“We’re reaching that point in the HIV epidemic that can best be described as a tipping point,” Salim Abdool Karim told the International Congress on Infectious Diseases in Cape Town.
He said that in the past four years, there had been rapid progress in new ways to prevent sexual transmission of the virus, including new evidence on antiretroviral (ARV) treatment.
This was as opposed to the past 30 years of research which had yielded one new technology in the form of male circumcision.
Karim said ARV therapy coverage had been steadily increasing in every part of the world, which translated to a steady decrease in the number of related deaths and new infections.
Scaling up ARV treatment had increased adult life expectancy from 49.2 years in 2003 to 60.5 years in 2011.
“If we can just continue on the trajectory we have already achieved… we will continue to gain the benefits of that decline [in new infections],” he said.
However, if countries used a combination “toolkit” of behavioural interventions, condom use, circumcision and ARVs for example, then declines would be even greater.
Karim said this toolkit would not help countries if there were no resources in place.
It was encouraging that there had been a rapid growth in new resources and funds in the past decade, particularly in the Brazil, Russia, India, China, and South Africa (Brics) group of countries with the greatest affected populations.
Between 5.5 million and 6.5m people in South Africa were on ARV treatment, he said.
However, several problems remained in implementing ARV therapy.
The first problem was testing, linkage to care, retention and adherence.
Karim said the virus continued to grow in key populations that had not been reached by new technologies.
Where technologies were in place, it was sometimes hard to get people to adhere to treatment, which had a negative effect on effectiveness.
To change adherence, one had to get a feel for the population’s behaviour.
“It’s important to consult and understand our study population, our target population we are aiming for,” he said.
In sub-Saharan Africa, young women “bore the brunt” of HIV and had up to eight times more chance of HIV than men.
Another problem was ARV resistance.
“We have to be ready for this probability because it is clearly evident in those patients with treatment failure.”
Karim said it was only evident in a small group but it was a warning signal for researchers.
He also spoke about the future of HIV treatment.
Currently people on ARV treatment had to take a tablet every day and visit clinics often, resulting in some people being turned away due to severe patient numbers.
Karim said the future held promise of four injections a year, using drug nanocrystals suspended in liquid.
This would greatly decrease the administration load.
The congress at the Cape Town International Convention Centre was organised by the International Society for Infectious Diseases, in collaboration with the Federation of Infectious Diseases Societies of Southern Africa.