Although great progress has meant that in resource-limited settings more HIV-infected people receive antiretroviral treatment,
While mother-to-child HIV transmission has been greatly reduced, even eradicated in countries like Thailand and Cuba,
Whereas AIDS-related mortality has decreased overall,
… we still have far to go in controlling the worldwide AIDS epidemic, which in 2016 affected 36.7 million people and continues to spread alarmingly in some regions, such as Eastern Europe and Asia. In France and in most developed countries, infection is not decreasing, in particular in high-risk populations.
A poverty-related infection and illness, subject to stigmatization and exclusion, HIV/AIDS reveals social and cultural injustice, denial of reality, and a lack of political determination and courage in a good many regions. HIV/AIDS is continuing to spread because we are paying insufficient attention to the populations most affected by new infections.
To meet the aims set by UNAIDS, ie, the 90-90-90 objective by 2020 (90% of people infected diagnosed, 90% on treatment, and 90% virally suppressed), and to hope to counter the epidemic by 2030, we must continue our research effort.
Screen, treat early, prevent infection … The research that has helped to improve tools and strategies, by mobilizing teams in all areas of research, still has a central role to play if we want to reach the aim set by UNAIDS.
The ANRS is present in all areas of research in order to respond to situations arising in the developed world and in resource-limited countries. To do this, we need to:
Reach “key” populations, those most exposed to the risk of infection and of transmission
- promote screening and treatment, as quickly as possible, for the benefit of the people themselves and of their community, by limiting the risk of transmitting the virus to someone else: this is the “screen and treat” strategy;
- encourage people who are seronegative and at very high risk of infection to take advantage of innovative programs of combined prevention, with pre-exposure prophylaxis, in particular;
- reduce the risk of exposure to HIV, by making suitable programs accessible;
- decrease stigmatization and exclusion.
Develop prevention strategies able to block new infections, using a vaccine:
- understand immune response mechanisms;
- develop candidate vaccines, which when combined optimize the immune response;
- evaluate candidate vaccines in animals;
- validate candidate vaccines in humans, using strictly controlled protocols.
All these strategies are supported by the ANRS through the Vaccine Research Institute
Understand the mechanisms involved in infection and seek to control infection in viral reservoirs:
- develop animal models and innovative technologies;
- intensify the study of remission observed in rare patients who have stopped their treatment;
- clarify host-virus interactions;
- develop innovative therapeutic approaches to achieve remission and assess their impact on quality of life.
Improve patient care:
- evaluate therapeutic strategies at the time of primary infection in the hope of procuring a substantial effect on viral reservoirs;
- simplify therapy, and de-escalate treatment, in particular in pregnant seropositive women;
- understand, and so be in a better position to counter, the increase in resource-limited countries of the number of treated patients who, like more than half of those in France, present numerous comorbidity factors; effectively treat HIV co-infections and manage treatment failures.