Is the number of people infected with HIV growing?

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With the global epidemic of HIV/AIDS over two decades in the rear-view mirror, the notion that today’s antiretroviral medicines have eliminated the threat of HIV and should prevent HIV-related deaths as readily as modern contraceptives has begun to gain traction. The American Medical Association (AMA) even endorsed antiretroviral medications as preventive measures for HIV in a landmark 2008 paper that also advocated making pre-exposure prophylaxis (PrEP) a routine clinical practice.

But what many don’t know is that while pre-exposure prophylaxis—the term used by the National Institutes of Health to refer to HIV prevention or self-protection efforts where those individuals take antiretrovirals prior to exposure—has been around since the early 1990s, it was not until 2016 that scientists demonstrated that at least one antiretroviral drug could prevent HIV infection altogether.

In November 2016, the University of Texas Southwestern Medical Center published the results of its latest phase III clinical trial, Lopinavir/Tritonavir (LT) Plus Rx, that found an HIV-infected adult using antiretroviral drugs was at less than one-percent risk of acquiring HIV. This is an exciting advance that opens the door to what many call an “endgame,” where a cure would not only be possible, it would be within reach of all HIV patients as a matter of course.

Experts warn that while a one-percent risk of acquiring HIV isn’t great, a new case of HIV is still considered an epidemic.

In a global perspective, antiretroviral medications have rendered an HIV diagnosis or transmission largely inconsequential. While the Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people in the United States are currently living with HIV, and it would take six years for HIV to make up five percent of that population, these statistics represent a dramatic decrease from 1991, when HIV/AIDS made up 28 percent of new diagnoses in the United States.

While there are about 23 million people with HIV worldwide, nearly 35 million individuals have been diagnosed with HIV at some point, and that number is expected to rise.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), HIV continues to make up an average of 2.8 percent of all new infections each year. Yet with nearly all HIV cases stemming from exposure, scientists believe it is possible to eliminate HIV infection from this global epidemic.

In April of this year, the NIAID released a report detailing how nearly all HIV transmissions that were diagnosed by testing for HIV and linked to HIV treatment between 2009 and 2014 were self-infections. If correct, this means that a majority of HIV transmissions are in fact not related to sexual behavior or drug use, and that there are many other factors at work. These include complications with HIV treatment, some related to medications and other to individuals choosing to forgo treatment.