The latest federal funding cuts are already affecting progress against HIV, according to a panel of experts at a briefing hosted by the Infectious Diseases Society of America (IDSA).
“Through four decades of hard-fought progress, we have reached the point where HIV can be a chronic disease,” said Anna K. Person, MD, vice chair of the HIV Medicine Association and professor of medicine at Vanderbilt University Medical Center, Nashville, Tennessee, in the briefing.
In President Trump’s first term, he created the first initiative to end HIV epidemic in America (EHE), Person said. However, in the current environment of funding cuts, “we are on a fast track to undoing decades of progress,” and the future of the EHE program is uncertain, she said.
The current plan to restructure the Department of Health and Human Services has threatened the existence of the Office of Infectious Disease and HIV/AIDS Policy and the Health Resources and Services Administration, both of which were essential to accessing resources, Person said.
“These actions are inefficient and will lead to an increase in healthcare costs,” Person emphasized. “It is far cheaper to prevent HIV infection than to treat someone living HIV,” she said.
Unfortunately, the loss of access to resources is already affecting patients, said Person, who practices in the southern United States, where HIV is more prevalent than in other parts of the country. Person said that she sees many patients with a delay in diagnosis and who are critically ill with opportunistic infections. Patients are worried that they will lose access to their medications, and they fear a return to the death counts seen in the 1980s, Person added.
Women and Children Will Suffer
The latest cuts have affected grants supporting the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), said Lynne M. Mofenson, MD, IDSA member and a senior HIV technical advisor to the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, in the briefing.
The mission of the ATN is to conduct research on treatments for adolescents and youth aged 13-24 years living with or at risk for HIV, she said. In the United States, 20% of new HIV infections occur in adolescents and young adults, and this group has a higher mortality rate than older patients, she added.
Since its establishment in 2001, ATN activity has resulted in the availability of new biomedical tools and treatment approaches, as well as nationally implemented testing and prevention strategies for young people with or at risk for HIV, Mofenson said.
“The ATN is and was the only adolescent-focused HIV network in the United States, and terminating support dissolves a network that spans 24 years of scientific inquiry,” she said.
In addition, cuts to program support and resources will significantly affect the transmission of HIV from pregnant women with the disease to their infants, said Mofenson.
“In the 1980s, 25% of infants born with HIV in the US and 50% of those born with HIV in developing countries died before the age of 2 years,” she said.
However, progress in research has resulted in the near elimination of mother to infant transmission of HIV, and antiretroviral therapy has brought transmission rates in the United States to less than 1%, she said. Programs in the developing world have saved millions of lives because of the resources to treat pregnant women with HIV, she emphasized.
Recovery Is Complicated
Without treatment, however, the HIV virus in a pregnant women will rebound within weeks, increasing the risk for transmission from mother to child, Mofenson said during a Q&A session following the briefing.
Unfortunately, restoration of progress in HIV “is not like a light switch that we can turn on and off,” Mofenson said. The rollback of the infrastructure, both domestically and internationally, will take decades to rebuild, she added. In the short-term, Mofenson said she has seen HIV clinics closed in other countries and mothers and children are not getting treatment. “Those actions are not so reversible,” she said.
Model Shows Potential Increases in Infections and Deaths
Estimating the short- and long-term impact of the current cuts on HIV/AIDS mortality in the United States is difficult because there is so much chaos, Person said in the Q&A session.
However, modeling data from the Foundation for AIDS Research (amfAR) suggest that total elimination of the Centers for Disease Control and Prevention’s (CDC’s) Division of HIV Prevention would result in approximately 14,000 more AIDS-related deaths in the United States by 2030, she said. The amfAR data also estimate 144,000 more HIV infections in the United States by 2030 if the CDC’s Division of HIV Prevention were totally eliminated, with cumulative lifetime costs of those infections of approximately $60 billion.
“Rolling back scientific progress is not efficient, and that is what we are doing right now,” Person added.
The briefing was hosted by the IDSA. The participants had no relevant financial conflicts to disclose.
