Leveraging early HIV diagnosis and treatment in Thailand to conduct HIV cure research
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AIDS Research and Therapy Open Access
REVIEW
Leveraging early HIV diagnosis and treatment in Thailand to conduct HIV cure research Camilla Muccini1*, Trevor A. Crowell2,3, Eugène Kroon4, Carlo Sacdalan4, Reshmie Ramautarsing5, Pich Seekaew5, Praphan Phanuphak4,5,6, Jintanat Ananworanich2,3,4,7, Donn J. Colby4 and Nittaya Phanuphak4,5
Abstract Thailand has the highest prevalence of HIV among countries in Asia but has also been a pioneer in HIV prevention and treatment efforts in the region, reducing the incidence of new infections significantly over the last two decades. Building upon this remarkable history, Thailand has set an ambitious goal to stop the AIDS epidemic in the country by 2030. A key component of the strategy to achieve this goal includes scale-up of HIV screening programs to facilitate early HIV diagnosis and investment in mechanisms to support immediate initiation of antiretroviral therapy (ART). Initiation of ART during early or acute HIV infection not only reduces viremia, thereby halting onward transmission of HIV, but also may facilitate HIV remission by reducing the size of the latent HIV reservoir and preserving immune function. In Thailand, many efforts have been made to reduce the time from HIV infection to diagnosis and from diagnosis to treatment, especially among men who have sex with men and transgender women. Successfully identifying and initiating ART in individuals with acute HIV infection has been leveraged to conduct groundbreaking studies of novel strategies to achieve HIV remission, including studies of broadly-neutralizing HIV-specific monoclonal antibodies and candidate therapeutic vaccines. These efforts have mostly been deployed in Bangkok and future efforts should include other urban and more rural areas. Continued progress in HIV prevention, screening, and treatment will position Thailand to substantially limit new infections and may pave the way for an HIV cure. Keywords: Acquired immunodeficiency syndrome, AIDS vaccines, HIV antibodies, HIV seropositivity, AIDS serodiagnosis, Anti-retroviral agents, Highly active antiretroviral therapy, Disease reservoirs Introduction In Thailand, there are an estimated 440,000 people living with HIV (PLWH) and 15,000 die of AIDS-related illnesses annually [1]. Despite having the highest prevalence of HIV in Asia, Thailand has gained fame for tremendously effective deployment of HIV prevention programs that reduced the number of annual new HIV infections from 115,000 in 1992 to 6400 in 2016 [2–4]. These public health interventions were most successful in decreasing HIV transmission among reproductive age
*Correspondence: [email protected] 1 Vita-Salute San Raffaele University, via Stamira D’Ancona 20, 20127 Milan, Italy Full list of author information is available at the end of the article
adults populations and people who inject drugs (PWID) [2, 5]. Building upon this success, Thailand has set the ambitious goal of stopping AIDS by 2030 [6]. As part of the strategy to achieve this goal, the country intends to increase HIV testin
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