AIDS experts doubt UNAIDS claim of a cure by 2030

Local AIDS experts are at odds with the United Nations Programme on HIV/AIDS (UNAIDS) over its claims that AIDS could be cured by 2030 if pharmaceutical companies allow much more effective new drugs to reach middle and poor income countries.

This week, UNAIDS sounded the alarm at the World Economic Forum's annual meeting in Davos, Switzerland. The organisation stated that new medications could help usher in the end of AIDS if corporate and political leaders "move quickly and urgently to prioritise access for all low and middle-income countries."

However Prof. Clive Gray, professor of immunology in the division of immunology at the department of Biomedical Sciences at Stellenbosch University said these drugs are pre-exposure prophylaxis (PrEP) and not as a treatment.

“This will do nothing for those already infected but will possibly put a stop to new transmissions and keep people HIV-free. It is possible that these drugs (either Lenacapavir or Cabotegravir) are likely to be a very effect treatment as well – but we will need to see the results of these clinical trials to make that judgement.

“Regarding a cure. As a prevention measure, the use of these drugs in PrEP will not result in a cure – but can halt new infections and so in the long run the numbers of people living with HIV will get smaller and smaller. This is what is meant by putting a stop to the pandemic. In terms of a ‘cure’ – we should rather speak about curing at-risk populations.“

UNAIDS said Lenacapavir, produced by Gilead Sciences, has proved to be more than 95% effective in preventing HIV with just two doses a year, and the company is now conducting trials of once-yearly shots. ViiV Healthcare has developed the injectable medicine Cabotegravir, administered once every two months to prevent HIV, which is already being used in some countries. Month-long vaginal rings are also in use, and longer-acting pills and vaginal rings are being trialled.

"These new technologies offer us a real shot at ending AIDS by 2030," said Winnie Byanyima, Executive Director of UNAIDS and Under-Secretary-General of the United Nations. "But it comes with a caveat—only if pharmaceutical companies, governments, international partners and civil society unite around an HIV prevention and treatment revolution can we use these medicines to their full potential and end AIDS much sooner than we previously thought."

Prof. Gray disagrees with the assertion that AIDS can be cured by 2030.

“2030 is five years away. After 40 years of intensive research into HIV prevention and treatment measures, I’m not sure that a cure using PrEP will be achievable by 2030. Certainly not a cure of those already infected. Good adherence to effective drugs for those already living with HIV will keep people healthy and also lower the risk of transmitting HIV to other.”

Rudi de Koker, project manager at Digital Health Cape Town and PhD student at the Africa Centre for HIV/AIDS, said while the UNAIDS statement does not suggest that the new long-acting HIV prevention is a cure, the advancements in long-acting HIV medicines mark a significant leap forward.

"These medicines are tools to prevent and manage HIV, and their full potential could help achieve the goal of ending AIDS by 2030. However, this depends on collective action by corporate and political leaders to ensure equitable access for all."

Dr Munya Saruchera, director at the Africa Centre for Inclusive Health Management at Stellenbosch University, believes that politics is at the centre of why a cure has not been found yet, citing the US withdrawal from the World Health Organisation (WHO) and the withdrawal of funding by the US, which will have a bearing on funding commitments to fight HIV/AIDS.

"The inequalities we find are the biggest social pandemic in the world. There is greed, and those who want to make money at the expense of human life, and not all human life is viewed as equally important, as we have seen in how the world looks between the North and South. My view is that we should have had a cure for HIV/AIDS a long time ago."

He said substantial money has gone into HIV/AIDS research and development, but politics remains central, with pharmaceutical companies controlled by those who have money and power. He said this was particularly evident during the COVID-19 pandemic when countries like Canada were hoarding vaccines at the expense of other countries who needed them far more.

UNAIDS said the breakthrough long-acting medicines that could stem new HIV infections are already being used to suppress the virus for some people living with HIV, but their potential cannot be unlocked unless everyone who could benefit has access.

UNAIDS is urging pharmaceutical companies to move faster and ensure "affordable pricing and generic competition" in the market for the new HIV medicines. "We have no problem with profit, but we will not stand for profiteering," said Byanyima.

Prof. Gray said it is not correct that poor and middle income countries don’t have access to these new drugs.

“Until those generic makers’ production is fully underway, Gilead will provide them with its own product to bridge the gap at a ‘no profit price,’ the company said. In this effort, it will prioritise 18 countries which together account for 70% of the HIV burden among the 120 countries covered by the agreement. These are Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Philippines, Rwanda, South Africa, Tanzania, Thailand, Uganda, Vietnam, Zambia, and Zimbabwe,” said Gray.

UNAIDS however said Gilead and ViiV have licensed generics manufacturing to several countries, but generics are not expected until next year—and many countries have been left out.

“Nearly all of Latin America, a region of rising HIV infections, has been excluded. Additionally, to provide for the whole world, Gilead has licensed just six companies to make generic versions of the medicine—with no producer in sub-Saharan Africa.”

Prof. Linda-Gail Bekker, director at the Desmond Tutu HIV Centre and CEO of The Desmond Tutu Health Foundation said these new drugs should be celebrated.

“However, these novel drugs can only have impact if they are get to all the people around the world who need them and can benefit from them. The greatest global benefit will be derived if they are not rationed or restricted due to price of availability. This will need many stakeholders to come together to make sure manufacturing is scaled up, the agents are affordable and available, clinical guidance is in place and people in communities are educated to step up,” she said.

De Koker said some of the reasons why middle and low-income countries cannot get access to these medications include regulatory approvals, healthcare budgets, healthcare infrastructure and licensing for generic production. "In the South African context, the high cost of these medicines and restricted manufacturing licensing agreements for generics are key barriers."

Prof Saruchera said poverty is at the centre of why poor and middle-income countries cannot have access.

"The world belongs to those with money; that is just the bluntest way I can put it. If you are poor, you are forsaken. If you are poor, you do not have power; if you are poor, you hardly have a voice; if you are poor, you do not have a vote." He said only those who are wealthy and affected by the disease will be able to afford these expensive drugs.