The most amazing thing happened while I was writing this month’s cover story — my numbers were off. In the time it took me to complete an article about ending the HIV epidemic, the total number of people cured of HIV changed from two to three.
This number may seem insignificant when considered alongside all the other numbers involved in the HIV epidemic: 37.7 million people are living with HIV. 1.5 million people were newly infected with HIV in 2020. 36.3 million people have died from AIDS-related illnesses since the start of the epidemic.
And yet, to the American woman who has shown no evidence of an ‘HIV rebound’ in the 14 months since stopping her antiretroviral treatment regimen, subtracting one person from the total matters.
Ending the HIV epidemic has very much been about the numbers. Mathematical modeling has long been used as a tool to analyze and understand HIV infection and transmission dynamics and to propose mitigation measures to control the spread.
Recently, a Johns Hopkins Medicine research team developed a mathematical model to help end the HIV epidemic in the U.S. The algorithm splits each city’s population into categories of race, age, sex and HIV risk factors — and estimates the number of HIV infections associated with each. From there, the model can predict what would likely happen if cities adopted particular interventions.
The model is being utilized in the Ending the HIV Epidemic in the U.S. initiative, which, like many epidemic-ending plans, has a goal date of 2030. Global and federal health agencies around the world are pushing to meet individually defined targets over the next eight years. Researchers and industry have also joined the race — but everyone has a slightly different version of what ‘ending the epidemic’ looks like and unique plans to get there.
HIV has always been a complex problem to solve, both from a pharmacologic and socioeconomic perspective. Approaches to treatment and prevention have evolved greatly over the last 40 years, putting the end of the HIV epidemic seemingly within reach.
But what mathematical models and federal initiatives rarely factor into the math is a cure — and for the 37.7 million people with HIV who face a lifetime of antiretroviral therapy, that matters.
Fortunately, the cure research space is buzzing with enthusiasm. On the pharma side, the efforts are multi-pronged and collaborative, with most companies acknowledging that there will be no silver bullet, single cure to the notoriously stealth virus.
Whether it’s engineering arenaviruses to deliver virus-specific genes directly into patients to evoke a T-cell response; utilizing broadly neutralizing antibodies and engineered HIV inhibitors to identify and eliminate the dormant HIV that may be hiding in human cells; or even using CRISPR/Cas9 gene editing to remove the HIV genome integrated into infected cells — the pharma cures space is full of promising science.
Treatment and prevention may be the lead tools for ending the HIV epidemic, but cures give people hope. And to those for whom the HIV epidemic is personal, even a nascent and modest cures pipeline makes a difference.
As we move towards a future that may no longer include an HIV epidemic, we remember a past where AIDS activists took to the streets of New York demanding to be heard. Included in this final equation should be the most historically influential factor — the voice of people who refuse to be counted out.
