Fauci: ‘We Have the Tools’ to End HIV

This is great news so I wanted to share with our readers.

Author: Marie Rosenthal MS

Anesthesiology News

The statistics prove the imperative that something has to be done: 1.1 million people live in the United States with HIV, and 14% don’t even know they are infected; 38,000 new infections occur every year; and since the 1980s, 703,413 people have died with AIDS in this country.

When Dr. Fauci first started treating HIV in the early 1980s, there was no treatment, the median lifespan of a patient was one year and the disease didn’t even have a name. Today, there are many treatments available that can reduce the viral load to undetectable levels, and that is a “game changer,” he said in the opening address.

Studies of “tens of thousands of condomless sex acts” have shown that if the viral load of an HIV-infected person can be reduced to undetectable levels, HIV will not be transmitted to a sexual partner.

“Undetectable really does mean untransmittable,” he said.

“Theoretically, if we access and put on antiretroviral therapy everyone who has HIV infection and provide pre-exposure prophylaxis for everyone at high risk, we actually could rapidly end the epidemic,” Dr. Fauci said. “But unfortunately, we don’t live in a theoretical world. So, the task at hand is bridge the gap between what is theoretical and what we can do.”

They will do that because they can pinpoint geographic and demographic “hot spots” where rates of HIV transmission are high. He cited San Francisco, New York and Washington, D.C. as examples. These cities had very high rates of HIV transmission. Public health officials in those areas put programs in place to reach out to people at high risk, get them tested and on treatment if infected or on PrEP if at risk, and greatly reduced their infection rates.

If the new national effort tried to tackle HIV everywhere in the country, the effort would be diffuse and not work, Dr. Fauci said. In contrast, by targeting high-incidence hot spots and people at highest risk, the plan could work to end infections.

“The thing that blew us away is when you look at the geographic hot spots. We have 3,007 counties in the United States. During 2016-2017, more than 50% of all new infections occurred in 48 counties, D.C. and San Juan, Puerto Rico. The majority [of new infections] are among African American and Latino men who have sex with men, transgender and injection drug users. There were also seven southern states that had a very high HIV incidence in rural areas.”

That’s where the plan begins, he said—targeting those areas and getting those people on treatment or prevention if they are at risk.

“The goal [is] to decrease by 75% in five years new infections, to decrease by 90% new infections in 10 years. It is not complicated. It is being done in places like San Francisco and Washington.

“Diagnose to the best of our ability everyone with HIV, treat them as quickly as you possibly can, prevent new infections using PrEP as the major component—if someone comes into an STD clinic and doesn’t have HIV, they need to be on PrEP—and rapidly respond to different clusters,” he explained.

Dr. Fauci has been talking about ending HIV for a decade, but his idea just gained traction, he said. The reason: the right people at the right time in the right place. To implement this plan, many different agencies will have to work together.

“It is the first time that an accelerated effort to implement HIV treatments and prevention in the U.S. has been simultaneously undertaken by multiple [Health and Human Services] agencies that is focusing on highly specific and concentrated target populations,” he said.

An area of concern to people is that money will be shifted away from HIV work here and abroad, and he said the administration has assured NIH that there would be new money allocated to the program, although how much won’t be known until the federal budget is released.

At a press conference, Dr. Fauci said he has encountered a lot of skepticism about the new plan because of the political climate in Washington, but he said people need to look away from D.C. and consider the people running and implementing the effort. “The people who are going to be implementing the program are not political people. I think you need to separate what you might perceive as a certain attitude [in Washington] with the people who are going to implement this program,” he said.

“The people who are implementing this have been in the business for a long time,” he noted.

Dr. Fauci said ending HIV was a moral imperative. “We don’t have any excuses anymore since we have the tools.”