A national HIV expert at Rutgers discusses the progress made and the challenges to overcome in ending the disease by 2030
The United Nations’ World Health Organization declared December 1 as World AIDS Day, an international day of awareness and education about the challenges that remain to achieve the goals of ending HIV/AIDS by 2030. This year’s theme is “Let communities lead.”
Jeffrey Kwong, a professor at the Rutgers School of Nursing and co-medical director of the American Academy of HIV Medicine’s HIV and Aging Initiative, was appointed in October as a Centers for Disease Control and Prevention Clinical Ambassador for the “Let’s Stop HIV Together” campaign.
Kwong discussed the progress made and the work that still needs to be done to eradicate this disease.
What are the most important issues in HIV care and treatment today?
A tremendous amount has changed over the past decade in regard to HIV care and treatment. First, the treatments that we have available for HIV are some of the best that we’ve ever had, and they do an incredible job at controlling HIV. Additionally, most of the medications are generally well tolerated and many individuals can take as few as one pill a day or in some cases an injection every two months.
As of the end of 2022, there were about 39 million people living with HIV, with about 1.2 million in the United States, and people living with HIV are now aging into older adulthood. Current projections estimate that by 2030 nearly 70 percent of people living with HIV will be 50 years or older. This will cause an increased demand for clinicians, health systems and policymakers to take into consideration the unique needs of this population.
Older adults with HIV face many challenges. We see a higher prevalence of multiple chronic conditions, such as heart disease, diabetes, kidney disease, hypertension, cancer and depression occurring at earlier ages compared to persons without HIV. These patients are being cared for by a variety of specialists who may not necessarily be familiar with HIV or may lack the knowledge of how HIV treatment may impact other diseases or illnesses. And there is a paucity of data and clinical evidence to help inform our decisions.
Where do you see the future of HIV treatment and prevention?
We are on the cusp of having a complete transition of the HIV treatment landscape. Over the last few years, we have seen the emergence of long-acting treatment options.
One option that is available is for people who are doing well on their oral treatment who may not want to take pills every day. This long-acting antiretroviral regimen that became available in 2021 allows people to get an injectable treatment every eight weeks. This is truly remarkable when you consider that when the very first HIV treatment [AZT] was approved in 1987, people had to take pills every four hours around the clock and some people needed to take 12 or more different pills a day.
There are other long-acting agents that are approved for people who may not be doing well on their current regimen. One is an injectable medication that can be administered every six months.
They are also investigating newer forms of treatments, such as implantable medications that can last for months at a time. Additionally, we have new classes of drugs that are under investigation that will hopefully be available soon. This really provides people with HIV the option of finding a regimen that fits into their routines.
In terms of HIV prevention, we are seeing similar successes. Oral HIV pre-exposure prophylaxis (PrEP) has been available for over a decade. PrEP allows people without HIV to take antiretrovirals to reduce the risk of HIV transmission. There is now a long-acting form of PrEP that is administered by injection every eight weeks.
What are some of the biggest challenges that remain in regard to HIV prevention?
Access to PrEP and awareness of its benefits remains a challenge. Data suggests that populations that would benefit most from PrEP – communities of color, women and older adults – are not receiving it. The CDC estimates that approximately 30,000 new infections occur annually in the U.S., with the highest percentage of new infections occurring in persons of color.
Many factors play into this: People who could benefit from PrEP may not think that they are eligible; providers may not know a lot about the medications or think they should be prescribed by HIV or infectious disease specialists and therefore not consider offering PrEP to patients; and stigma related to HIV might prevent people from taking the medication out of concern that others may think that have HIV.
Discuss your role in the “Let’s Stop HIV Together” Campaign.
I am part of a group with 10 other clinicians – physicians, nurse practitioners and physician assistants – who are considered national experts in the field of HIV treatment and prevention. The campaign is part of the Ending the HIV Epidemic in the U.S. (EHE) initiative and the National HIV/AIDS Strategy. The aim of this campaign is to empower communities, partners and health care providers to reduce HIV stigma and promote HIV testing, prevention and treatment.
In my role, I educate other providers about the importance of reducing stigma and how to incorporate and increase HIV testing and prevention services into their practices. I also reinforce the benefits of HIV treatment.