posts: 28711

{
    "id": "wp-28711",
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                "text": [
                    {
                        "text": "Millions of lives are saved by ART",
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                        "text": "Since the first version of ART was introduced in the late 1980s, the treatment has saved millions of lives.",
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                        "text": "The chart here shows the annual number of deaths from HIV/AIDS and the number of deaths averted due to ART.\u00a0",
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                        "text": "Globally, 850,000 people died from HIV/AIDS in 2016, but even more deaths \u2013 1.2 million \u2013 were averted due to ART. Without ART, more than twice as many people would have died from HIV/AIDS.\u00a0",
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                "url": "https://ourworldindata.org/grapher/hivaids-deaths-and-averted-due-to-art",
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                "text": [
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                        "text": "People who use ART are living longer",
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                        "text": "ART not only saves lives but also gives a chance for people living with HIV/AIDS to live long lives. Without ART, very few infected people survive beyond ten years.{ref}We should note, though, that the life expectancy for people living with HIV infection without ART can vary depending on the age when a person got infected with HIV, a person's immune status (e.g., CD4 count), and socioeconomic factors.\u00a0",
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                    {
                        "text": "Babiker, A., Darby, S., De Angelis, D., Kwart, D., Porter, K., Beral, V., ... & Prins, M. (2000). ",
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                    },
                    {
                        "url": "https://www.sciencedirect.com/science/article/pii/S0140673600020614#tbl1",
                        "children": [
                            {
                                "text": "Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis. Collaborative Group on AIDS Incubation and HIV Survival including the CASCADE EU Concerted Action.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " Concerted Action on SeroConversion to AIDS and Death in Europe. ",
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                    {
                        "children": [
                            {
                                "text": "Lancet",
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                    },
                    {
                        "text": ", ",
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                        "children": [
                            {
                                "text": "355",
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                    {
                        "text": "(9210).",
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                    {
                        "text": "Wandel, S., Egger, M., Rangsin, R., Nelson, K. E., Costello, C., Lewden, C., ... & Minga, A. (2008). ",
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                    },
                    {
                        "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569418/",
                        "children": [
                            {
                                "text": "Duration from seroconversion to eligibility for antiretroviral therapy and from ART eligibility to death in adult HIV-infected patients from low and middle-income countries: collaborative analysis of prospective studies",
                                "spanType": "span-simple-text"
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                        ],
                        "spanType": "span-link"
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                    {
                        "text": ". ",
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                    {
                        "children": [
                            {
                                "text": "Sexually transmitted infections",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", ",
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                        "children": [
                            {
                                "text": "84",
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                    {
                        "text": "(Suppl_1), i31-i36.{/ref} ",
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                        "text": "According to a 2016 study, a person in a high-income country who started ART in their twenties can now expect to live for another 46 years \u2014 well into their 60s.{ref}This number is based on a study that used European and North American countries. Few studies have systematically assessed the life expectancy of people living with HIV/AIDS in middle and low-income countries, but it is predicted to be significantly lower between 60-74% of the life expectancy of the general population (see Wandeler et ",
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                    {
                        "children": [
                            {
                                "text": "al. ",
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                    {
                        "text": "reference).\u00a0",
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                        "text": "Multiple factors account for this difference, including a higher prevalence of other diseases, such as co-infections with hepatitis or tuberculosis, and a higher prevalence of opportunistic diseases. In addition, people tend to adhere to ART regimens less strictly because of poorer care for AIDS patients, less access to medical clinics, and social stigma.\u00a0",
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                        "text": "Wandeler, G., Johnson, L. F., & Egger, M. (2016). ",
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                    },
                    {
                        "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055447/",
                        "children": [
                            {
                                "text": "Trends in life expectancy of HIV-positive adults on ART across the globe: comparisons with general population",
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                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                    {
                        "children": [
                            {
                                "text": "Current Opinion in HIV and AIDS",
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                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", ",
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                        "children": [
                            {
                                "text": "11",
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                    {
                        "text": "(5), 492.",
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                        "text": "Currently, no equivalent estimate for life expectancy is available for low and middle-income countries. However, we do know that with decreasing rates of HIV mortality in low and middle-income countries, the life expectancy of the general population has increased. Haris et al. discuss this, and you can read more about life expectancy and HIV ",
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                    {
                        "url": "https://ourworldindata.org/hiv-aids#hiv-aids-has-had-a-major-impact-on-life-expectancy-across-sub-saharan-africa",
                        "children": [
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                                "text": "here",
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                        ],
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                        "text": ".",
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                "value": [
                    {
                        "text": "Harris, T. G., Rabkin, M., & El-Sadr, W. M. (2018). Achieving the fourth 90: healthy aging for people living with HIV. ",
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                    {
                        "children": [
                            {
                                "text": "AIDS (London, England)",
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                        "text": ", ",
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                        "children": [
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                                "text": "32",
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                    {
                        "text": "(12), 1563.",
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                        "text": "Trickey, A., May, M. T., Vehreschild, J. J., Obel, N., Gill, M. J., Crane, H. M., ... & Cavassini, M. (2017). ",
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                    },
                    {
                        "url": "https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30066-8/fulltext#figures",
                        "children": [
                            {
                                "text": "Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies.",
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                            }
                        ],
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                        "children": [
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                                "text": "The Lancet HIV",
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                        "text": ", ",
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                        "children": [
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                                "text": "4",
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                        "text": "(8), e349-e356.{/ref}",
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                        "text": "While the life expectancy of people living with HIV/AIDS in high-income countries has still not reached the ",
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                        "url": "https://ourworldindata.org/life-expectancy",
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                                "text": "life expectancy",
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                        "text": " of the general population, we are getting closer to this goal.{ref}Global average ",
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                        "url": "https://ourworldindata.org/grapher/life-expectancy?tab=chart&time=1543..latest&country=Africa~Americas~Asia~Europe~Oceania~OWID_WRL",
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                                "text": "life expectancy",
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                        "text": " in 2019 was 72.6 years. The average life expectancy in Europe is 78.6 years.{/ref}\u00a0",
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                        "text": "The combination of antiretroviral drugs which make-up ART has progressively improved. Recent research shows that a person who started ART in the late 1990s would be expected to live ten years less than one who started ART in 2008.{ref}Trickey, A., May, M. T., Vehreschild, J. J., Obel, N., Gill, M. J., Crane, H. M., ... & Cavassini, M. (2017). ",
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                        "url": "https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30066-8/fulltext#figures",
                        "children": [
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                                "text": "Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies.",
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                        "children": [
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                                "text": "The Lancet HIV",
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                        "text": ", ",
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                                "text": "4",
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                        "text": "(8), e349-e356.{/ref} This increase goes beyond the general increase in life expectancy in that period and reflects the improvements in ART \u2014 fewer side effects, more people following the prescribed treatment, and more support for the people in need of ART.",
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                "text": [
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                        "text": "ART prevents new HIV infections",
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                        "text": "There is considerable evidence to show that people who use ART are less likely to transmit HIV to another person.{ref}\u00a0G Williams, B., Lima, V., & Gouws, E. (2011). ",
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                        "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529404/",
                        "children": [
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                                "text": "Modelling the impact of antiretroviral therapy on the epidemic of HIV.",
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                        "children": [
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                                "text": "Current HIV research",
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                        "text": ", ",
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                                "text": "9",
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                        "text": "(6), 367-382.{/ref} ART reduces the number of viral particles in an HIV-positive individual; therefore, the likelihood of passing the virus to another person decreases.\u00a0",
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                        "text": "In 2011, the journal ",
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                                "text": "Science",
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                        "text": " named a study that found that ART reduced the risk of HIV transmission between couples by 96% as its \u201cBreakthrough of the Year\u201d.{ref}",
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                        "text": "Science announcement: ",
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                        "text": "Cohen, J. (2011). ",
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                        "url": "https://science.sciencemag.org/content/334/6063/1628",
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                                "text": "HIV treatment as prevention",
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                        "text": ".",
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                        "text": "Study that was awarded: ",
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                        "text": "Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., ... & Godbole, S. V. (2011).",
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                        "url": "https://www.nejm.org/doi/full/10.1056/Nejmoa1105243",
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                            {
                                "text": " Prevention of HIV-1 infection with early antiretroviral therapy.",
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                                "text": "New England journal of medicine",
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                        "text": ", ",
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                        "children": [
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                                "text": "365",
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                        "text": "(6), 493-505.{/ref} Many other studies have now shown similar findings, with a range of reduction in transmission attributable to ART depending on location and groups studied.{ref}PARTNER study showed chances of transmission between gay couples with successfull virus suppression by ART are \u201ceffectively zero\u201d.\u00a0",
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                        "text": "Rodger, A. J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Degen, O., ... & Raben, D. (2019). ",
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                        "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext",
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                                "text": "Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.",
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                                "text": "The Lancet",
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                        "text": ".",
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                        "text": "Transmission rates in Madrid fell by 86% after ART became available",
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                        "text": "Castilla, J., Del Romero, J., Hernando, V., Marincovich, B., Garc\u00eda, S., & Rodr\u00edguez, C. (2005). ",
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                        "url": "https://journals.lww.com/jaids/Fulltext/2005/09010/Prevalence_of_Unsafe_Sexual_Behavior_Among.16.aspx?casa_token=4RZtew6owdYAAAAA:YrqHOyO0wmGz7hSrlm0r6loCZUtsZd1wVRVQvR2U0_XPeUnJpSC9ykITGg0bsGmB1IjAinXZbUd9hslCBo-DtYCk",
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                                "text": "Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV",
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                        "text": ". ",
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                        "children": [
                            {
                                "text": "JAIDS Journal of Acquired Immune Deficiency Syndromes",
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                        "text": ", ",
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                                "text": "40",
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                        "text": "(1), 96-101.",
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                        "text": "A study in San Francisco showing after ART became available, viral loads dropped to 40% and HIV infection rates fell by 60%.",
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                        "text": "\u00a0Das, M., Chu, P. L., Santos, G. M., Scheer, S., Vittinghoff, E., McFarland, W., & Colfax, G. N. (2010). ",
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                    {
                        "url": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011068",
                        "children": [
                            {
                                "text": "Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco",
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                        "text": ". ",
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                        "children": [
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                                "text": "PloS one",
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                        "text": ", ",
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                        "children": [
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                                "text": "5",
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                        "text": "(6), e11068.",
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                        "text": "After ART became freely available in Taiwan transmission rates fell by 50%.\u00a0Fang, C. T., Hsu, H. M., Twu, S. J., Chen, M. Y., Chang, Y. Y., Hwang, J. S., ... & Division of AIDS and STD, Center for Disease Control, Department of Health, Executive Yuan. (2004). ",
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                        "url": "https://academic.oup.com/jid/article-abstract/190/5/879/868453",
                        "children": [
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                                "text": "Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan.",
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                        "children": [
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                                "text": "Journal of Infectious Diseases",
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                        "text": ", ",
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                                "text": "190",
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                        "text": "(5), 879-885.{/ref} A study from British Columbia, for example, showed that with every 10% increase in ART coverage there was an 8% decrease in new diagnoses of HIV.{ref}\u00a0Hogg, R. S., Heath, K., Lima, V. D., Nosyk, B., Kanters, S., Wood, E., ... & Montaner, J. S. (2012). ",
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                    },
                    {
                        "url": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0047260",
                        "children": [
                            {
                                "text": "Disparities in the burden of HIV/AIDS in Canada",
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                    },
                    {
                        "text": ". ",
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                    {
                        "children": [
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                                "text": "PLoS One",
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                    },
                    {
                        "text": ", ",
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                        "children": [
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                                "text": "7",
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                    {
                        "text": "(11), e47260.{/ref}",
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                "text": [
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                        "text": "We need to increase ART coverage",
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                        "text": "The number of people who receive ART has increased significantly in recent years, especially in African countries where the prevalence of HIV/AIDS is the highest.",
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                "value": [
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                        "text": "But many millions of people who could benefit from the life-saving treatment currently don\u2019t.\u00a0",
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                        "text": "To increase ART coverage, we must first improve access to testing for HIV status. In 2018, 79% of people living with HIV knew their status. This means 1-in-5 people living with HIV were unaware.{ref}The 79% figure is based on ",
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                        "url": "https://www.unaids.org/en/resources/fact-sheet",
                        "children": [
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                                "text": "2019 UNAIDS estimates",
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                        "text": "The frequency of undiagnosed HIV/AIDS can be measured using observational studies. Measures of the expected rate of HIV infection, the actual number of people diagnosed with HIV, and delay in diagnosis are taken into account to predict the true expected prevalence of HIV in a population and the proportion of undiagnosed cases (see Singh et ",
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                    {
                        "children": [
                            {
                                "text": "al.",
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                        "text": " reference).\u00a0",
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                "value": [
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                        "text": "The initial HIV infection is often followed by flu-like symptoms, which subside in a few weeks. The infected patient can then live without symptoms for months or years while their immune system may be slowly deteriorating. Hence, people infected with HIV may not even know they need to be tested due to the lack of symptoms. Models used to predict HIV incidence rate often use an expected 5-year lag between infection and diagnosis.\u00a0",
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                "type": "text",
                "value": [
                    {
                        "text": "Singh, S., Song, R., Johnson, A. S., McCray, E., & Hall, H. I. (2018). ",
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                    },
                    {
                        "url": "https://annals.org/aim/fullarticle/2675979/hiv-incidence-prevalence-undiagnosed-infections-u-s-men-who-have",
                        "children": [
                            {
                                "text": "HIV incidence, prevalence, and undiagnosed infections in US men who have sex with men.",
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                    {
                        "children": [
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                                "text": "Annals of internal medicine",
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                        "text": ", ",
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                        "children": [
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                                "text": "168",
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                        "text": "(10), 685-694.{/ref} And awareness is also not enough. In Sub-Saharan Africa, among people who are HIV positive, only 57% went on to complete the required pre-treatment assessments.{ref}",
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                        "text": "WHO eligibility criteria are based on CD4 counts, which go down as the illness progresses. A healthy person\u2019s CD4 counts are >500/mm3. WHO recommends ART for anyone with HIV diagnosis and CD4 count >350 cells and \u2264500/mm3, regardless of clinical symptoms. All children, people with TB, HBV, and pregnant women diagnosed with HIV regardless of their CD4 status, should get ART.\u00a0",
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                        "url": "https://www.who.int/hiv/pub/guidelines/arv2013/art/statartadolescents/en/",
                        "children": [
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                                "text": "https://www.who.int/hiv/pub/guidelines/arv2013/art/statartadolescents/en/",
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                        "text": "Kranzer, K., Govindasamy, D., Ford, N., Johnston, V., & Lawn, S. D. (2012). ",
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                    },
                    {
                        "url": "https://onlinelibrary.wiley.com/doi/full/10.7448/IAS.15.2.17383",
                        "children": [
                            {
                                "text": "Quantifying and addressing losses along the continuum of care for people living with HIV infection in sub\u2010Saharan Africa: a systematic review.",
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                            }
                        ],
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                        "children": [
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                                "text": "Journal of the International AIDS Society",
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                        "text": ", ",
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                        "text": "(2), 17383.{/ref} Of those who should start ART, only 66% did.{ref}For some countries, eligibility for ART treatment is determined by the so-called CD4+ counts, which go down as the illness progresses.\u00a0",
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                        "text": "\u00a0Kranzer, K., Govindasamy, D., Ford, N., Johnston, V., & Lawn, S. D. (2012). ",
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                    {
                        "url": "https://onlinelibrary.wiley.com/doi/full/10.7448/IAS.15.2.17383",
                        "children": [
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                                "text": "Quantifying and addressing losses along the continuum of care for people living with HIV infection in sub\u2010Saharan Africa: a systematic review.",
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                        "children": [
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                                "text": "Journal of the International AIDS Society",
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                        "text": ", ",
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                                "text": "15",
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                        "text": "(2), 17383.{/ref} ",
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                        "text": "Stigmatization of people who have HIV/AIDS also leads to a decrease in engagement with care, treatment, and prevention services.{ref}Mahajan, A. P., Sayles, J. N., Patel, V. A., Remien, R. H., Ortiz, D., Szekeres, G., & Coates, T. J. (2008). ",
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                        "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835402/",
                        "children": [
                            {
                                "text": "Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. ",
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                    {
                        "children": [
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                                "text": "AIDS (London, England)",
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                        "text": ", ",
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                        "children": [
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                                "text": "22",
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                        "text": "(Suppl 2), S67.{/ref}",
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