By Anthony Fauci SS 8 January Anthony SS Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. In the summer of 1981, the world became aware of a mysterious new disease that was first seen among a relatively small group of gay men in the United States and was soon shown was If a virus causing human immunodeficiency. Fast forward more than thirty years and the whole world is struggling with one of the most devastating pandemics in history.Over 70 Millions of infectionsoccurred predominantly among heterosexuals in the developing world, resulting in more than 30 million deaths. Despite these terrible statistics, advances in HIV prevention and treatment have transformed the lives of these HIV-infected people who have access to health care and have given us highly effective methods of preventing HIV infection. Why does this global pandemic continue to reap lives and ruin families? It is not because they lack the medical advances and interventions to end the pandemic. It's because our proven tools have not been implemented properly or evenly. Combination of anti-HIV therapy became available in the mid-90 decade, and although the therapeutic regimens were highly effective in suppressing the virus to undetectable levels, patients were allowed to live healthy lives, some questioned whether the cumulative toxicity of pharmacological treatment to long term; would deny beneficial effects over time. Controlled clinical trials have since provided the reassurance concern showing that most management measures against anti-HIV therapy toxicities are far less harmful than continued HIV replication in the absence of therapy. Then a revolutionary study showed that early treatment of HIV-infected individuals sooner than later dramatically reduced the likelihood that they would infect their sexual partners. The benefit to public health, from treatment to prevention of later transmission was clear. Still, some have argued that the health benefit to the infected person has been proven, putting doctors in an unenviable position: they knew that individuals infected with viruses could infect others in uncontrollable ways, but they were not able to take the treatment accordingly we strongly recommend to all patients.A study published last year It would put an end to this dilemma by showing that treating a person as soon as possible after diagnosis was much more beneficial than waiting until the person's immune system has been completely (or nearly) damaged. With these hinged studies, there is now no excuse for delays; all people infected with HIV should be offered antiviral medications at the time of diagnosis. But this requires looking for people at risk for the infection and testing them; which links infected individuals to medical care; work to keep them in the care; and providing anti-HIV drugs. This also requires careful attention to avoiding barriers to care, such as poverty, substance abuse, and housing and food insecurity. Globally and internally we do not reach these goals.
Most of this relates to those that are already infected with HIV. However,2 million of new infections occur globally each year, including50.000In the United States; the last number remained stable for nearly two decades. The frustrating thing is that we know exactly who is infecting whom. Of the approximately 1,2 million people living with HIV in the United States, 13 percent who do not know they are infected are responsible for transmission of about thirty percent of new infections per year. More surprisingly, more than sixty percent of new HIV infections are transmitted by people who are even aware that carry HIV but who are not receiving appropriate care. Thus, it identified all people infected in the country and immediately thereafter, with effective care, including anti-HIV treatment, could prevent more than 90 percent of new infections each year.For people not infected, at risk of individuals, various forms of prevention are available.An important recent advanceIt comes from a number of clinical trials which demonstrated convincingly that regularly taking a single pill containing two anti-HIV drugs can reduce an individual's risk of contracting HIV for more than 90 percent. Unfortunately, this prevention strategy - called pre-exposure prophylaxis, or PrEP - is vastly underused.The Centers for Disease Control and Prevention of Opportunistic diseases. That more than 1,2 million people in the United States are at great risk of HIV infection and could benefit from PrEP; however, less than 5 percent of these people are receiving this treatment. To make matters worse, one-third of primary care providers and nurses are aware of the health and potential earning potential that PrEP offers. This situation has to change. Even in the absence of an effective HIV vaccine, which would be the last nail in the coffin of the pandemic, we have the tools to end the HIV / AIDS epidemic in the United States and globally. We can save the lives of infected individuals and prevent them from infecting others by getting them to click on treatment programs and their maintenance. In addition, we can effectively prevent HIV infection in populations at risk by a number of means, including the use of highly effective PrEP. It is often said that we were slow to recognize the severity of the emerging HIV pandemic during the early part of the decade. At present, our ability to fight against the spread has been slim. Today we have the tools for the end of this modern plague. We should not miss the opportunity. History will judge us severely if we fail. Translated by Cláudio Souza from the original inNo more excuses. We have the tools to end the HIV / AIDS pandemic.