July 22, 2015

Treatment cascades show 90-90-90 goal within reach for some – but Eastern Europe lags behind Africa

Written by Keith Alcorn

This post originally appeared on NAM’s website.

Global analysis of HIV treatment cascades – the proportions of people diagnosed with HIV, in care, on treatment and virally suppressed – shows that some of the world’s richest countries are still far short of achieving the UNAIDS 90-90-90 target, research from Imperial College London shows. Progress is worst in Eastern Europe, where most countries lag behind average performance in sub-Saharan Africa on every indicator.

The findings were presented by Jacob Levi on Monday at the Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015) in Vancouver, Canada – described by numerous speakers this week as the ’90-90-90′ conference.

The 90-90-90 target set by UNAIDS aims to diagnose 90% of all people with HIV, provide antiretroviral therapy for 90% of those diagnosed and achieve undetectable HIV RNA for 90% of those on treatment, by 2020. This ambitious target translates into undetectable viral load in 73% of all people living with HIV.

How far are countries from achieving these targets? In some cases fairly close, but in others, the gap is enormous.

Research conducted by a team from Imperial College, London, and the Cantonal Hospital of St. Gallen, Switzerland, updating a previous survey presented at the 2014 Congress on Drug Therapy in HIV Infection in Glasgow, shows that Switzerland, Australia and the United Kingdom have the highest proportion of people living with HIV with undetectable viral load. In each of these countries, over 60% of the estimated population of people living with HIV have undetectable viral load, compared with 30% in the United States.

Worldwide, 36.9 million people are estimated to be living with HIV of whom 53% are diagnosed, 13.4 million people short of the 90% target, the researchers calculated, drawing on recent data from UNAIDS. Forty-one per cent are on treatment, 14.9 million people short of the target, and 32% are virally suppressed, 15.3 million people short of the target. Approximately 2 million people each year are becoming infected at current rates of transmission.

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