Human immunodeficiency virus (HIV) is no longer a death sentence to patients as anti-retroviral therapy (ART), the treatment used to suppress the virus in people living with HIV, has improved dramatically over the past 40 years, making HIV a manageable chronic disease.

Reflecting this, a study found that people in their 20s who are living with HIV and on ART worldwide have a life expectancy of nearly 78 years, which is comparable to the Organisation for Economic Co-operation and Development (OECD)'s average life expectancy of the same age group at 80.5 years.

As a result, prolonging safe and effective ART has become a top priority for treating HIV patients.

To get a better insight into the treatment of HIV in the actual medical field, Korea Biomedical Review sat down with Gilead Sciences Medical Affairs Senior Director Calvin Cohen and Professor Choi Jun-yong of the Department of Infectious Medicine at Severance Hospital to talk about the recent trends in diagnosis, prevention, and treatment of HIV.

HIV infections down during Covid-19 but on the rise in endemic phase

Professor Choi, who plays a central role in domestic HIV testing, believes that concentrating most infectious disease response capabilities on Covid-19 depleted resources for HIV management.

"While there was a temporary decrease in new HIV infections reported during Covid-19, the numbers are rising again," Choi said. "The precise reason, whether there was an actual decrease in infections or hidden cases due to the suspension of HIV screening and anonymous testing by most health centers and medical institutions, remains unclear."

However, a survey conducted on HIV patients showed that while Covid-19 had little impact on treatment, some limitations were felt in prevention and diagnosis, Choi added.

Choi stressed that he believes the suspension of HIV tasks by public health centers and medical institutions hampered prevention and diagnostic testing.

Cohen stressed that the U.S. faced similar challenges, with many people reluctant to go out, leading to difficulties in HIV management.

"However, efforts were made to address both Covid-19 and HIV," Cohen said. "Telemedicine through phone calls and video systems like Zoom was adopted (in the U.S.), and efforts were made to maintain diagnostic tests and prescriptions."

As the situation shifted to an endemic phase, American healthcare providers have adapted by offering both face-to-face and remote consultations, depending on patient preferences.

Regarding telemedicine, Choi stressed that the Korean government also allowed temporary authorization for telemedicine.

"This allowed for consultations and medication delivery over the phone, particularly benefiting those in remote areas or those in stable conditions," he said. "People who just wanted to get a prescription without a doctor's appointment seemed to feel more comfortable with telemedicine."

However, not many patients used the platform, and the majority were much more likely to visit a doctor's office, he said.

Global trends in HIV treatment

According to Cohen, the global trend in HIV treatment is diagnosis and treatment on the same day.

"With the introduction of drugs like Gilead's Biktarvy, treatment can begin on the same day as a diagnosis without waiting for test results," Cohen said.

Cohen stressed that this is also a very positive change for healthcare providers as HIV is a disease that needs to be treated as quickly as possible.

Other major guidelines, such as the U.S. Department of Health and Human Services (DHHS), also recommend starting treatment as soon as possible after diagnosis.

When asked about what the long-term treatment considerations were, Cohen said that when selecting a medication for long-term treatment, doctors should look at long-term viral suppression, safety, resistance, and ease of medication.

"Biktarvy is designed with these factors in mind, with a high resistance barrier being a notable feature," the Gilead Science director said.

Choi emphasized the importance of medication compliance.

"Taking medication every day can be challenging for those infected with HIV," Choi said. "While adherence is usually poorer in people who are psychologically disturbed, such as depression or alcoholism, or who are economically disadvantaged, the majority of HIV-infected people simply forget to take their medication on time."

To help people remember the importance of taking their medication, Choi recommended teaching patients to take their medication before or after a certain daily routine or to enlist the help of others.

Long-term data on Biktarvy

The two doctors also noted on the recent release of 5-year long-term data on Gilead's Biktarvy for treatment-naive HIV-infected adults.

"Biktarvy's five-year clinical trials on 634 adults revealed significant findings," Cohen said. "Biktarvy achieved and consistently maintained a viral suppression level of over 98 percent, and the discontinuation rate was less than 1 percent.

The results not only demonstrate effectiveness but tolerance as well, he added.

Cohen further emphasized that Biktarvy allowed many infected individuals to maintain their condition and accept the medication as part of their daily lives.

Choi also stated that the long-term data reaffirms Biktarvy's role as a leading treatment.

"Biktarvy's five-year data is considered to provide confidence to doctors in all aspects, including efficacy, safety, tolerance to drugs, and resistance barriers," Choi said. "The immediate availability of Biktarvy without pre-testing also sets it apart from other treatments out in the market."

The ability to begin treatment without waiting for lengthy test results is also considered an advantage, he added.

Korea's HIV challenges

Regarding the HIV situation in Korea, both experts agreed on the urgent need for a national support and strategy.

"I think assistance at the national level is needed," Cohen said. "The concept of U=U (Undetectable=Untransmittable) means that if HIV remains undetectable in the body, it cannot be transmitted to others."

If everyone at high risk is aggressively tested, and all those who are hiding are identified and started on treatment, there will be no new infections, which means complete eradication of HIV, Cohen added.

Cohen stressed that he believes that there is no need to hesitate any longer because we have the treatments to make this happen,

Choi also agreed that early diagnosis is the most urgent task.

"To do this, Korea needs to address the social stigma surrounding HIV," he said. "While Korea has near-95 percent cure and viral suppression rates, diagnosis rates are relatively low."

For early diagnosis to take off, key targets at risk of HIV need to be actively tested, but prejudice and stigma make it difficult for them to do so, he added.

Choi stressed that this is why it's important to ease social perceptions so that people at risk of HIV can actively get tested.