The fight against the HIV pandemic is in the past decades marked by successes and disillusionment. Controlling it is paradigmatic for global health.
On December 1st, 1988, World AIDS Day was celebrated for the first time on the initiative of the “Global Program on AIDS”. Its motto was "Communication". At that time there was great uncertainty about HIV. The WHO's “Global Program on Aids” was only started in 1987 and was an attempt to find global answer to the HIV epidemic (). There was no reliable epidemiological data on the extent of the pandemic. A first commercial diagnostic HIV ELISA test was only approved by the FDA in 1985.
In some countries, those who died of AIDS were recorded in registers; in 1988 about 72,000 deaths were reported, 40,000 of them from the United States. Data from African countries were de facto not available at the time. The WHO estimated the number of people infected with HIV at 5–10 million. In 1987, azidothymidine (AZT) was the first HIV drug available. However, due to the development of resistance, it quickly lost its antiviral effect (). The molecular biology of HIV replication and the development of resistance were still insufficiently known.
In Germany at the end of 1987, the then Minister of Health Rita Süssmuth implemented her prevention strategy against fierce resistance. Her conviction was to fight the disease and not the sick. It therefore relied on education and support with the involvement of civil society groups and especially the AIDS service (,).
Virus leaves deep traces
The HIV pandemic has been in the 30 years since the 1st World AIDS Day left deep marks. It has caused millions of people to suffer, die, discriminate and criminalize people with HIV infection. In some African countries life expectancy fell, social coexistence changed and millions of children became AIDS orphans.
At the same time, however, tremendous movement of local and global solidarity on this scale emerged. HIV changed the doctor-patient relationship, the forms of counseling and the role of self-help groups. In global context, new institutions and financing structures emerged - such as UNAIDS as coordinating institution among the UN departments, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the Presidential Emergency Plan for Aids Relief (PEPFAR).
The fight against the HIV pandemic is in the past decades marked by successes and disillusionment. Controlling it is paradigmatic for global health.
On December 1st, 1988, World AIDS Day was celebrated for the first time on the initiative of the “Global Program on AIDS”. Its motto was "Communication". At that time there was great uncertainty about HIV. The WHO's “Global Program on Aids” was only started in 1987 and was an attempt to find global answer to the HIV epidemic (). There was no reliable epidemiological data on the extent of the pandemic. A first commercial diagnostic HIV ELISA test was only approved by the FDA in 1985.
In some countries, those who died of AIDS were recorded in registers; in 1988 about 72,000 deaths were reported, 40,000 of them from the United States. Data from African countries were de facto not available at the time. The WHO estimated the number of people infected with HIV at 5–10 million. In 1987, azidothymidine (AZT) was the first HIV drug available. However, due to the development of resistance, it quickly lost its antiviral effect (). The molecular biology of HIV replication and the development of resistance were still insufficiently known.
In Germany at the end of 1987, the then Minister of Health Rita Süssmuth implemented her prevention strategy against fierce resistance. Her conviction was to fight the disease and not the sick. It therefore relied on education and support with the involvement of civil society groups and especially the AIDS service (,).
Virus leaves deep traces
The HIV pandemic has been in the 30 years since the 1st World AIDS Day left deep marks. It has caused millions of people to suffer, die, discriminate and criminalize people with HIV infection. In some African countries life expectancy fell, social coexistence changed and millions of children became AIDS orphans.
At the same time, however, tremendous movement of local and global solidarity on this scale emerged. HIV changed the doctor-patient relationship, the forms of counseling and the role of self-help groups. In global context, new institutions and financing structures emerged - such as UNAIDS as coordinating institution among the UN departments, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the Presidential Emergency Plan for Aids Relief (PEPFAR).
For long time, antiretroviral therapy (ART) was considered impracticable in Africa; A lack of structures in the health systems, high costs and concerns about the development of resistance were cited as decisive reasons and were coupled with prejudices (,). The new institutions, hard-won price reductions and the production of antiretroviral drugs by Indian generics manufacturers ultimately led to an impressive roll-out of HIV therapies worldwide. As result of the large HIV treatment programs, life expectancy has risen again in the severely affected regions of Africa ().
However, the hope for vaccine has not been fulfilled to this day, but several vaccine candidates are currently in clinical trials () .
But regardless of this, HIV remains one of the great challenges facing global health.
Balance 2018
While the past few years were characterized by optimism and the idea of eliminating AIDS due to medical and structural successes, the analyzes and forecasts are currently falling much more skeptical. The reasons for this lie in the epidemiological development and the changed political landscape. Because HIV control is dependent on global cooperation ().
According to the UNAIDS report from July 2018, around 36.9 million people worldwide live with HIV, 53% of them in sub-Saharan Africa. At the end of 2017, 21.7 million people had access to antiretroviral treatment. Associated with this is decline in HIV-associated mortality, which has fallen below 1 million for the first time in over decade. The number of new infections in 2017 was 1.8 million. This means that the decline continues, especially in Africa, but is not enough to achieve the stated goal of fewer than 500,000 new infections in 2020.
Outside of southern Africa, the rate of new infections has increased hardly changed in recent years. In Eastern Europe (including Ukraine, Russia), Central Asia, the Middle East and North Africa in particular, the number of new infections is increasing, while AIDS mortality has only decreased moderately ().
The treatment of the HIV infection is through the development of newer drugs are easier to take, better tolerated and effective in the long term. There are now more than 5 different fixed dose combinations available. This makes it possible to ensure comprehensive first-line therapy with just one tablet day.
For long time, antiretroviral therapy (ART) was considered impracticable in Africa; A lack of structures in the health systems, high costs and concerns about the development of resistance were cited as decisive reasons and were coupled with prejudices (,). The new institutions, hard-won price reductions and the production of antiretroviral drugs by Indian generics manufacturers ultimately led to an impressive roll-out of HIV therapies worldwide. As result of the large HIV treatment programs, life expectancy has risen again in the severely affected regions of Africa ().
However, the hope for vaccine has not been fulfilled to this day, but several vaccine candidates are currently in clinical trials () .
But regardless of this, HIV remains one of the great challenges facing global health.
Balance 2018
While the past few years were characterized by optimism and the idea of eliminating AIDS due to medical and structural successes, the analyzes and forecasts are currently falling much more skeptical. The reasons for this lie in the epidemiological development and the changed political landscape. Because HIV control is dependent on global cooperation ().
According to the UNAIDS report from July 2018, around 36.9 million people worldwide live with HIV, 53% of them in sub-Saharan Africa. At the end of 2017, 21.7 million people had access to antiretroviral treatment. Associated with this is decline in HIV-associated mortality, which has fallen below 1 million for the first time in over decade. The number of new infections in 2017 was 1.8 million. This means that the decline continues, especially in Africa, but is not enough to achieve the stated goal of fewer than 500,000 new infections in 2020.
Outside of southern Africa, the rate of new infections has increased hardly changed in recent years. In Eastern Europe (including Ukraine, Russia), Central Asia, the Middle East and North Africa in particular, the number of new infections is increasing, while AIDS mortality has only decreased moderately ().
The treatment of the HIV infection is through the development of newer drugs are easier to take, better tolerated and effective in the long term. There are now more than 5 different fixed dose combinations available. This makes it possible to ensure comprehensive first-line therapy with just one tablet day.
The recommended treatment regimens are currently mostly based on integrase inhibitors and are recommended globally for all regions (-). In this way, the therapeutic goal of bringing viral replication below the detection limit can be achieved for many people. This goal serves your own health and prevents the transmission of HIV practically completely ("undetectable = untransmittable", see photo).
Long-acting antiretroviral drugs - as injections, implants or tablets - will further simplify the treatment in the foreseeable future. For some people, the new dosage forms will allow access to ART and better therapy adherence ().
Strategy 90–90–90
For people at high risk of HIV infection or In certain phases of life, pre-exposure prophylaxis (PrEP) is another instrument available for preventing HIV transmission (see following article). Safety and benefit have been proven in various approval studies and "real-life" cohorts, for example with MSM.
In the meantime, PrEP is also available to other groups, for example for integration into family planning offers for pregnant women or after delivery (-).
Intensive research is carried out with the aim of cure - functionally or through actual eradication of HIV from the genome. One of the hurdles is that HIV can dwell in cell pools for very long periods of time ().
Currently, global HIV control aims to ensure that 90% of all people with HIV know their status by 2020, at least 90 % of them have access to antiretroviral therapy and at least 90% of them are successfully treated, i.e. the virus replication is below the detection limit in the long term (). By reducing transmission, major step is being taken towards ending the HIV pandemic.
These goals have already been achieved in few countries (Scandinavia). Globally, however, the situation is difficult. In relation to all estimated people with HIV infection, only 59% are under treatment and 47% are virally suppressed - an end to HIV as global public health problem is still long way off (,).
The Furthermore, impressive increases in access to ART cannot hide the fact that there are clear regional differences - also with regard to certain key populations. There are major deficits in Eastern Europe, Central Asia, North and West Africa ().
The motto of this year's World AIDS Day “know your status” is aimed at the 90–90–90 strategy of knowing one's own HIV status . Consulting and testing are the key functions for access to care, access to it has improved significantly over the years ().
The recommended treatment regimens are currently mostly based on integrase inhibitors and are recommended globally for all regions (-). In this way, the therapeutic goal of bringing viral replication below the detection limit can be achieved for many people. This goal serves your own health and prevents the transmission of HIV practically completely ("undetectable = untransmittable", see photo).
Long-acting antiretroviral drugs - as injections, implants or tablets - will further simplify the treatment in the foreseeable future. For some people, the new dosage forms will allow access to ART and better therapy adherence ().
Strategy 90–90–90
For people at high risk of HIV infection or In certain phases of life, pre-exposure prophylaxis (PrEP) is another instrument available for preventing HIV transmission (see following article). Safety and benefit have been proven in various approval studies and "real-life" cohorts, for example with MSM.
In the meantime, PrEP is also available to other groups, for example for integration into family planning offers for pregnant women or after delivery (-).
Intensive research is carried out with the aim of cure - functionally or through actual eradication of HIV from the genome. One of the hurdles is that HIV can dwell in cell pools for very long periods of time ().
Currently, global HIV control aims to ensure that 90% of all people with HIV know their status by 2020, at least 90 % of them have access to antiretroviral therapy and at least 90% of them are successfully treated, i.e. the virus replication is below the detection limit in the long term (). By reducing transmission, major step is being taken towards ending the HIV pandemic.
These goals have already been achieved in few countries (Scandinavia). Globally, however, the situation is difficult. In relation to all estimated people with HIV infection, only 59% are under treatment and 47% are virally suppressed - an end to HIV as global public health problem is still long way off (,).
The Furthermore, impressive increases in access to ART cannot hide the fact that there are clear regional differences - also with regard to certain key populations. There are major deficits in Eastern Europe, Central Asia, North and West Africa ().
The motto of this year's World AIDS Day “know your status” is aimed at the 90–90–90 strategy of knowing one's own HIV status . Consulting and testing are the key functions for access to care, access to it has improved significantly over the years ().
Gaps in primary prevention
A potentially important innovation is the further spread of self-testing (). However: In many African countries, test offers reach men to significantly lower extent than women. In Eastern Europe, the Middle East and Central Asia, in turn, discrimination and criminalization are significant obstacles to testing, prevention offers and treatment. This particularly affects MSM, drug users and people with transgender identities.
With improved access to life-sustaining ART, primary prevention - structurally and individually - may have been neglected. In Africa, girls and young women who are growing up are particularly at high risk of infection. In Eastern Europe, Central Asia and the Middle East, it is people with special sexual identities, sex workers and drug users who have an extremely higher risk of HIV than the general population, while at the same time having poor access to prevention and treatment (,). However, this is difficult to enforce in authoritarian states.
Data from HIV surveillance by the European Center for Disease Prevention and Control (ECDC) emphatically underline the importance of this worrying development ().
" Pamela Das and Lancet Editor-in-Chief Richard Horton describe the situation ().
Conclusion
- The successes of HIV control in the past 2 decades are paradigmatic for global health. The global health architecture that has developed in connection with HIV is exemplary. Likewise, the civil society movement, the commitment and self-organization of HIV-infected people.
- These structures, however, need to be renewed in order not to gamble away the successes achieved and not to risk new expansion of the epidemic. For example, synergies with other infectious diseases (hepatitis C, tuberculosis), but also with non-communicable diseases must be identified and expanded.
- The control of HIV infection can become test of global political development (similar to climate , Flight and migration). This should also include countries such as China, Russia and India. However, the call for global solidarity is countered by the tendency towards more national-interest-led politics.
- There is an urgent need to mobilize sufficient financial resources for the global fund (Replenishment 2019). This requires reasonable effort on the part of the countries concerned and considerable international funding. The current stagnation in financial resources is already leading to growing funding gap that cannot be covered without clear financial commitment from donor countries such as Germany.
Gaps in primary prevention
A potentially important innovation is the further spread of self-testing (). However: In many African countries, test offers reach men to significantly lower extent than women. In Eastern Europe, the Middle East and Central Asia, in turn, discrimination and criminalization are significant obstacles to testing, prevention offers and treatment. This particularly affects MSM, drug users and people with transgender identities.
With improved access to life-sustaining ART, primary prevention - structurally and individually - may have been neglected. In Africa, girls and young women who are growing up are particularly at high risk of infection. In Eastern Europe, Central Asia and the Middle East, it is people with special sexual identities, sex workers and drug users who have an extremely higher risk of HIV than the general population, while at the same time having poor access to prevention and treatment (,). However, this is difficult to enforce in authoritarian states.
Data from HIV surveillance by the European Center for Disease Prevention and Control (ECDC) emphatically underline the importance of this worrying development ().
" Pamela Das and Lancet Editor-in-Chief Richard Horton describe the situation ().
Conclusion
- The successes of HIV control in the past 2 decades are paradigmatic for global health. The global health architecture that has developed in connection with HIV is exemplary. Likewise, the civil society movement, the commitment and self-organization of HIV-infected people.
- These structures, however, need to be renewed in order not to gamble away the successes achieved and not to risk new expansion of the epidemic. For example, synergies with other infectious diseases (hepatitis C, tuberculosis), but also with non-communicable diseases must be identified and expanded.
- The control of HIV infection can become test of global political development (similar to climate , Flight and migration). This should also include countries such as China, Russia and India. However, the call for global solidarity is countered by the tendency towards more national-interest-led politics.
- There is an urgent need to mobilize sufficient financial resources for the global fund (Replenishment 2019). This requires reasonable effort on the part of the countries concerned and considerable international funding. The current stagnation in financial resources is already leading to growing funding gap that cannot be covered without clear financial commitment from donor countries such as Germany.
- Globally and nationally, great efforts and innovations are required to strategically anchor the containment of HIV under the changed political framework in the agendas for global health and in the sustainability goals.
Prof. Dr. med. Jürgen Rockstroh Head of Outpatient Department for Infectious Diseases & Immunology, Medical Clinic and Polyclinic I, University Hospital Bonn
Conflict of interest: Dr. Neuhann has received consultancy fees from Gilead. Prof. Rockstroh lecture and consulting fees from Abbvie, Abivax, MSD, Janssen, Gilead and ViiV.
Literature on the Internet: www./lit4718 or via QR code.
PrEP successful in Australia
The free dispensing of pre-exposure prophylaxis (PrEP) drugs to high-risk group of men who have sex with men (MSM) has seen noticeable decline in the Australian state of New South Wales within year of new HIV infections. In March 2016, the combination of tenofovir / emtricitabi began to be distributed as PrEP to HIV-negative MSM who have significantly increased risk of HIV infection (receptive anal intercourse with casual acquaintances, other sexually transmitted diseases).
The program provided regular controls of the infection status. 3,069 participants took part in at least one appointment in the first 12 months. During this time there were only 2 new infections because those affected had not taken the PrEP regularly.
Andrew Grulich from the Kirby Institute in Sydney determined an incidence of 0.048 per 100 person-years (95% CI 0.012 –0.195), i.e. fewer than 2 new infections per 1,000 people within one year. In the 12 months before PrEP was introduced, 295 new infections had occurred; in the first year after 221. This is significant decrease of 25.1% (10.5–37.4%) and the lowest number of new infections in New South Wales since the beginning of HIV surveillance in 1985. Rüdiger Meyer
Grulich AE, Guy R, Amin J, et al .: Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV 2018; doi: 10.1016 / S2352–3018 (18) 30215–7.
1.Mann JM: The World Health Organization's global strategy for the prevention and control of AIDS, In AIDS-A global perspective. West J Med 1987; 147: 732–732.HIV.gov: A Timeline of HIV and AIDS. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline (last accessed on 15 November 2018).3.- Globally and nationally, great efforts and innovations are required to strategically anchor the containment of HIV under the changed political framework in the agendas for global health and in the sustainability goals.
< p> Dr. med. Florian Neuhann Heidelberg Institute for Global Health Heidelberg University HospitalProf. Dr. med. Jürgen Rockstroh Head of Outpatient Department for Infectious Diseases & Immunology, Medical Clinic and Polyclinic I, University Hospital Bonn
Conflict of interest: Dr. Neuhann has received consultancy fees from Gilead. Prof. Rockstroh lecture and consulting fees from Abbvie, Abivax, MSD, Janssen, Gilead and ViiV.
Literature on the Internet: www./lit4718 or via QR code.
PrEP successful in Australia
The free dispensing of pre-exposure prophylaxis (PrEP) drugs to high-risk group of men who have sex with men (MSM) has seen noticeable decline in the Australian state of New South Wales within year of new HIV infections. In March 2016, the combination of tenofovir / emtricitabi began to be distributed as PrEP to HIV-negative MSM who have significantly increased risk of HIV infection (receptive anal intercourse with casual acquaintances, other sexually transmitted diseases).
The program provided regular controls of the infection status. 3,069 participants took part in at least one appointment in the first 12 months. During this time there were only 2 new infections because those affected had not taken the PrEP regularly.
Andrew Grulich from the Kirby Institute in Sydney determined an incidence of 0.048 per 100 person-years (95% CI 0.012 –0.195), i.e. fewer than 2 new infections per 1,000 people within one year. In the 12 months before PrEP was introduced, 295 new infections had occurred; in the first year after 221. This is significant decrease of 25.1% (10.5–37.4%) and the lowest number of new infections in New South Wales since the beginning of HIV surveillance in 1985. Rüdiger Meyer
Grulich AE, Guy R, Amin J, et al .: Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV 2018; doi: 10.1016 / S2352–3018 (18) 30215–7.
1.Mann JM: The World Health Organization's global strategy for the prevention and control of AIDS, In AIDS-A global perspective. West J Med 1987; 147: 732–732.HIV.gov: A Timeline of HIV and AIDS. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline (last accessed on 15 November 2018).3.Robert Koch Institute (RKI): 1981 to 1990: AIDS - the political dimension in the 1980s. https://www.rki.de/DE/Content/Institut/Geschichte/Bildband_Salon/1981-1990.html (last accessed on 15 November 2018).4.Süssmuth R: Key political experience - Responsible prevention without exclusion and isolation. https://www.rita-suessmuth.de/arbeitsschwerpunkte/aids/ (last accessed on 15 November 2018).5.Stevens W , Kaye S, Corrah T: Antiretroviral therapy in Africa. BMJ 2004; 328 (7434): 280–26.Neuhann F, Hosseinipour M: (Letter) Rapid Response to Warren Steven, Steve Kay and Tumani Corral: Antiretroviral Therapy in Africa. BMJ 2004: 328: 280–27.Reniers G, Blom S, Calvert C, et al .: Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study. Lancet HIV 2016; 4 (3): e113-218.ClinicalTrials.gov: HVTN 117 / HPX2004 / IPCAVD011 / TRAVERSE; official Code: NCT02788045 https://clinicaltrials.gov/ct2/show/NCT02788045?cond=NCT02788045&rank=1 (last accessed on 15 November 2018).9.Bekker LG, Alleyne G, Baral S, et al .: Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society - Lancet Commission Lancet 2018; 392 (10144): P312–58.10.UNAIDS: GLOBAL AIDS UPDATE 2018. Miles to go closing gaps, breaking barriers, righting injustices . http://www.unaids.org/en/resources/documents/2018/global-aids-update (last accessed on 15 November 2018).11.WHO: Guidelines and policy briefs on HIV. http://www.who.int/hiv/pub/guidelines/en/ (last accessed on 15 November 2018).12.European AIDS Clinical Society (EACS): Guidelines Version 9.0, October 2017. http://www.eacsociety.org/files/guidelines_9.0-english.pdf (last accessed on 15 November 2018).13.German AIDS Society (DAIG), Austrian AIDS Society: German-Austrian guidelines for antiretroviral therapy for HIV-1 infection. AWMF reg. No. 055–001, Version 7 of November 29, 2017. https://daignet.de/site-content/hiv-therapie/leitlinien-1/Deutsch%20Osterreichische%20Leitlinien%20zur%20antiretroviralen%20Therapie%20der%20HIV%201% 20Infektion.pdf (last accessed on 15 November 2018).14.Kerrigan D, Mantsios A, Gorgolas M, et al .: Experiences with long acting injectable ART: A qualitative study among PLHIV participating in Phase II study of cabotegravir + rilpivirine (LATTE-2) in the United States and Spain. PLoS One 2018; 13 (1): e019048715.Robert Koch Institute (RKI): 1981 to 1990: AIDS - the political dimension in the 1980s. https://www.rki.de/DE/Content/Institut/Geschichte/Bildband_Salon/1981-1990.html (last accessed on 15 November 2018).4.Süssmuth R: Key political experience - Responsible prevention without exclusion and isolation. https://www.rita-suessmuth.de/arbeitsschwerpunkte/aids/ (last accessed on 15 November 2018).5.Stevens W , Kaye S, Corrah T: Antiretroviral therapy in Africa. BMJ 2004; 328 (7434): 280–26.Neuhann F, Hosseinipour M: (Letter) Rapid Response to Warren Steven, Steve Kay and Tumani Corral: Antiretroviral Therapy in Africa. BMJ 2004: 328: 280–27.Reniers G, Blom S, Calvert C, et al .: Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study. Lancet HIV 2016; 4 (3): e113-218.ClinicalTrials.gov: HVTN 117 / HPX2004 / IPCAVD011 / TRAVERSE; official Code: NCT02788045 https://clinicaltrials.gov/ct2/show/NCT02788045?cond=NCT02788045&rank=1 (last accessed on 15 November 2018).9.Bekker LG, Alleyne G, Baral S, et al .: Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society - Lancet Commission Lancet 2018; 392 (10144): P312–58.10.UNAIDS: GLOBAL AIDS UPDATE 2018. Miles to go closing gaps, breaking barriers, righting injustices . http://www.unaids.org/en/resources/documents/2018/global-aids-update (last accessed on 15 November 2018).11.WHO: Guidelines and policy briefs on HIV. http://www.who.int/hiv/pub/guidelines/en/ (last accessed on 15 November 2018).12.European AIDS Clinical Society (EACS): Guidelines Version 9.0, October 2017. http://www.eacsociety.org/files/guidelines_9.0-english.pdf (last accessed on 15 November 2018).13.German AIDS Society (DAIG), Austrian AIDS Society: German-Austrian guidelines for antiretroviral therapy for HIV-1 infection. AWMF reg. No. 055–001, Version 7 of November 29, 2017. https://daignet.de/site-content/hiv-therapie/leitlinien-1/Deutsch%20Osterreichische%20Leitlinien%20zur%20antiretroviralen%20Therapie%20der%20HIV%201% 20Infektion.pdf (last accessed on 15 November 2018).14.Kerrigan D, Mantsios A, Gorgolas M, et al .: Experiences with long acting injectable ART: A qualitative study among PLHIV participating in Phase II study of cabotegravir + rilpivirine (LATTE-2) in the United States and Spain. PLoS One 2018; 13 (1): e019048715.McCormack S, Dunn DT, Desai M, et al .: Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of pragmatic open-label randomized trial. Lancet 2016; 387 (10013): 53-6016.Desai M, Field N, Grant R, McCormack S: Recent advances in pre-exposure prophylaxis for HIV. BMJ 2017; 359: j501117.Molina JM, Captain C, Spire B, et al .; ANRS IPERGAY Study Group: On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med 2015; 373: 2237-4618.Pintye J, et al .: Uptake of PrEP within family planning clinics. TUAC0304 - Oral Abstract at IAS Conference, Amsterdam 2018. http://programme.aids2018.org/Abstract/Print/?abstractid=7467 (last accessed on 15 November 2018).19.Ponte R, Miller RL, Kinloch NN, et al .; The ORCHID study group: HIV-1 reservoir diversity and genetic compartmentalization in blood and testis. TUPDA0105 - Oral Abstract at IAS Conference Amsterdam 2018. https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25148 (last accessed on 15 November 2018).20.UNAIDS: 90–90–90: An ambitious treatment target to help end the AIDS epidemic. http://www.unaids.org/en/resources/documents/2017/90–90–90 (last accessed on 15 November 2018).21.UNAIDS: World AIDS Day 2018 theme encourages everyone to know their HIV status. http://www.unaids.org/en/resources/presscentre/featurestories/2018/september/20180917_WAD_theme (last accessed on 15 November 2018).22.Johnson C, Baggaley R, Forsythe S, et al .: Realizing the potential of self testing. AIDS Behav 2014; 18 (Suppl 4): 39123.ECDC / WHO: HIV / AIDS Surveillance in Europe 2017–2016 data. https://ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2017–2016-data (last accessed on 15 November 2018).24.The Global Fund: Resource Mobilization available at https://www.theglobalfund.org/en/replenishment/ (last accessed on November 15, 2018).
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