David P Wilson, Mark A Stoové, Margaret Hellard
Original Article: bit.ly/1yNksBV
UNAIDS recently proposed the ambitious 2020 target of 90% of people living with HIV knowing their status, 90% of people diagnosed with HIV on treatment, and 90% of people on treatment with suppressed viral loads.1 The 90-90-90 call was linked to a 90% reduction in HIV incidence by 2030 compared with 2010 levels.1 McMahon and Medland2 recently highlighted that the 90-90-90 target is substantially higher than the levels currently achieved in any setting. Even in high-income countries with low overall HIV endemicity, such as Australia and the UK, which are closest to achieving the UNAIDS targets, substantial gains are still required to reach 90-90-90.
Attaining this target will not necessarily lead to the control of HIV transmission despite strong evidence of reduced infectiousness of people on suppressive treatment.3 HIV-related mortality is now rare in most high-income countries because of good antiretroviral therapy (ART) access and coverage. Increases in the number of HIV-positive individuals living well in the community, alongside incident infection adding to the prevalence pool, raise the probability of HIV-negative individuals having sexual contact with HIV-positive individuals. Depending on how this situation balances against other factors, such as negotiated condom or non-condom-based risk reduction strategies, an increase in the total number of new HIV infections per year might occur as has been observed over the past 15 years in various high-income settings despite improvements in test-and-treat indicators.4
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