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December 1 marks World AIDS Day, a disease discovered more than 40 years ago. What at the time was identified as Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV), is a pathogen that has challenged the entire scientific community since its appearance and, therefore, also society.
After four decades of research, diagnosis and treatment, the panorama has completely changed since the 1980s and 1990s, when mortality associated with the virus reached its peak. Nevertheless, there are still 1.3 million new infections worldwide each year, so there are still many scientific and medical challenges to be addressed.
Even though AIDS or HIV is not on the front page or in the headlines, and this may give the impression that the disease is under control, nothing could be further from the truth. These are the 2023 statistics we found from UNAIDS:
- 39.9 million (36.1 million-44.6 million)* were living with HIV globally in 2023, and 630 000 (500 000-820 000) people died of AIDS-related illnesses last year.
- Seventy-seven percent (61-89%) of all people living with HIV had access to treatment.
- Since the peak in 1995, the number of new HIV infections has declined by 60%.
- In 2023, there were 1.3 million (1 million-1.7 million) new HIV infections, compared with 3.3 million (2.6 million-4.2 million) in 1995.
- 44% of all new infections in 2023 were in women and girls.
- Since the peak in 2004, the number of AIDS-related deaths has fallen by more than 69%, and by 51% since 2010.
- In 2023 , about 630 000 (500 000-820 000) people died of AIDS-related illnesses worldwide, compared with 2.1 million (1.6 million-2.7 million) people in 2004 and 1.3 million (1 million-1.7 million) in 2010.
- In 2023, someone died of HIV every minute.
One of the main current problems is late diagnosis. According to the Spanish Ministry of Health, 48.7% of new diagnoses in 2022 corresponded to patients who already had an advanced stage of infection (Spain HIV Report 2023). Early diagnosis and treatment is effective, but stopping the disease at advanced stages of the disease makes it very difficult to achieve good results.
New milestones in HIV research
One of the most recent milestones in HIV research is the case of the “Geneva patient”, who was cured of HIV after a stem cell transplant. Unlike previous cases, this transplant did not use the CCR5Δ32 mutation, opening new doors in the development of therapies based on genetic engineering and genome editing(The Lancet HIV). Innovative research has also led to the development of more effective drugs. In 2022, the FDA approved lenacapavir, a bi-annual antiretroviral drug that has been shown to be highly effective in preventing and treating HIV, especially in patients with drug resistance(NEJM).
Role of In Vitro Diagnostics
Early diagnosis of HIV is key to controlling its spread and improving clinical outcomes. In this regard, in vitro diagnostic tests, which have evolved dramatically in recent decades, are of particular relevance. Fourth-generation tests, which detect both antibodies and the p24 antigen, significantly reduce the “window period”, making it possible to identify infections in early stages (CDC).
On the other hand, both automation and digitization have allowed a more than considerable improvement in the accuracy and accessibility of this type of tests. Among others, there are diagnostic machines that have already incorporated Artificial Intelligence (AI) and are capable of analyzing samples with much greater speed and accuracy.
According to a study published in Nature Biotechnology, AI systems incorporated into this type of machinery have shown much greater efficacy in detecting early-stage viral infections. This will undoubtedly represent a paradigm shift in the fight not only against HIV, but also against other viruses and pathogens. Thanks to the combination of technological and scientific advances, the future looks more promising and hopeful.
In addition, the work being done in parallel to ensure global and equitable access to diagnosis and treatment, especially in the most disadvantaged countries and areas of the world, will undoubtedly have an impact on improving the figures. And indeed, long-term success will depend on this condition.
And although it may not be in the media for more than one day a year, it is crucial to continue working to raise awareness and educate the world’s population about the disease, the risk factors, the vectors of infection and the importance of early diagnosis. This day reminds us that, although the road has been long, we still have a long way to go. Collaboration between researchers, clinicians, governments and communities remains essential to achieve the goal of an HIV-free generation.
* UN estimates