Before 1996, the outlook for individuals diagnosed with HIV was grim. In wealthier countries, death from AIDS was almost a certainty. However, a game-changing advancement arrived in the form of combination antiretroviral therapy (ART). This therapy was remarkably effective at suppressing HIV, leading to a dramatic drop in AIDS-related deaths, particularly in Europe and North America.
Evolution of ART Administration
Initially, from 1996 to 2012, ART was not always initiated immediately. Treatment began only when a person’s CD4 count—a measure of immune health—fell below a certain threshold or if they exhibited symptoms. This approach shifted between 2012 and 2015 following robust research showing that starting ART immediately, regardless of CD4 count, was the best strategy. Consequently, there was a global push to commence treatment as soon as HIV was diagnosed.
Impact on Longevity and Mortality
Thanks to effective treatment, individuals with HIV are now living longer. While deaths from AIDS have significantly decreased, other causes of death have emerged as concerns. Substance use and hepatitis C continue to impact this population, and as people with HIV age, they are increasingly likely to die from conditions like heart disease or cancer.
Key Findings from HIV Cohort Studies
Researchers examined data from 17 HIV cohorts in Europe and North America, encompassing over 189,000 individuals who started ART between 1996 and 2020. During this period, the average age of people with HIV increased, reflecting the positive impact of ART on longevity.
Here’s a snapshot of the numbers:
- AIDS-related deaths dropped by 33% between 1996 and 2020.
- Overall death rates decreased from 17.1 deaths per 1,000 people between 2000 and 2003 to 7.9 deaths per 1,000 people between 2016 and 2020.
Challenges Persist
Despite the remarkable progress, some concerning trends remain. While death rates for gay and bisexual men have decreased, women who inject drugs continue to face significant challenges. Their death rates have actually increased by 7%, highlighting ongoing issues within this subgroup. Substance use-related deaths have shown improvement in Europe but remain a serious problem in North America, where the opioid crisis is still a major issue.
Looking Ahead
While the overall picture shows substantial improvement in survival rates for people with HIV, certain groups still face significant hurdles. It’s important to acknowledge and address these disparities to ensure that all individuals benefit from advancements in HIV treatment.
Additionally, as highlighted in a recent video, there are promising new initiatives, such as those in the US, where infants put on ART within 48 hours of birth have a chance to achieve sustained remission. This indicates ongoing efforts to improve the odds of survival for those affected by HIV from the earliest stages of life.
Conclusion
The journey from 1996 to the present has seen significant advancements in the treatment and survival of people with HIV, thanks to the introduction and evolution of ART. While there are still challenges to overcome, particularly for certain at-risk groups, the progress made so far offers hope and a path forward towards better health outcomes for all individuals living with HIV.
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https://www.YouTube.com/@ShareTreckHIV
Sources:
- World Health Organization (WHO)
- UNAIDS Global AIDS Update
- Centers for Disease Control and Prevention (CDC)
- Journal of Acquired Immune Deficiency Syndromes (JAIDS)
- The Lancet HIV
Sharetreck - Tracking Genomic Investments & clinical trials for HIV. 
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