by Claudius D’evemy in Paris

HIV can be divided in two types: HIV-1 and HIV-2. HIV-1 constitutes the bulk of what we call the HIV pandemics. A very interesting assessment of the evolution of the HIV-1 global pandemic appeared in the April issue of The Journal of Clinical Investigation. This study observes the advantages of very comprehensive but short and accessible up-date information over its (HIV) spread, its prevention and its treatment.

A socially discriminatory epidemic

According to WHO and UNAIDS, more than 30 million people are now living with HIV-1, and during the year 2007, 2.5 million individuals became newly infected with HIV-1 while 2.1 million people died of AIDS. The authors of this study point out that one of the most surprising aspects of the pandemic is its unequal spread. "Although no population has been spared (HIV-1 does not respect social status and borders), some regions and populations have been affected far more than others."

In the US, the most heavily affected country of the ’industrialized world’, African Americans and Hispanics are disproportionately affected by HIV/AIDS. About three quarters of the newly reported infections in the US are men, most of them — especially African American — in the ’men having sex with men (MSM) category. In Europe, a large number of infections is found among immigrants from sub-Saharan Africa.

There is no scoop here, but it is important to recall that 68% of people living with HIV/AIDS and 90% of children living with HIV-1 in the world as well as 76% of all deaths due to AIDS are in sub-Saharan Africa. 8 countries in southern Africa even see their prevalence of HIV-1 going over 15%, representing one third of the new HIV-1 infections and AIDS deaths worldwide. In 2007, about 61% of people living with HIV-1 were women. Even though declines in HIV-1 prevalence have occurred in a number of countries in recent times, Africa has witnessed the full devastation of the HIV/AIDS pandemic in an unequalled way. After Africa, the most affected region in the world is the Caribbean

"Unequal spread of HIV-1 reflects a broad combination of biological and social factors" say the authors. L’étude n’en dit pas plus. However, the results they publish terribly highlight how important the roles of discrimination and stigmatization are in the spread of the epidemic.

Challenges

The most spectacular advancement as well as the biggest challenges have been witnessed in the treatment sector. The discovery of various types of molecules as well as their combination in a therapy known as HAART has drastically changed the course of the epidemic, while getting the right antiretroviral drugs to the right people at the right time still remains a challenge.

However, the authors recall that unfortunately ARV cannot cure, the virus can become resistant to ARV drugs. Moreover these medications bring various adverse health consequences like opportunistic infections, cardiovascular complications and death.

The universal access to ARV therapies has been hugely hampered by different obstacles. Cost being one of the major problems, is not only limited to medications but also the subsequent costs, like CD4-T cell count or blood plasma viral load or viral resistence testing among others, as well.

Malfunctioning health sector is understaffed not only because of brain drain in the regions mostly affected but also because of the impact of HIV amid health workers themselves leading communities-based cares to successfully pioneer.

In the absence of curative therapy, prevention is still at the heart of every strategy to control HIV/AIDS epidemic. In 2006, for each person put on HAART, six new individuals became infected with HIV-1. "Since no single intervention has been found to be universally effective at preventing the transmission of HIV-1, packages of specific interventions must be designed for geographic settings according to the local transmission patterns and risk behaviors" say the authors distinguishing six types of intervention: behavioral prevention methods, male circumcision, treating STDs, vaccines, microbicides and antiviral agents.