Is HIV epidemic control by 2030 realistic?

Rates of new HIV acquisition remain unacceptably high in most populations in low-income, middle-income, and high-income settings despite advances in treatment and prevention strategies. Although biomedical advances in primary prevention of new infections exist, systematic scale-up of these interventions has not occurred at the pace required to end AIDS by 2030. Low population coverage, adherence to oral pre-exposure prophylaxis in settings with high rates of HIV acquisition, and the fact that a significant proportion of new HIV infections occurs in populations not identified as high risk and are hence not targeted for prevention approaches impedes current prevention strategies. Although long-acting injectables and monoclonal antibodies are promising approaches to help reduce incidence, high cost and the need for high coverage rates mean that a vaccine or vaccine-like intervention still remains the most likely scenario to produce a population-level impact on HIV incidence, especially in countries with generalised epidemics. Current global efforts are not sufficient to meet 2030 HIV epidemic goals; acknowledgment of this issue is required to ensure persistent advocacy for population-based control of the ongoing HIV pandemic.
Competing Interests: Declaration of interests SB receives grants paid to institution from Gilead, ViiV, GSK, and Merck. LC reports grants from the National Institute of Allergy and Infectious Diseases and National Institutes of Health paid to institution. GDT reports grants from National Institutes of Health paid to institution and contracts from Janssen, Regeneron, BioNTech, and Sanofi and honorariums for scientific advisory boards from Michelson Prizes, Gilead Scholars, University of Alabama, University of North Carolina, Emory University, and NIH Vaccine Research Center. All other authors declare no competing interests.
(Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)