Since the first case was reported over 40 years ago, the world has made significant progress in the fight against the Human Immunodeficiency Virus (HIV).1 Before regular testing and treatments became available in the 1990s, the average life expectancy for people living with HIV in the United States was only 10-12 years after initial diagnosis.2 However, thanks to increased access to testing and treatment, people living with HIV can expect to live as long as their peers who do not have HIV.3
UNAIDS’s Global AIDS Strategy 2021-2026 aims to close the gaps in HIV prevention, testing, treatment, and support by 2025 and put the world back on course to end AIDS by 2030.4
Although progress has been made in reducing new HIV diagnoses, it is important to recognize that AIDS remains an urgent global crisis, and progress has been slowing. It is crucial that patients undergo screening for HIV using reliable and high-quality tests. Those who test positive for HIV should be connected to high-quality treatment to achieve viral suppression, while those who are at high risk of HIV infection should receive care to prevent future HIV transmission. By taking these important steps, and understanding that accurate diagnosis and diagnostic testing is the gateway to eliminating this epidemic, we can help curb the spread of HIV and ultimately end the global AIDS crisis.5,6
Today, December 1st, marks the 35th annual World Aids Day, which serves as a reminder of our progress and the work that still needs to be done.7 Let us continue to strive towards effective screening, reliable testing, and high-quality treatment and care for all those living with or without HIV as we Remember and Commit to the fight against HIV/AIDS.
Currently, there is no cure for HIV/AIDS, and once a person has the infection, there is no way for the body to eliminate it. However, there are many medications that can help control and suppress HIV viral load and help prevent HIV-related complications.8 This is where diagnostic testing comes in.
At the heart of the fight against HIV/AIDS is diagnostic testing; knowing your HIV status has both individual and public health benefits.6 Early and accurate diagnosis of HIV infection can help guide treatment plans to achieve viral suppression, confirm undetectable viral loads, and reduce transmission rates.9
In 2022, it was reported that of the 39 million people living with HIV globally, 86% of people with HIV knew their status, 89% were accessing treatment, and 93% were virally suppressed.10 The UNAIDS has set the goal of ‘95-95-95’ to end the epidemic by 2030, and in order to meet these targets, we need to continue improving, scaling, and introducing new innovations in the space of HIV testing and diagnostics.11
While it's critical for healthcare professionals to manage the HIV disease, it's equally important to address the stigma associated with people living with HIV. The stigma and discrimination associated with HIV impede HIV response at every step, limiting access to prevention services, testing, and treatment, ultimately impacting patient adherence. That's why it is also important not only to provide these services but also to work on reducing the stigma associated with HIV.12
The UNAIDS’s 95-95-95 target would mean that 95% of people living with HIV know their HIV status, 95% of people who know they are living with HIV are on antiretroviral treatment, and 95% of people on treatment are virally suppressed. Ensuring global access to diagnostics testing is essential to accurate HIV diagnosis and achieving these targets.6
Despite advances in the scientific understanding of HIV and its prevention and treatment, many individuals across the globe still lack access to prevention, care, testing, and treatment.13 Two-thirds of the 39 million people living with HIV live in Africa.14 Thankfully progress to expand access to HIV diagnostics and treatment, especially in low and middle-income countries, is being made.1
As we strive to expand global access to HIV testing, we need to address the challenges for those living in resource-limited settings. In the past, patients would have to travel long distances to crowded clinics to get testing, which often led to missed appointments or delayed tests.15 Offerings such as innovative sample collection devices, self-testing, and mobile health clinics could help to overcome these issues.
Self-testing has emerged as a viable approach to ensuring global access. It offers a simple and efficient way to obtain results within a short time span of 15-20 minutes. However, they come with limitations as they are unable to provide detailed results, just a simple detected/undetected result. Therefore, self-testing is recommended to be used as part of a package and should be confirmed and elaborated by a trained facility.16
These trained facilities can be satellite labs or mobile clinics that have the ability to conduct tests with greater accuracy using advanced technologies like HIV RNA qualitative and quantitative tests to confirm HIV diagnoses and a patient's viral load.16 Therefore, the continuous support and development of these labs will be essential to ensure global access to HIV diagnostics.
When it comes to HIV we are used to hearing Undetectable = Untransmissionable.17 However, at the 12th International AIDS Society Conference on HIV Science (IAS) 2023 this year, the WHO changed this to <1000 = untransmissible, which is a huge step for patients living with HIV.18
This puts even more pressure on the reliability and accuracy of diagnostic testing; now, not only do diagnostic tests need to be able to say your viral load is detectable/undetectable but they have to accurately say your viral load is less than 1000 copies per ml. From the patient's perspective, now you need to be able to trust your test results even more in order to confidently inform your partner that you are untransmissible.17 If the test is not accurate this could lead to further spread, which goes against our goals of eradication.
Laboratories will need to ensure they are able to deliver results with this level of precision and make sure they are ready for the heavier workload as the amount of individual testing increases.18
Continuous testing and monitoring of a patient's HIV viral load after diagnosis is important not just to the patient but also to the global population as a whole as it allows us to better understand the progress of the eradication of HIV by 2030.11 However, this requires support from labs, manufacturers, and communities across the globe.
If we are to achieve the goal of eradicating HIV by 2030, we need to increase the frequency of testing. It is crucial we also conduct testing with highly sensitive methods to identify additional cases. This is particularly important for patients with suppressed viral loads, low-viral load acute infections, and individuals with the newly identified Long-acting Early Viral Inhibition (LEVI) syndrome. Without more frequent testing, we run the risk of missing these cases, which could have negative effects on the progress of eradicating HIV.18
Testing and laboratories are at the heart of a strong health system, therefore in order to support the new <1000 = untransmissible standard for HIV diagnosis, laboratories need to be well-prepared for the expected increase in sample testing workload. It is important for labs to invest in reliable and accurate diagnostic equipment, as well as ensure proper training and supervision of lab personnel.19,20 Additionally, labs should prioritize quality control measures to minimize errors and ensure accurate and reliable testing results.21 Overall, by investing in the necessary resources and processes, labs can play a vital role in supporting the new standard and helping to prevent the spread of HIV.
As we look to the future and the goals of ending the epidemic by 2030, it is important to understand what this means for the realm of diagnostic testing. This means increasing testing efforts, improvements in reliability and accuracy, and a commitment to making testing globally accessible. Without this commitment from the ENTIRE healthcare industry and communities to support testing capacity and improve reliability we will not be able to end the HIV epidemic by 2030.