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About 8.3 million people cannot access HIV medicines as a result of the COVID-19 pandemic.

As a result of the COVID-19 pandemic, global supplies of antiretroviral (ARV) medicines to treat HIV/AIDS are at risk of becoming out of stock in seventy-three countries. While there is no cure for HIV, ARVs control the symptoms and prevent sexual transmission to other people.

The human immunodeficiency virus (HIV) is a sexually transmitted disease that attacks white blood cells, specifically CD4 cells, that help the body fight infections. Eventually, the progression of this virus causes acquired immunodeficiency syndrome (AIDS). In this condition, the immune system progressively fails, allowing life-threatening, opportunistic infections and cancers to flourish in the body.

“A failure of suppliers to deliver ARVs on time and a shut-down of land and air transport services, coupled with limited access to health services within countries as a result of the pandemic, were among the causes cited for the disruptions in the survey,” reported the WHO. 

WHO and UNAIDS Survey Reveals COVID-19’s Taxing Influence on HIV/AIDS Response

In May, a modeling exercise orchestrated by the WHO and UNAIDS, the joint United Nations program in HIV/AIDS, predicted the increase in the number of deaths resulting from global disruption to AIDS-related medications. The forecast is grim: AIDS-related deaths in sub-Saharan Africa could double by the end of 2020 after a six-month disruption in access to ARVs.

The WHO conducted a new survey to prepare for the International AIDS Society’s biannual conference (IAS), a global platform for professionals working at the cutting edge of the fight against AIDS. According to the survey, twenty-four countries reported have “either a critically low stock of ARVs or disruptions in the supply of these life-saving medicines.” 

According to data released today from UNAIDS and WHO, “new HIV infections fell by 39% between 2000 and 2019. HIV-related deaths fell by 51% over the same time period, and some 15 million lives were saved through the use of antiretroviral therapy.”

Now, the pandemic stalls progress in the global fight against HIV/AIDS.

The perilous supply shortages threaten the health of an estimated 8.3 million people of the twenty-four countries taking ARVs in 2019. This estimated population represents about one third (33%) of all the people taking HIV treatment globally.

“The findings of this survey are deeply concerning,” said Dr. Tedros Abhanom Ghebreyesus, the WHO Director-General. He stressed, “countries and their development partners must do all they can to ensure that people who need HIV treatment continue to access it. We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.”

Progress Towards Global Targets Is Stalling

Despite steady advances to expanding treatment coverage, improvement in targeting is “critical to reinvigorating the global response to HIV.” In 2019, more than 25 million people needed ARVs. The WHO fears that, especially with the COVID-19 pandemic, key 2020 global targets will fall drastically short.

Proven prevention and testing services must target the groups that need them the most. In the past two years, the annual number of new HIV infections plateaued at 1.7 million. The WHO reports that there was only a modest reduction in HIV-related death, from 730,000 in 2018 to 690,000 in 2019.

The WHO recently developed guidelines on how countries could continue services for HIV treatment during the pandemic.

To limit disruptions in access to HIV treatment, WHO recommends that countries adopt “multi-month dispensing,” a policy where prescriptions extend for periods up to six months. 

Until the pandemic is mitigated globally, shortages in HIV essential medicines will continue. So far, 129 countries implemented this policy.

On the national and local levels, countries also work to moderate the effects of disruptions. Many countries toil to maintain flight and supply chains, collaborate with medication manufacturers to overcome logistic challenges, and engage communities to orchestrate the delivery of HIV medicines.

FDA Approves New Drug That Helps Young Children Living With HIV 

Young children disproportionately feel the effects of the HIV/AIDs epidemic. In 2019, an estimated 95,000 children died because of HIV, and about 150,000 kids got the virus.

Only about half (53%) of the children in need of the antiretroviral medications receive it. Optimal medicine with suitable pediatric formulations is not available.

WHO: Just last month, the U.S. Food and Drug Administration (FDA) approved a new “5mg formulation of dolutegravir (DTG) for infants and children older than 4 weeks and weighing more than 3 kg.

This decision will ensure that all children have rapid access to an optimal drug that, to date, has only been available for adults, adolescents, and older children. [We] are committed to [expediting] the prequalification of DTG as a generic drug so that it can be used as soon as possible by countries to save lives

Dr. Meg Doherty, Director of the Department of Global HIV, Hepatitis, and STI Programmes at WHO said, “through a collaboration of multiple partners, we are likely to see generic versions of dolutegravir for children by early 2021, allowing for a rapid reduction in the cost of this medicine. This will give us another new tool to reach children living with HIV and keep them alive and healthy.”

At the International AIDS Society’s biannual conference, the WHO will spotlight “how global progress in reducing HIV-related deaths can be accelerated by stepping up support and services for populations disproportionately impacted by the epidemic, including young children.”

Tackling Opportunistic Infections like HIV and COVID-19

HIV is an opportunistic infection. As a result, HIV often develops into acquired immunodeficiency syndrome (AIDS). 

In such infections, pathogens like viruses, bacteria, and fungi keenly recognize opportunities to infect and prey on an individual’s weakened immune system. 

Other examples include bacterial infections such as tuberculosis (TB), viral diseases like hepatitis and COVID-19, parasitic infections such as toxoplasmosis, and fungal infections.

Histoplasmosis is a type of fungal infection that is an AIDS-defining condition among people living with HIV. This fungus affects the lungs, and symptoms include fever, chest pain, chills, and a dry cough. For people, particularly with HIV, histoplasmosis could spread to other parts of the body, including the brain or gastrointestinal tract. Histoplasmosis is particularly prevalent in the WHO Region of the Americas. The WHO reports that there are “as many as 15,600 new cases and 4,500 deaths are reported each year among people living with HIV.”

The WHO is now releasing new guidelines on the “diagnosis” and “management” of histoplasmosis for people living with HIV. 

“Many of these deaths could be prevented through timely diagnosis and treatment of the disease,” said the WHO. “In recent years, the development of highly sensitive diagnostic tests has allowed for rapid and accurate confirmation of histoplasmosis and earlier initiation of treatment. However, innovative diagnostics and optimal treatments for this disease are not yet widely available in resource-limited settings.”

As the world battles many opportunistic infections at once, many await a cure for HIV/AIDS and related conditions, like histoplasmosis. For the time being, the focus must be on improving timely diagnosis, the allocation of treatments and resources to manage symptoms, and the improvement of healthcare around the world.

Karen Jang

Karen Jang is a Generation Z Voice at The Pavlovic Today. She is studying Chemistry at Barnard College of Columbia University and Classical Violin at the Manhattan School of Music. Karen is a graduate...