Forty years after its discovery, HIV is still not defeated

(Keystone-ATS) 40 years ago, the US government announced that HIV causes AIDS. Despite significant progress, the disease continues to be a problem today. In Switzerland, more than a hundred people are diagnosed with the virus every year.

“But the current situation is fundamentally different from forty years ago,” Dominic Brown from the University Hospital of Zurich told Keystone-ATS. This physician and researcher is part of the Swiss HIV cohort study, which has been ongoing for more than 35 years.

Exactly forty years ago, scientists around the world began an arms race against the human immunodeficiency virus, or HIV. On April 23, 1984, US Secretary of Health Margaret Heckler announced at a press conference: “A possible cause of AIDS has been found!”

His bold prediction is that a vaccine that prevents the infection will likely be available within two years. A great moment, because contracting HIV back then was tantamount to a death sentence. Five to six years after infection, the immune systems of people with AIDS (the last stage of infection is called) were so weakened that they died.

In 1994, AIDS was the leading cause of death among people ages 25 to 44 in the United States. Currently, there is still no vaccine and the number of infections continues to rise around the world.

First effective treatment

The first major breakthrough in the fight against HIV did not come until 1996 with triple therapy. It is a combination of three drugs that target HIV in different places. In this way, mortality can be significantly reduced. The Swiss HIV Cohort Study played a crucial role in demonstrating the effectiveness of this therapy.

“However, these early treatments were so toxic that the quality of life of the people concerned was poor,” says Dominic Brown. Only gradually did the side effects decrease.

Another big step was taken in 2008: The Bulletin of Swiss Doctors published the “Swiss Statement”, which mentioned that people receiving effective treatment are no longer infectious.

“It was liberating for the people affected and their loved ones,” the doctor emphasizes. Thus, Switzerland became the first country to provide that HIV-positive people undergoing treatment can refuse to use condoms during sexual intercourse.

Today, HIV is highly treatable. Not only are people receiving treatment no longer infectious, but their life expectancy is comparable to that of the general population. The vast majority of patients take combination tablets containing two or three active ingredients per day.

Sharp reduction

Thus, even without vaccination, the number of infections can be sharply reduced. While in the 1990s an average of 1,300 cases per year were reported to the Federal Office of Public Health (FOPH), in 2022 there will be only 371. Proportionally, men who have sex with men are most affected.

Experts hope for further reductions thanks to pre-exposure prophylaxis (PrEP), which protects against infection. It will be reimbursed by health insurance in Switzerland from July 2024. It is intended for men and women who are not HIV positive and who have sex with multiple partners or with people whose serostatus is unknown.

According to the World Health Organization (WHO), approximately 39 million people worldwide are living with HIV. WHO’s goal is to end the HIV epidemic by 2030.

“We have tools that could theoretically reduce the number of new infections even further,” says Dominic Brown. But in practice everything is more complicated, the researcher adds, considering this goal “very ambitious.” The political situation or financial resources in some countries make control or prevention efforts difficult.

Research is also being conducted on the treatment of AIDS. Five cases of healing recorded in the world prove that this is possible. We know how it can work, but the risks are still too great compared to the good treatment options that currently exist, the doctor concludes.