IAS HIV Co-Infections and Co-Morbidities
MISSION: Address existing gaps in the response to HIV co-infections and co-morbidities, in particular at the intersection of HIV with hepatitis C, tuberculosis and non-communicable diseases.
With increased access to antiretroviral therapy and improved monitoring of treatment effectiveness in much of the world, fewer people are dying from AIDS-related causes, and those with HIV are living longer than ever before. However, while the number of AIDS-related deaths has decreased by 45% since its peak in 2005, an estimated one million people continue to die from AIDS-related illnesses each year. Among people living with HIV, morbidity and mortality is increasingly driven by co-infection with other diseases, including tuberculosis (TB) and hepatitis C (HCV), and co-morbidity with non-communicable diseases (NCDs). Successfully addressing the challenge of co-infections requires tackling the complexities of multiple epidemics, including reaching vulnerable populations and expanding access to new diagnostics and curative medicines.
The IAS HIV Co-Infections and Co-Morbidities initiative focuses on a number of areas, taking advantage of overlapping populations and service delivery needs of HIV and related co-infections and co-morbidities. These include:
- HIV/HCV co-infection
Worldwide, 71 million people are estimated to be living with chronic HCV infection, and approximately 700,000 die each year from HCV-related causes. Despite recent breakthroughs and dramatically improved curative options, the response to the global HCV epidemic continues to be limited, and treatment remains out of reach for the vast majority of those affected. The intersection of HCV with HIV presents an opportunity to accelerate the global HCV response, as well as bring increased attention to those disproportionately affected by both diseases, including people who inject drugs.
- HIV/TB co-infection
TB represents a major global public health challenge in and of itself. Within the context of the global HIV epidemic, TB is the leading cause of death for people living with HIV worldwide. The enduring threat that TB presents to people living with HIV is exacerbated by the growing prevalence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. Focusing on HIV/TB co-infection highlights the need for new strategies for integrating health services and brings a focus to those populations disproportionately affected by both diseases, including prisoners, children and people who inject drugs.
- HIV/NCDs co-morbidity
As HIV becomes a chronic illness, the growing population of people living and aging with HIV will be confronted with an increasing burden of NCDs. HIV programmes will represent an opportunity to address these issues, given their strength in countries where health systems are often otherwise weak. Addressing HIV/NCDs co-comorbidity will also protect today’s investment in young people living with HIV.
Learn more about the IAS HIV Co-Infections and Co-Morbidities working group
People-centred, evidence-based and integrated policies
The initiative contributes to the broader health policy environment, encouraging integration of HIV with co-infections and co-morbidities, and strengthening health and community systems. The response to HIV, especially in resource-limited settings, has provided many lessons that can give orientation for the scale up of care in other disease areas, in particular HIV co-infections and co-morbidities. A less siloed approach that focuses more on populations than on individual diseases should be developed. This includes a need for the key concepts from the HIV differentiated service delivery movement to be applied to HIV co-infections and co-morbidities to improve the cascade of care, maximize efficiencies and reduce the burden on health systems.
TB 2016 galvanized political leadership for intensified implementation policies and an inspired new generation of TB activists and leaders. Taking place prior to AIDS 2016, it was a unique occasion to bring together leading TB researchers and advocates with the broad HIV community.
Collaboration across disease areas
The increased engagement of the HIV research community with specializations beyond HIV, including co-infections and co-morbidities is essential.
Unfortunately, scientific advancements in diverse disease areas remain vertically segmented. There is a need to overcome the fragmentation of research agendas related to the various aspects of HIV and its co-infections and co-morbidities by promoting interdisciplinary research and bringing together researchers from diverse fields together. Fostering interdisciplinary collaboration of the HIV research community with other research communities, civil society organizations, the private sector, local and national governments, and regional bodies, will stimulate engagement and enthusiasm in these fields.
4th International HIV/Viral Hepatitis Co-Infection Meeting
The 4th International HIV/Viral Hepatitis Co-Infection Meeting took place prior to IAS 2017. Its theme was The Rocky Road to Viral Hepatitis Elimination: Assuring access to antiviral therapy for ALL co-infected patients from low- to high-income settings. Building on the previous three annual meetings, it provided a unique opportunity to bring together a diversity of scientific, technical and community interests to discuss current opportunities and challenges for increased prevention, diagnosis and treatment of viral hepatitis in people living with HIV.
People who inject drugs
This initiative aims to remove structural barriers and address human rights violations that inhibit access to and uptake of comprehensive HIV and other health services for vulnerable populations and communities. In particular, people who inject drugs (PWID) are disproportionately affected by HIV and HCV because of limited investments in and hugely restricted access to proven interventions. Even when effective care is available, the combination of punitive laws and experiences of stigma – both within healthcare settings and in the broader community – create barriers to their use. There is a need to support the rationale for inclusive HIV and HCV care policies that use an evidence- and human rights-based approach to drug policies and harm-reduction interventions.
Elimination of HCV as a public health concern among people who inject drugs by 2030
On World Hepatitis Day, we reflected on what it will take to eliminate HCV as a public health concern among people who inject drugs by 2030. A commentary in JIAS discusses why PWID should be considered as a priority population in HCV elimination efforts; it also details the reasons why this goal could be attainable among PWID, the challenges that must be overcome, and key recommendations for action.