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 hepatitis C (HCV) and tuberculosis (TB), 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 and to bring increased attention to those disproportionately affected by both diseases, in particular people who inject drugs.
  • TB/HIV 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 TB/HIV co-infection is urgently needed in the areas of political commitment (to strengthen political commitment to and policies for TB/HIV co-infection), operational and service integration research (to address urgent TB/HIV operational and service integration research gaps) and awareness and stigma (to raise TB awareness among the HIV community and address TB stigma).
  • 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 investments in young people living with HIV.

Learn more about the IAS HIV Co-Infections and Co-Morbidities working group


POLICY

People-centred, evidence-based and integrated policies

The HIV Co-Infections and Co-Morbidities 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.

Featured work:

TB 2018 statement to global leaders - Together we can prevent 2 million deaths by 2022
Tuberculosis (TB) is the leading killer of people living with HIV: it causes 40% of all HIV deaths worldwide. Every year, we lose almost half a million family members, friends and colleagues living with HIV to TB. But there is no reason for anyone to die from this curable disease, and all should commit to intensify and accelerate TB/HIV efforts to save the millions at risk.

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RESEARCH

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.

Featured work:

5th International HIV/Viral Hepatitis Co-Infection Meeting – HCV elimination in Latin America and globally: How close are we?
The 5th International HIV/Viral Hepatitis Co-Infection Meeting will take place on 20-21 July 2019, prior to IAS 2019 in Mexico City, Mexico. The meeting will cover implementation challenges to achieving elimination of hepatitis B and C worldwide. Abstracts submitted to IAS 2019 have the opportunity to be considered also for this pre-meeting.

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STRUCTURAL BARRIERS

People who inject drugs

The HIV Co-Infections and Co-Morbidities 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 such as harm reduction. 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.

Featured work:

Ending an epidemic: Prioritizing people who inject drugs in HCV elimination efforts
The time to end HCV as a threat to global public health is upon us. Countries have an unprecedented opportunity to harness the collective power of evidence-based HCV prevention and safe, highly effective treatment. Once they commit to scaling up needle and syringe programmes (NSP) and opioid substitution therapy (OST) alongside treatment, they will be able to halt and reverse the HCV epidemic. This will be true if efforts invested in the HCV response are accompanied by progressive evidence-, human rights- and health-based drug policies. For World Hepatitis Day 2018, we released a policy brief shining a spotlight on the rationale for prioritizing people who inject drugs in global HCV elimination efforts.

Read more in English, in Spanish or in Russian

Women who inject drugs: Overlooked, yet visible
Gender inequality is greatly magnified among women who inject drugs. Women who inject drugs are uniquely vulnerable to medical, legal, economic and social consequences, gender-based violence and loss of custody of their children, and experience high levels of stigma, both within the general society and among the community of people who use drugs. Our policy brief highlights the need for (1) gender-disaggregated data collection for women who inject drugs; (2) meaningful involvement of women who inject drug in the design, implementation and oversight of research, policies and services; and (3) decriminalization of drug use and possession of drugs for personal consumption.

Read more in English, in Spanish, in Portugese or in Russian

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