November 2022 • PharmaTimes Magazine • 10-11
// HIV/AIDS //
Listen without prejudice
The UK is making progress towards the zero HIV transmissions milestone
As the UK pushes towards the goal of zero new HIV transmissions by 2030, Gilead is striving to challenge inequity, bring forward innovation and eliminate prejudice to end the HIV epidemic for everyone, everywhere.
In the early days of the HIV epidemic, the race was on to find any treatment that could potentially help the thousands of people who were testing positive for the virus. In 1987, a landmark approval of azidothymidine (AZT) marked the start of the journey that we have been on over the last 35 years and the multiple revolutions in treatment that have followed.
There have been ups and downs along the road. Over the years many different treatments that have been able to suppress the virus within the blood to undetectable levels have become available.
While working as a pharmacist in the NHS, I witnessed the introduction of a wave of combination and triple therapies that become available for people living with HIV. Until that point, people had relied on taking multiple treatments, often multiple times a day.
These treatment regimens would often come with side effects and, unfortunately, some would work less effectively over time. With the introduction of combination therapies, treatments could be considered that were not only effective but could also improve the quality of life for many people.
Lightening the load
Progress with HIV/AIDS has continued anew – recently we have seen innovation continue in the care of HIV with the introduction of treatments that can be delivered by injection.
This innovation has the potential to be an important change in how we are able to manage HIV. Stigma is still persistent for many who live with the virus, and for some of those individuals, daily oral treatment reinforces both external and internal stigma.
While there may now be a multitude of different options available to support managing HIV, each and every new development – with their different modes of administration, mechanisms of action and dosing schedules – are all of huge importance. Namely because they offer choice.
Ultimately, this could be one of the key opportunities in meeting the UK government’s ambition in getting towards zero HIV transmissions by 2030.
Although traditionally some populations, such as men who have sex with men (MSM), have been more actively engaged in their HIV care, the prevailing stigma among certain communities can mean higher proportions of these groups becoming ‘lost to follow-up’.
Recent HIV surveillance figures found that at least one in seven people with HIV in England, and possibly as many as one in five, has a detectable and transmissible HIV viral load. An estimated doubling since before the COVID-19 pandemic, when this was estimated to be less than one in ten.
March of time
One of the shared priorities across the HIV community, and something that is of utmost importance to us at Gilead, is being able to understand the rationale for these patterns and properly support individuals to re-engage in care.
‘It does not matter if we have an effective treatment – if it
does not suit the individual, they are not going to take it’
As a community, we understand the collective responsibility to support these individuals, and so rather than considering this group as ‘lost to follow-up’ we now think of them as those we ‘need to find’.
The knowledge and expertise of patient support groups and healthcare professionals who work with groups that are more likely to disengage with care is immeasurable. Working alongside them, we are delivering and supporting various programmes that aim to broaden support, break down barriers between communities, reduce stigma and improve education around HIV.
Nevertheless, once we have found these individuals, we have only taken the first step. At that point, it is critical that we remember that every person living with the virus is individual, and every treatment plan should be considered on a personalised basis.
Working in the NHS and directly among people living with HIV, this was one of my own biggest learnings. It does not matter if we have an effective treatment – if it does not suit the individual, they are not going to take it.
Here’s where the story ends?
View from PharmaTimes Editor, John Pinching:
The HIV/AIDS story is unique. Its initial narrative involved the astonishing bravery of mainly gay men in 1980’s California, and then in London, who were suffering demonisation from wider society, but found the resolve to protest on the streets until their situation came into sharp focus.
Of course, this illness affects us all. The first person in the UK diagnosed with HIV was a female suburban housewife – as far from any caricature as you could possibly imagine.
Nevertheless, HIV and AIDS has still carried its toxic stigma, in spite of the knowledge, awareness and incredible leaps in life-transforming therapy. Indeed, it is only through popular culture – notably the feature film Dallas Buyers Club and the recent TV series It’s a Sin – that people who are HIV positive felt ‘normalised’ and empowered.
High profile people are now feeling comfortable enough to announce their status in the knowledge most will understand that this is only part of who they are. Contrast this with Freddie Mercury, over 30 years ago, announcing his condition only the day before he died.
Mercifully, people who are HIV positive now have the chance to realise their dreams without the all-encompassing fear of previous decades. It is not, however, all about the promised land of single-pill therapies – employers, communities and healthcare institutions still have much to learn about what it is like to live with HIV.
The only way this can happen is – not through academic pondering – but by tapping into the knowledge, humour and realities of people living with HIV/AIDS. This isn’t where the AIDS story ends, but we are embarking on a new route where hope, opportunity and decency prevail.
That is why with every new development that comes – and any of those that may come in the future – ensuring the patient voice is heard and fully involved in care decisions helps to make sure that no individual is left behind.
Continuing the current momentum in HIV care over the next few years will be critical in reaching the goal of zero new HIV transmissions by 2030 and it will take a collective effort to do so.
Ultimately, we have a passionate belief that together we can end the HIV epidemic for everyone, everywhere.
Chris Robinson is Medical Director for HIV at Gilead Sciences UK & Ireland. Go to gilead.co.uk
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