accessing treatment in 2015, up from 23% [21–25%] in 2010.
49% [42–55%] of all children living with HIV were accessing treatment in 2015, up from 21% [18–23%] in 2010.
77% [69–86%] of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their babies in 2015.
New HIV infections
New HIV infections have fallen by 6% since 2010.
Worldwide, 2.1 million [1.8 million–2.4 million] people became newly infected with HIV in 2015, down from 2.2 million [2 million–2.5 million] in 2010.
New HIV infections among children have declined by 50% since 2010.
Worldwide, 150 000 [110 000–190 000] children became newly infected with HIV in 2015, down from 290 000 [250 000–350 000] in 2010.
AIDS-related deaths
AIDS-related deaths have fallen by 45% since the peak in 2005.
In 2015, 1.1 million [940 000–1.3 million] people died from AIDS-related causes worldwide, compared to 2 million [1.7 million–2.3 million] in 2005.

European demonstration projects and opinions on PrEP
A meeting a month ago at the European Centre for Disease Control (ECDC) in Stockholm found that cost was regarded as the biggest barrier to the adoption of HIV pre-exposure prophylaxis (PrEP) by European countries. Many regarded significant price reductions in the drugs used as a pre-condition for adopting PrEP.
The ECDC held the meeting to discuss considerations for PrEP implementation throughout Europe and invited clinicians, researchers, epidemiologists, community advocates and, significantly, a high proportion of representatives from various countries’ Ministries of Health – the people who would actually make recommendations on PrEP to their governments.
The ECDC conducted a survey of 31 European countries as part of the monitoring work it does on the implementation of the 2004 Dublin Declaration on fighting HIV in Europe and Central Asia. It found that 17 countries ranging from Portugal to Azerbaijan had demonstration projects of PrEP either in progress or planned.
It also asked: “What issues are limiting or preventing the implementation of PrEP in your country?” By far the most common issue cited was cost. Twenty-one out of the 31 countries considered the cost of PrEP drugs as a highly important limiting factor and only two considered it of low importance; the second most important limiting factor was the cost of service delivery, which 11 countries considered as highly important and again only two of low importance.
Compared with these, the medical or moral objections often used against PrEP were less often cited. While lower condom use as a possible consequence of PrEP was cited by 20 countries as of some importance only five thought it was of high importance and increases in STIs were cited by seven countries as a possibly highly-important consequence.
Other cost issues that the ECDC meeting highlighted as important included the fact that only in the UK and the Netherlands have thorough cost-effectiveness studies of PrEP been done and that even if models do show PrEP to be cost-effective, PrEP programmes will require a considerable initial spend before they start achieving significant-enough reductions in infections. There was general consensus that the barriers to rolling out PrEP would be considerably lower once drugs come off-patent and are available at generic prices.
The meeting looked at a number of other issues that might need to be addressed in order to make accessing PrEP easier in Europe.
One particularly important consideration is the sheer difference in healthcare systems from one country to another. This makes a standard European ‘template’ for adopting PrEP impossible, and requires each country to come up with its own answers.
Who, for instance, will provide PrEP? STI clinics? Community testing sites? Infectious disease physicians? Primary care physicians? Through online order schemes? Different arrangements and even laws already exist in different countries on who can conduct an HIV test and these are likely to affect PrEP provision too.

HIV is undetectable in the pre-ejaculatory fluid of men taking suppressive antiretroviral therapy, investigators from the United States report in the online edition of AIDS . Approximately a fifth of men with an undetectable viral load in their blood had low-level HIV replication in their semen, but none were shedding virus in pre-ejaculate.
“Our study provides the first evidence that pre-ejaculatory s*xual secretions in men on [ART], unlike those from untreated men, do not contain detectable HIV,” comment the investigators.
There is now overwhelming evidence that men and women who are taking stable ART that suppresses HIV in blood to undetectable levels are extremely unlikely to transmit the virus to their s*xual partners. However, persistent HIV replication has been detected in the semen of men taking treatment that suppresses viral load in blood.
HIV has been detected in the pre-ejaculatory fluid – colloquially called pre-cum – of HIV-infected men not on ART and also in pre-ejaculatory samples obtained from ART-exposed monkeys. Pre-ejaculate is thought to be a possible source of HIV transmission.
Investigators in Boston wanted to see if HIV-replication persists in pre-ejaculatory fluid in the context of treatment that suppresses viral load in blood and also to establish if there is a relationship between detectable viral load in semen and viral shedding in pre-ejaculate.
Their study sample comprised 60 men. All were s*xually active and had been taking a stable antiretroviral regimen for at least three months.
Samples of pre-ejaculate, semen and blood were provided for viral load quantification. The men were also screened for urethral s*xually transmitted infections (STIs), urethritis and HSV infections.
Eight of the men had detectable viral load in their blood (range, 80-640,000 copies/ml) and were excluded from the principal a**lysis.
The remaining 52 men all had blood viral load below the limit of detection (40 copies/ml). Their median age was 43 years, median CD4 cell count was 518 cells/mm3, 96% reported s*x with other men, and 44% said they had had insertive unprotected a**l s*x within the past three months. None of the patients had a bacterial urethral STI, one had urethritis and one was shedding HSV-2 in semen.
Four of the men with detectable HIV in their blood were also shedding virus in their semen, viral load ranging between 40 and 96,000 copies/ml. One man in this group also had detectable virus in his pre-ejaculate (2,400 copies/ml).
Of the 52 men with undetectable viral load in their blood, ten (19%) had low level HIV replication in their semen (59 to 800 copies/ml). However, none had virus in their pre-ejaculatory fluid.
Both the patients with urethritis and the individual with seminal HSV-2 both had detectable HIV in their semen.
“Although HIV-1 RNA was detected in semen of men on stable ART with undetectable blood viral load, it was not detected in pre-ejaculatory secretions,” conclude the authors. “These data indicate that pre-ejaculatory fluid may not contribute to HIV transmission in men on ART, at least in men without ge***al infections