HIV: A new normal needs to be a better normal

This website has been created by Gilead for the purposes of disease education and awareness.

Those who have worked in or lived with HIV are no strangers to a pandemic and the challenges associated with the public health fight against viruses. While striving to end the HIV epidemic globally by 2030, the deadline set by the United Nations (UN) Sustainable Development Goal 3(SDGs)1, the UK has learned some lessons that are not only pertinent for HIV but for COVID-19 too.

The current crisis offers an opportunity to reflect on the progress in HIV achieved to date and to reemphasize the necessary actions needed going forward which can be similarly applicable to fight other viruses such as COVID-19.

Data: the use of data is essential to tracking a virus. Knowing in detail the numbers of people affected or at greatest risk of infection is essential to mapping care and commissioning services accordingly. This summer, ‘HIV Lens’, a collaboration between NAM, Public Health England and Gilead Sciences, will be launched to improve HIV data collection in England.

Matthew Hodson, Executive Director of NAM (providers of aidsmap and the new data site, HIV Lens) said,“The UK is among the world’s leaders for detecting and treating HIV but even here we see inequalities relating to locality, ethnicity and sexuality. Accurate data enables us to pinpoint where the gaps in service or failures in outcomes are, signposting where action needs to be stepped up. Data monitoring at large scale is a critical tool to successfully address any future viral pandemic.”

Test, Test, Test: regular and repeated testing for at risk groups, testing in communities, hospitals and at home and partner notification are all essential to prevent the spread of infection and to link people to care. In the current COVID-19 crisis, the UK authorities with support from Gilead Sciences UK have been leveraging the opportunity presented by the need for COVID-19 testing of groups including the homeless, temporarily housed in hotels, to additionally test them for both HIV and Hepatitis C. These and other innovative testing initiatives should be scaled up and other risk groups considered.

Treatments: substantial research and development efforts into innovative treatments options have been critical to the transformation of HIV care2 and building on the years of HIV innovation can guide our response to new viral pandemics. Ensuring those infected are on treatment and that their viral load is controlled to reduce the risk of onward transmission is key and should remain a priority for health authorities if we wish to successfully make progress towards the end of the HIV epidemic.

Quality of life: People with HIV are at higher risk than the general population of experiencing co-existing medical conditions3 (co-morbidities) such as cancer (I.e. smoking related and virological cancers)4, heart conditions5, bone fractures6, kidney failure7 or mental health issues (particularly depression) . As new models of care for HIV evolve it is crucial that tools are in place to monitor, manage and prevent other conditions that may occur. With fewer face-to-face consultations – including non-HIV care related – with healthcare professionals comes the risk that opportunities to fully assess and provide appropriate management of co-morbidities may be reduced. New approaches for monitoring and managing co-morbidities to optimise well-being and long-term health are needed.

Professor Jane Anderson, co-lead of London’s Fast-Track Cities Initiative and consultant physician in HIV medicine at Homerton University Hospital NHS Foundation Trust said, “Making sure that people living with HIV experience person centred integrated care is really important particularly when multiple professionals are involved. Finding effective ways for seamless, joined up care across different specialties and organisations is becoming more and more important. Finding solutions and improving quality of life means working in partnership with people living with HIV to tailor interventions to particular circumstances.”

Quality of life for people affected is an element that health authorities should take into account when tackling pandemics, whatever the virus.

Virtual care: COVID-19 has created the necessity for rapid uptake of digital care tools for people with HIV. Whilst this might be welcome for many patients, it is not without its risks. If digital care becomes the ‘new normal’, ensuring that patients have thorough annual health checks (reviewing all co-morbidities and mental health) will become even more essential and new virtual and digital tools should be used to capture patient reported outcomes of care including quality of life measures.

Moving forward: time for a National HIV strategy in England

The COVID pandemic is challenging the healthcare systems as never before and showing the critical role scientific research and innovation can play in fighting such virus. There are clear lessons to learn from fighting HIV, another pandemic the world has yet to defeat. As we strive forward to a ‘new normal’, governments should not forget the outstanding challenges related to HIV. Particularly, England needs a new National HIV Strategy, building on years of progress, in order to get us to zero new infections and retain the great advances in treatments and care that decades of investment, research, activism and clinical expertise have enabled. The battle against HIV is far from over and it is critical for governments to avoid taking their eye off the ball and to strengthen their commitment to fight HIV.