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In the 1980s, a person diagnosed with HIV faced a frightening prognosis: no cure, no treatment — and very little hope. Four decades later, many people with HIV can live longer, healthier lives by taking HIV treatment as prescribed.
This progress has been remarkable. But the 10,000-foot view of the HIV epidemic can be deceptive, like looking out the window of an airplane. Researchers and clinicians can feel at times like they’re barely moving, even though they are, toward their destination — an end to the HIV epidemic.
“There are days when the complexity can be overwhelming,” Jared Baeten, vice president of HIV clinical development at Gilead Sciences, Inc., said at STAT’s Breakthrough Summit West in San Francisco about the work to end the HIV epidemic. “But then I’ll have a meeting with someone who has just solved a tiny problem in that big complexity, and then I’ll think, ‘OK — this whole thing could come together.’”
That day feels tantalizingly close. “The [United Nations] has a goal of ending HIV as a global epidemic by the end of this decade,” Baeten said.
What will it take to complete that final stretch? Let’s look at where we are today, where we’re looking to go next, and what can be done in the meantime to help improve the lives of people impacted by HIV.
What does the HIV epidemic look like in 2024?
The positive changes made in terms of what living with HIV looks like are a testament to the culmination of years of global scientific research. “I remember well the start of the epidemic in the 80s and how devastating it was,” Baeten said. “I’ve been privileged to see the advancements made over the years. Many of those advancements were spearheaded by Gilead, which has helped transform HIV from a virus resulting in fatal illness to a treatable chronic condition.”
“Gilead developed the first single-tablet regimen to treat HIV as well as the first pre-exposure prophylaxis (PrEP) medication to help prevent HIV transmission. And today, we’re laser-focused on research that will hopefully one day lead to a cure.”
What are some of the challenges that remain?
Worldwide, an estimated 1.3 million people were diagnosed with HIV in 2022. In the U.S., one-third of those living with HIV are not receiving needed HIV care based on 2018 data.
“But it’s not because their virus is untreatable,” Baeten said. “It’s because the medicines available may not be fully workable in their lives. A lot of that is driven by the stigma and discrimination that have accompanied HIV since the very beginning. Fear, stigma, and discrimination often drive people away from getting the treatment that they need. So we’re really focusing on being able to meet people where they are.”
Bettina Bauer, vice president of U.S. HIV treatment and prevention at Gilead Sciences, concurred in a Summit West interview in the STAT Brand Studio multimedia lounge. “We can’t do this with medicine alone,” she said. “I’ve seen myself how communities are still impacted by the epidemic. There is a disproportional impact on some communities that experience severe health disparities and that have higher barriers to accessing care. This is particularly true in the Black communities, Latino communities, women, and transgender communities, just to name a few. This underscores the need for person-centric care, particularly that recognizes the intersectionality between these groups.”
What can be done to meet those challenges?
Education is one of the most important steps. It’s critical to reach both the general public — a 2020 study found that 40% of people surveyed didn’t know that HIV is a treatable medical condition — and communities who may experience barriers to accessing or understanding their options.
Those options include not just treatment but also preventive measures, such as the use of condoms during sex and PrEP, as appropriate. Taken as prescribed routinely before exposure to HIV, pre-exposure prophylaxis is highly effective in reducing the likelihood of getting HIV through sex by about 99%, according to the Centers for Disease Control and Prevention.
Providing educational resources that are tailored to different communities, helping to destigmatize HIV and normalize sexual health, and encouraging knowledge-sharing wherever possible are all key foundational steps when it comes to reducing the impact of HIV.
What is an emerging area of focus in HIV treatment, and how is Gilead working to address this from a clinical perspective?
“A recurring challenge we’re seeing is the emergence of HIV drug resistance,” Baeten said.
HIV drug resistance occurs when the virus mutates and becomes insensitive to a drug that was previously effective, potentially leading to treatment failure. Treatment-resistant strains of HIV can also be transmitted to others, potentially undermining the broader efforts to end the epidemic. “There’s no sneakier virus out there than HIV,” Baeten said. “It can work its way around a lot of things that you put in front of it.”
While HIV drug resistance is irreversible, it is addressable, and the risk of developing resistance can be reduced — which is a key goal in HIV care. Working with healthcare teams to identify potential HIV resistance mutations, considering a regimen’s barrier to resistance during HIV treatment selection, and encouraging people with HIV to prioritize adherence are all crucial.
“When we make new medicines, or when we use the medicines that we have now, we are attentive that they have to be able to stand up to the virus becoming resistant to them,” Baeten said.
What’s being done to help improve the lives of people with HIV?
Knowing that each person with HIV has unique needs and preferences, there is a great focus on the research to advance options that could address their different needs and preferences. “We’re putting a lot of work into long-acting strategies right now,” Baeten said. “We hope to give people additional options that may work for them. We also know that we cannot end the HIV epidemic alone. We work really hard to build partnerships with the community, with advocates, with scientists, with people affected by HIV at the local and national levels to address barriers and help people get the care that they deserve.”
In the end, said Bauer, “This means when you look into [HIV] treatment, you want to have options that are effective in a very broad range of people. And in the prevention space, to be very honest, we would love more people who could benefit from it to access it. We are committed to bringing person-centric innovation to people that helps meet their individual needs.”
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