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Progress and challenges in the global fight against HIV/AIDS: Examining goals to end the epidemic by 2030

  December 1st is the 36th “World AIDS Day”. According to data from the United Nations Program on AIDS (UNAIDS), since humans first discovered HIV in 1981, approximately 84.2 million people around the world have been infected and 40.1 million people have died from related diseases.
  Last year, there were approximately 1.3 million new HIV infections worldwide, and 630,000 people died from the disease, which is equivalent to 1.2 people dying from HIV every minute.
  Not long ago, Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, passed away. What the public doesn’t know is that he was well-known for the COVID-19 epidemic, but he was actually a world-renowned expert on AIDS prevention and control and a sexually transmitted disease expert at the Chinese Center for Disease Control and Prevention. Former Director of the Center for AIDS Prevention and Control. Wu Zunyou has won the UNAIDS Gold Medal and made great contributions to China’s AIDS prevention and control.
  The deceased has passed away, but the pace of AIDS prevention and control has never stopped.
  Looking around the world, there is still a long way to go to prevent and control AIDS. As Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), said at the 12th International AIDS Scientific Conference, financing for AIDS prevention and control is still unstable. Many high-burden countries remain overly reliant on external support; new infections and deaths are falling, but not fast enough, and HIV incidence is rising in some countries and communities — a critical step in meeting the 2030 goals countries have set to end the AIDS epidemic. All parties need to work together.

  In July this year, UNAIDS released the “2023 Global AIDS Prevention and Treatment Progress Report”. The report, subtitled “The Road to Ending AIDS”, pointed out that Botswana, Swaziland, Rwanda, Tanzania and Zimbabwe have achieved “three 95% ” goals (i.e. 95% of people living with HIV know their status, 95% of those who know their status are receiving antiretroviral treatment, and 95% of those on treatment are virally suppressed).
  Sub-Saharan Africa has always been the hardest hit area by AIDS, accounting for about 65% of the global number of infections. What is gratifying is that of the 16 countries that are close to achieving the “95-95-95” goal, 8 are from the above-mentioned regions.
  In terms of eliminating childhood AIDS, 82% of pregnant or breastfeeding women infected with HIV globally received antiretroviral treatment last year, much higher than 46% in 2010. Since 2010, the number of children infected with HIV has dropped by 58%, which is Historically low levels.
  However, both UNAIDS and WHO believe that there are still many areas beyond the reach of current AIDS prevention and control. In areas with high HIV prevalence, such as sub-Saharan Africa, only 42% provide HIV prevention programs specifically targeted at young women.
  And when the original high-incidence areas are under certain control, new infection cases are rising rapidly in the Asia-Pacific region, with nearly a quarter of the world’s new infections occurring here. The number of new infections in Eastern Europe, Central Asia, the Middle East, and North Africa continues to rise rapidly, which is somewhat like “pressing the gourd will lift the gourd.”
  The situation around us seems to support the above situation. Although China has made encouraging achievements in AIDS prevention and control, there are still some unsatisfactory results. A few days ago, the Centers for Disease Control and Prevention’s weekly report pointed out that from 2002 to 2018, the reporting rate, mortality rate and prevalence rate of HIV infection and AIDS patients in China have been slowly and continuously increasing; after 2018, the reporting rate and mortality rate have increased. decline, but prevalence remains on an upward trajectory.
  In addition, in May 2019, Science magazine published an article from the Chinese Center for Disease Control and Prevention and Tsinghua University School of Medicine stating that HIV has soared among Chinese students; and a 2021 article by the Chinese Center for Disease Control and Prevention The article pointed out that more than 90% of young students infected with HIV are transmitted through sexual contact, especially same-sex sex without condoms.
  According to UNAIDS, under the COVID-19 epidemic, the funds allocated to AIDS prevention and treatment in various countries have significantly decreased. Last year, approximately US$20.8 billion was invested, equivalent to the level in 2013. In a previously released new research report titled “At Risk”, it stated that between 2020 and 2021, the number of new HIV infections globally fell by only 3.6%, which was the smallest annual decline since 2016.
  Even putting aside funds and investments, the monkeypox and COVID-19 epidemics in recent years have also posed new threats to the health of AIDS patients.
  The WHO analyzed more than 82,000 confirmed cases of monkeypox around the world and found that 52% were also HIV-infected, and these patients were also at increased risk of hospitalization and death. Considering that many of these patients are marginalized people in society, it is difficult to supervise and protect them, which also allows the virus to spread rapidly among this group of people.
  The impact of COVID-19 is similar. According to the WHO, from Delta to Omicron, the overall in-hospital mortality rate for HIV-infected people hospitalized due to COVID-19 infection reached 20% to 24%; during the epidemic of the Omicron variant, the mortality risk ratio of HIV-infected people was It was 142 times higher in people without HIV.
“Ending” AIDS by 2030?

  In June 1981, the U.S. Centers for Disease Control and Prevention released a special clinical case report. Five patients suffered from a “strange disease.” At first, the symptoms were just a cold-like fever, but since then the condition has become more serious, with mucosal infections and skin diseases. Injury, ultimately organ damage, life-threatening.
  The disease was later officially named Acquired Immune Deficiency Syndrome, which is AIDS (AIDS) that affects the world today.
  Since that year, mankind has been fighting AIDS for 42 years. Over these long years, scientists have gradually figured out the laws of AIDS. With more scientific treatment and prevention, the mortality and transmission rates of AIDS patients have also improved. Gradually reduce.
  In 1996, Chinese scientist He Dayi discovered that the combined use of three or more drugs with obviously different mechanisms of action to treat AIDS can not only avoid drug resistance caused by single drug use, but also delay the course of the disease and ultimately significantly extend the patient’s life. Effect.
  This therapy is called “highly active antiretroviral therapy” because it requires the “mixing” process of multiple drugs, which is very similar to making a cocktail, and is also called “cocktail therapy.”
  Before the advent of “cocktail therapy”, AIDS was almost synonymous with terminal illness. After the birth of this therapy, the mortality rate of AIDS has dropped significantly, it is not clinically contagious, and the life span of patients is close to that of ordinary people. AIDS is more like a chronic infectious disease that requires lifelong medication, and countless people infected with AIDS have benefited from this.

  When the original high-incidence areas are under certain control, new infection cases are rising rapidly in the Asia-Pacific region.

  NBA star “Magic” Johnson was diagnosed with HIV in 1991. Thanks to “cocktail therapy”, he is still alive today. As a result, He Dayi was awarded the Person of the Year by Time magazine. The latter said that He Dayi was a real hero who turned the tide against AIDS.
  However, medical advances have not completely eliminated AIDS. In the years since, the disease has continued to spread widely around the world. It was not until 40 years after AIDS was discovered that in June 2021, the United Nations General Assembly adopted a declaration on ending the AIDS epidemic by 2030 with 165 votes in favor: committing to effective comprehensive AIDS prevention programs covering 95% of people at risk of infection by 2025 To achieve the goal of ending the AIDS epidemic by 2030, we will control the number of new HIV infection cases each year to less than 370,000 and the number of related deaths to less than 250,000.
  UNAIDS explains that “end” does not mean “eradicate” or “cure”. The complete statement of this declaration should be “end the threat of AIDS to public health before 2030”, that is, achieve the “three 95” goals on a global scale. %” target so that new HIV infections and transmission rates are low enough—just like when the WHO announced the “elimination” of smallpox in 1980.
  The goal has been set, but it is still difficult to achieve it. Not long before the declaration was adopted, UNAIDS released a report stating that the number of new HIV infections and related deaths in the world in 2019 was 1.7 million and 690,000 respectively, both far exceeding the goal set in 2016 to achieve “double HIV protection” by 2020. With the goal of 500,000, it is urgent for the world to join forces to control AIDS.

  During the COVID-19 epidemic, funds allocated to HIV/AIDS prevention and treatment in various countries have significantly decreased.
The vaccine is still difficult to deliver

  Compared with other well-known epidemics, HIV is more “smart”. It directly impacts the characteristics of the immune system, which also makes the development of vaccines more difficult. It is not easy to end the AIDS epidemic.
  For decades, countless scientists have tried to recreate the scene in which humans relied on vaccines to eradicate smallpox, hoping to develop a vaccine to solve the problem of AIDS, but they have never achieved much.
  In 2005, in order to commemorate the 125th anniversary of its founding, Science magazine raised 125 of the world’s most challenging scientific questions at that time. One of the questions was “Is there an effective HIV vaccine?”
  Science magazine pointed out at the time, Since the emergence of HIV, more money has been spent on finding a vaccine against the virus than on any vaccine in history, with the National Institutes of Health alone investing nearly $500 million (approximately RMB 3.6 billion) annually in HIV vaccine research, but producing an effective AIDS vaccine remains a distant dream.
  The characteristic of not directly attacking a certain organ makes HIV more difficult to “catch”. Unlike COVID-19, hepatitis B, etc., the pathogen cannot be directly found and inactivated, or controlled through genetic means. A researcher once used the metaphor of “flying without a compass” to describe the difficulty of developing an AIDS vaccine. The development of an AIDS vaccine has also gone through the process of stimulating the production of antibodies that stimulate humoral immunity, to stimulating T cell immune responses. And then stimulate the above two at the same time to achieve changes in the combined immune strategy.
  The only good thing is that the successful application of mRNA vaccines to COVID-19 has also provided new ideas for the development of vaccines for other diseases. The American biotech giant Moderna has launched an mRNA AIDS vaccine trial in 2021 and looks forward to more results in the future.