HIV and co-infections: Pathways to elimination

HIV rarely comes alone. That is why research takes a closer look at HIV viruses, and also at important pathogens of other infections like hepatitis and tuberculosis.

A discussion on how to combat infections

Chaired by the German virologist J├╝rgen Rockstroh, Marina Klein (Canada) and Jacqueline Huh (Switzerland) discussed with the audience the connections between the different infections, their similarities, their differences and, above all, ways out of the respective epidemics.

Klein, who works in Montreal at the Research Institute of the McGill University Health Centre as a physician and infectiologist, devoted herself to a comparison between HIV, hepatitis B (HBV) and hepatitis C (HCV). According to this comparison, the challenges in dealing with the three infections are different. This starts with the question of testing. Technically, HIV is the easiest to diagnose because, in principle, easy-to-use tests could be available everywhere. It is different with HBV because this infection runs in complex phases and is therefore detected with DNA tests. For HCV tests, on the other hand, RNA tests are required for chronic infection.

Treatment: access is crucial

There are also major, structurally relevant differences in the treatment of the three infections. HIV, like HBV, basically requires lifelong antiretroviral therapy. With HCV, on the other hand, cure is possible with treatment. The problem for all three infections: access to available drugs, especially in low- and middle-income countries.

Prevention needs harm reduction and justice

In prevention, there are different challenges for the three pathogens. A vaccination exists only for HBV, but it is highly effective. However, it could be used much better, especially among children in high-prevalence countries. For successful HCV prophylaxis, harm reduction measures are crucial, above all the decriminalisation of drug use. For HIV prevention, there is still no vaccination, which is why a variety of approaches come into question, although they are not available everywhere they are needed. Klein mentioned effective antiretroviral therapy (ART) as well as HIV pre-exposure prophylaxis (PrEP).

All in all, Klein showed the problems that the different and unjust conditions of access to prevention and therapy cause for public health. Whether someone can benefit from the existing possibilities depends too much on "who you are and where you are". For example, measures and services too rarely reach women and marginalised population groups. She called for the current vertical view of infections to be transformed into a holistic view of health.

Decentralisation effective against TB

Jacqueline Huh, co-founder of the Re-Imagining TB-Care initiative from Switzerland, focused on the fight against tuberculosis (TB).

In order to reduce the triple burden of HIV, TB and covid, she called in her presentation above all for comprehensive care, i.e. "integrated services" for health. In particular, the population groups that are most heavily burdened would have to be taken into account. Such groups and communities must also be able to act in a destigmatised and interconnected way. Huh reported on two pilot projects her organisation is planning with Uganda and Vietnam. It is in the hands of the respective countries how, for example, they decentralise their care - and thus also facilitate access to TB care services.

All countries are responsible

The exchange with the audience showed that there is still a long way to go to eliminate HIV, hepatitis and tuberculosis, as UNAIDS and the World Health Organisation have set as a goal. Medical options such as vaccinations are still lacking, but in principle, scientific progress can be judged as fast and effective, they said. Therefore, according to the experts, not only science but also political will is crucial for dealing with the respective pandemics. For example, Egypt, a country with at best medium incomes, has shown exemplary commitment to tackling HCV. But without stronger public health measures in all affected countries, the number of annual new cases and deaths from all infections will continue to rise.

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