The NHS in England plans to become the first country in the world to reduce HIV incidence (new cases) to zero, by promoting the dissemination of new pharmacological interventions in the UK.Following several deals secured by the NHS,87,000 people currently in treatment and 61,000 people taking prophylactic treatment will now be able to receive the latest HIV drugs regardless of their location in England. This is in the hope of further improving treatment and lowering transmissions.
HIV is a retrovirus which means it uses an enzyme called ‘reverse transcriptase’ to put its DNA into our white blood cells. The current and new treatments (both therapeutic and prophylactic) are called ‘anti-retrovirals.’ ‘Anti-retrovirals’ lower the viral load in the blood and reduce transmission as well as the virulence (severity of the disease).
What are some of these new treatments? How do these treatments work?
Amongst these HIV interventions are a long-acting injection as a treatment for HIV- cabotegravir and rilpivirine- instead of daily tablets and with less frequent doses required in these eligible patients. This could potentially also replace the daily preventative tablets. The NHS recently approved fostemsavir (a treatment for multi-drug resistant HIV infections) for those with limited options due to tolerance, resistance or contra-indications (safety concerns for not taking other more common treatments). This is the first treatment to be licensed as an HIV drug specifically for those with limited options.
These treatments aim to act on parts of the HIV replication cycle inside CD4+ (a type of T-helper cell, a white blood cell) to prevent the virus replication in the blood, thus reducing viral particles in the blood.This, in turn, reduces transmission and severity of the disease. This can be continued in conjunction with current PrEP prescriptions in place which prevent those without HIV from acquiring the virus from the infected who don’t know they have HIV and/or are not being treated for it.
These are firm steps that ensure England is put on the map for the global fight against HIV.
The Role of the NHS in Eradicating HIV
Being a national and integrated healthcare system, the NHS can effectively strike pharmacological agreements allowing affordable and accessible healthcare for UK taxpayers. The steps towards improving HIV control through continuously evolving testing, diagnosing and support (both medicinal and counselling) systems together with the ever-increasing awareness of HIV prevalence will hopefully help reach this 2030 aim of eradication in England. Awareness of information is crucial to the effective management of HIV, for example, knowing that taking post-exposure prophylaxis (PEP), can help prevent the acquisition of infection even after sexual contact with an HIV positive person.
Already, transmissions of HIV have been reduced by 34%between 2014 and 2019. The understanding of ‘at risk groups -those most likely to encounter the virus- as well as the array of options for suitable treatments(including prophylaxes) advances HIV management to a more personalised stage in which we can tackle the disease. Guidelines for the NHS England’s aim can be found on the British HIV Association and British Association for sexual health and HIV organisations’ websites.
- Do you think reducing the number of new HIV infections should be a priority for the NHS over the next few years, if not, why not?
- Can you briefly explain how HIV infection can lead to AIDS?
- What other globally present infections will also soon be tackled in this way?