In the light of the recent identification of a new variant of HIV, we spoke to Lycias Zembe, a medical virologist and technical officer at UNAIDS, about whether the new variant will have an impact on the global HIV response.
What is different about this new HIV variant?
HIV is one of the fastest-mutating viruses ever studied—versions of the virus can vary from person to person and sometimes even in a single individual. Its ability to mutate rapidly and evolve between and within individuals is a major obstacle to the development of an HIV vaccine—there is still no HIV vaccine available and no cure.
Up until now, HIV mutations have not been covered widely in the media because of the effectiveness and availability of antiretroviral therapy in responding to them.
The recently reported variant of HIV, subtype B, can cause more severe infection. According to a study by Chris Wymant and team, people infected with the variant have an average viral load that is about four times higher than is usual for HIV infection, and their immune system declines twice as fast, placing them at risk of developing AIDS more quickly. Fortunately, as with other HIV mutations discovered to date, it is readily amenable and treatable with all the standard antiretroviral medicines available today.
So, the main message is that there is no need to panic, mutating is what viruses do, and, fortunately for HIV, the current treatments still work for the variant of HIV subtype B.
However, 10 million people living with HIV worldwide are still not on antiretroviral therapy, so immense efforts are needed to reach those people, who are often marginalized and stigmatized, to ensure they have access to the life-saving treatment, which also prevents transmission of HIV.
How should the global HIV response react?
It is important to identify people who may be infected with HIV quickly and start treatment early, because treatments work well, even against this variant. It is equally important to ensure that people on treatment keep virally suppressed by reinforcing and supporting adherence to treatment regimens. Furthermore, the findings underscore the need for pandemic preparedness and surveillance to detect, characterize and respond to new versions of pathogens quickly.
What lessons can be learned from the discovery of the new variant?
The HIV response should not lose focus on preventing a resurgence of HIV, especially during a time when a lot of attention has been focused on the COVID-19 pandemic and huge resources and infrastructure for HIV have been repurposed for COVID-19.
HIV is the deadliest pandemic of recent times and remains a serious public health concern. There are 38 million people living with HIV, 10 million of whom are not on treatment. In 2020, around 680 000 people died of AIDS-related illnesses and 1.5 million became newly infected with HIV.
During the COVID-19 pandemic, HIV prevention efforts have been disrupted and fewer people have been initiating HIV treatment. Efforts must be massively stepped up in these areas, as well as investments in research and development to find a vaccine and a cure, to ensure we can get on track to end the AIDS pandemic by 2030 as part of the Sustainable Development Goals.
