Data from the World Health Organization (WHO) highlights that over 40 million lives have been lost to HIV since the epidemic began, with an estimated 39 million people currently living with the virus worldwide. However, the condition that was once considered fatal due to lack of effective treatments, is now viewed as a chronic but manageable condition due to medical advances in the field.
Over the past decade, HIV treatments have evolved significantly. Improvements in Antiretroviral Therapy (ART), including single-tablet regimens, have been game-changers, simplifying adherence and reducing the pill burden for patients. Long-acting treatments, advancements in Pre-Exposure Prophylaxis (PrEP), and global initiatives to expand access to treatment have all contributed towards better health outcomes for those living with the virus.
While the Middle East has the lowest prevalence globally, a recent UNAIDS report indicates that new HIV infections are increasing in the region, underscoring the critical need for continued action to improve awareness, as well as access to testing, care, and treatment. Building on the outcomes of last year’s Middle East HIV Summit hosted by Gilead Sciences, the latest edition focused on three priority areas: HIV awareness, access to testing, and prevention. The summit provided a platform for discussions on various challenges and shared best practices from across the Middle East.
Despite global advancements, there are still significant gaps in HIV care that need to be addressed. Public awareness about HIV and its therapies is still low. Many people still do not have easy access to HIV testing, which is crucial for early detection and management. Social stigma around HIV remains a major barrier, discouraging people from seeking testing and medical care. Additionally, it is essential to equip medical professionals with the necessary tools to guide patients toward the appropriate treatment for long-term success. This was extensively discussed on the second day of the summit, during which the latest advancements in HIV treatment were highlighted, including the ‘Power of Five’.
‘Power of Five’ is a transformative strategy to guide treatment selection and is built on five key pillars that are crucial to ensure long-term treatment success. Representing a comprehensive approach to HIV management, it not only finds durable viral suppression but also encompasses a broader vision aimed at enhancing patient quality of life and long-term health. The five treatment selection pillars are:
1. Safe and tolerable
People with HIV need a treatment they can stay on and that supports their overall health as they age. For example, older patients often face age-related comorbidities such as cardiovascular disease, diabetes, hypertension, and cancers. Management of these conditions becomes a critical part of their care, particularly as they are likely to require multiple medications to manage various conditions, increasing the risk of drug interactions and related side effects.
2. Person-centred
People with HIV deserve a simple treatment that is easy to take, even if they miss doses occasionally. It’s important to adjust treatments to fit individual needs and provide support to help them stick to their regimen.
3. High barrier to resistance
HIV is a rapidly mutating virus and drug resistance can develop quickly if the virus is not completely suppressed. A robust, forgiving treatment plan with a high barrier to resistance protects against the life-long complications associated with resistance mutations and helps ensure effective treatment for durable viral suppression. This stability reduces the likelihood of treatment failure and the need to switch to more complex and potentially less tolerable drug regimens. Additionally, maintaining effective viral suppression minimises the risk of HIV transmission and the development of drug-resistant strains, which can be harder to treat and manage, thereby improving overall patient outcomes and public health.
4. Rapid start
The rapid initiation of HIV treatment is recommended and can improve patient outcomes as well as protect the health of people with HIV and their partners. It also helps prevent opportunistic infections by preserving immune function and provides psychosocial benefits such as reduced anxiety and increased retention in care.
5. Experience
A treatment regimen that has demonstrated success in a broad population builds confidence and trust in healthcare providers and the people with HIV they see every day. Proven efficacy is critical in ensuring that the treatment will deliver consistent results across various demographics and clinical scenarios. When a treatment has a track record of success, it not only reassures medical professionals of its reliability but also helps build patient confidence in the prescribed therapy.
While there is still some work to do from an awareness perspective, both globally and in the Middle East — the latter facing unique challenges, the ‘Power of Five’ framework equips healthcare practitioners with an enhanced approach to treatment selection for existing and new patients. The combined power of the treatment selection pillars offers people with HIV the best chance to achieve long-term success, ultimately leading to improved outcomes and quality of life.
Dr. Jameela Al Salman is the Senior Consultant in Infectious Diseases, Internal Medicine and Geriatric Medicine, King Hamad American Mission Hospital, Bahrain.
