Emerging pandemic of HIV-associated diseases

Thursday, 8 February, 2018

Dr Denis Chopera, SANTHE Programme Executive Manager

The emergence of HIV-associated diseases is becoming a global pandemic which requires urgent attention. Reporting on some of the major highlights of the 16th European AIDS Conference which took place in Milan on 25-27 October, Medscape recounted the special recommendations for Human Papilloma Virus (HPV) vaccination. The European AIDS Clinical Society (EACS) suggests that people with HIV should be vaccinated for HPV until the age of 26, while HIV-positive gay men should be vaccinated up to the age of 40. These recommendations come as a direct result of the fact that emerging data show that HPV-related cancers are increasing in HIV-infected people.

The introduction of anti-retroviral therapy (ART) and subsequent development of more effective drugs has resulted in sustained declines in AIDS-related illnesses and deaths globally. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), new HIV infections have fallen by 35% since 2000, and AIDS-related deaths have fallen by 42% since the peak in 2004. The global response to HIV has averted 30 million new infections and nearly 8 million AIDS-related deaths since 2000.  Sub-Saharan Africa remains the worst affected region globally with over 25 million infected individuals.

The achievements made so far in combating HIV and AIDS are remarkable. However, while the world is focusing on prevention and management of HIV infections, there is the neglected but important aspect of the HIV pandemic. This is the long-term effect of HIV on individuals who are on treatment and have well-managed infections. The control of HIV infections due to ART results in reduced AIDS-associated deaths. This has culminated in an increasing population of ageing HIV-infected people. These individuals already have increased risks of developing several diseases associated with ageing such as hypertension, diabetes and several cancers. According to the United States National Cancer Institute (NCI), there has been an increase in the number of non-AIDS-defining cancers such liver and anal cancer among HIV-infected people. While this emerging surge of HIV-associated diseases is most likely going to be carefully controlled in developed countries with stronger health systems, it is the under resourced developing countries that will be disproportionately affected. The developing countries, mainly in sub-Saharan Africa, are already battling the current burden of diseases. For example, according to the latest UNAIDS global AIDS update, nearly half of HIV-infected people in sub-Saharan Africa still do not have access to ART. Furthermore, the emergence of HIV-associated diseases will increase the demand on the public health systems.

Unless drastic action is taken to combat the emerging trend of HIV-associated conditions, there is a huge risk of reversal of the gains made so far in combating HIV. There is urgent need for programmes aimed at developing local capacity to tackle HIV-associated diseases. While direct aid in terms of medicine and other consumable materials from developed countries and the international community will go a long way in alleviating the problem, capacity development offers a more sustainable solution. There are currently several scientific research capacity development programmes on the African continent, notably the Developing Excellence in Leadership, Training and Science (DELTAS) and Human Heredity and Health in Africa (H3Africa) initiatives. The DELTAS initiative is funded by the Wellcome Trust and the UK Department for International Development (DFID), while H3Africa is funded by the Wellcome Trust and the US National Institutes of Health (NIH). The administration of the two programmes has recently been handed over to the African Academy of Sciences’ Alliance for Accelerating Excellence in Science in Africa (AAS-AESA). This will enable the African people to identify priority areas for research focus. According to Dr Jeremy Farrar, Wellcome Trust Director, ”The biggest improvements in health will be met through research that is Africa-led and locally relevant.”

This provides a perfect and immediate opportunity for developing capacity to tackle the emerging problem of HIV-associated diseases on the continent. There is need to treat research on HIV-associated diseases as a focus area within these programmes. The research should focus on elucidating the mechanisms underlying the increased risk of the HIV-associated diseases in HIV-infected individuals. This will result in the identification of strategies to prevent or reduce the risk of these conditions in HIV-infected people. While strategies developed by researchers in developed countries may be extended to the developing world, the advantage of using results from local research is that this will address the problem of genetic and other differences that exist between different ethnic groups and environments.

Failure to develop local capacity to address HIV-associated diseases will result in increased pressure on the already over-burdened and under-resourced health systems on the African continent and increase the dependency of Africa on the developed world.