10.1186/s12977-016-0315-4Retrovirology1318

Lever, Andrew ML

Wainberg, Mark A

Retrovirology

English

PubMed

Mark A. Wainberg

Andrew M. L. Lever

Springer - Publisher Connector

Wainberg and Lever  Retrovirology  (2016) 13:80 
DOI 10.1186/s12977-016-0315-4
EDITORIAL
HIV and Zika: When will we be able 
to end these epidemics?
Mark A. Wainberg1* and Andrew M. L. Lever2
© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License 
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, 
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, 
and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/
publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
It seems that a year cannot go by without some new 
emergent infectious disease stealing away headlines from 
the HIV epidemic, even though the latter continues to 
kill several million people each year. For example, there 
was justifiable concern that the recent Ebola epidemic 
would become more widespread than it did [1]. Fortu-
nately, Ebola seems to have receded, at least for now, the 
epidemic being declared over in January 2016, although 
precautions must continue to be taken to ensure that it 
does not again become a threat.
This year, the world has been thrown into panic by 
Zika virus that has caused hundreds of infants to be born 
with a condition termed microcephaly. The reasons for 
this terrible birth defect are not well understood and it 
seems that it is the northeast area of Brazil that has been 
most prone to this devastating complication. Hopefully, 
new epidemiological data will shed light on the reasons 
that microcephaly has not occurred to nearly the same 
extent in other parts of Brazil or in Colombia and other 
countries where transmission of Zika has taken place on 
a large scale.
We need to be justly concerned about the mosquito-
borne transmission of flaviviruses in general and of Zika, 
dengue, and Chikungunya viruses in particular, since 
the latter are now endemic in many parts of the Carib-
bean, Africa, India, and elsewhere. And we should also 
hope that the novel hormonally-based strategies aimed at 
sterilization of the Aedes aegypti mosquitos that transmit 
these viruses will be successful.
Perhaps it is not surprising, given their transmission 
routes and acuity compared to HIV, that multiple differ-
ences exist between the flaviviruses and HIV in terms of 
strategies aimed at control of these diseases. The most 
important medical advances in regard to HIV have 
undoubtedly been in the area of antiretroviral (ARV) 
drug development, and there is little doubt that the 
ARVs have saved the lives of millions of people around 
the world [2]. At the same time ARVs have also proven 
useful in pre-exposure prophylaxis (PrEP), which is a 
concept whereby the same drugs that work in treatment 
can also be used to reduce the likelihood of infection 
[3, 4]. Furthermore, the development of ARVs has also 
spawned the principle known as Treatment as Preven-
tion, whereby it is hoped that the successful treatment 
of HIV-infected persons will lower their levels of plasma 
viremia to non-detectability, with the consequence that 
successfully-treated persons will no longer be infectious 
for their sexual contacts [5]. These advances have even 
propelled the World Health Organization to propose a 
plan termed ‘90–90–90’ aimed at ending the HIV epi-
demic by the year 2030. This concept articulates that we 
will identify 90% of the world’s HIV infected population, 
and then go on to use ARVs to treat 90% of those who 
test positive, and thereby successfully reduce viral load to 
non-detectability in 90% of the latter.
Although most observers agree that these are laudable 
goals, they question whether the identification of 90% of 
the world’s HIV infected subjects will be possible when 
estimates suggest that 40% of infected people are una-
ware of their HIV status and it is known, for example, 
that many persons who are at high risk for acquisition of 
HIV are often themselves reluctant to take an HIV test. 
Perhaps we will need to find ways of incentivizing people 
to be tested for HIV if we are to achieve the first 90 in the 
WHO scheme [6]. It will probably also be necessary to 
find ways of incentivizing care-givers as well so that they 
routinely offer the test and “insist” that it be used.
In contrast, most observers agree that the best way to 
control Zika, dengue and Chikungunya probably revolves 
around the development of safe and effective preventive 
vaccines. For example, how could we contemplate using 
a potential new anti-Zika drug to treat infected preg-
nant women, if we did not know with certainty that such 
a drug did not itself cause birth defects? The same can 
Open Access
Retrovirology
*Correspondence:  mark.wainberg@mcgill.ca 
1 McGill University AIDS Centre, Jewish General Hospital, Montreal, QC, 
Canada
Full list of author information is available at the end of the article
Page 2 of 2Wainberg and Lever  Retrovirology  (2016) 13:80 
•  We accept pre-submission inquiries 
•  Our selector tool helps you to find the most relevant journal
•  We provide round the clock customer support 
•  Convenient online submission
•  Thorough peer review
•  Inclusion in PubMed and all major indexing services 
•  Maximum visibility for your research
Submit your manuscript at
www.biomedcentral.com/submit
Submit your next manuscript to BioMed Central 
and we will help you at every step:
probably be said for drugs that might block the replica-
tion of dengue and Chikungunya, although there might 
be rationale for the use of such products in non-pregnant 
populations, and, of course, the use of antiviral com-
pounds might help to limit transmission from humans to 
Aedes aegypti mosquitos and help to break the chain of 
epidemic transmission. Hopefully, vaccines and related 
approaches such as the use of passively transfused anti-
bodies will soon be available to help control Zika infec-
tion. Thus, the approaches that need to be developed 
to arrest flavivirus transmission may differ significantly 
from those that have been used to interfere with trans-
mission of HIV.
The tragedy of Zika for a pregnant mother, her affected 
infant and the wider family is not something to dismiss 
lightly. It is good news that this is a relatively uncommon 
complication but it is no less terrible for that. At the same 
time, we should not lose sight of the fact that the world-
wide burden of HIV disease continues to expand, in part 
because so many people have been saved by ARVs. It is 
estimated that as many as 38 million people worldwide 
are now living with HIV. Sadly, a number almost equal 
to this are thought to already have died of HIV infec-
tion, making the epidemic one of the worst to have ever 
affected humankind. There are still several million new 
HIV cases occurring annually, and the problem of HIV 
drug-resistance in developing country settings is on the 
rise and poses a real threat to the success of the WHO 
90–90–90 goal to end the epidemic. On World AIDS 
Day, December 1, let us turn our attention with renewed 
energy toward finding ways of ending the HIV epi-
demic as well as other infectious diseases that continue 
to take a horrible toll, often of the most vulnerable and 
disadvantaged.
Author details
1 McGill University AIDS Centre, Jewish General Hospital, Montreal, QC, 
Canada. 2 Cambridge University, Cambridge, UK. 
Received: 9 November 2016   Accepted: 9 November 2016
References
 1. Wainberg MA, Lever AML. How will the ebola crisis impact on the HIV 
epidemic? Retrovirology. 2014;11:110.
 2. Walmsley SL, Antela A, Clumeck N, et al. Dolutegravir plus abacavir–
lamivudine for the treatment of HIV-1 infection. N Engl J Med. 
2013;369:1807–18.
 3. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophy-
laxis for HIV prevention in men who have sex with men. N Engl J Med. 
2010;363(27):2587–99.
 4. Molina JM, Capitant C, Spire B, et al. On-demand preexposure 
prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 
2015;373(23):2237–46.
 5. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with 
early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
 6. Wainberg MA, Hull M, Girard PM, Montaner J. A key to achieving the 
UNAIDS 90–90–90 target: financial incentives for HIV testing. Lancet. 
2016;16(11):1215–6.


HIV and Zika: When will we be able to end these epidemics?

Apollo (Cambridge)

Wainberg and Lever  Retrovirology  (2016) 13:80 DOI 10.1186/s12977-016-0315-4EDITORIALHIV and Zika: When will we be able to end these epidemics?Mark A. Wainberg1* and Andrew M. L. Lever2© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.It seems that a year cannot go by without some new emergent infectious disease stealing away headlines from the HIV epidemic, even though the latter continues to kill several million people each year. For example, there was justifiable concern that the recent Ebola epidemic would become more widespread than it did [1]. Fortu-nately, Ebola seems to have receded, at least for now, the epidemic being declared over in January 2016, although precautions must continue to be taken to ensure that it does not again become a threat.This year, the world has been thrown into panic by Zika virus that has caused hundreds of infants to be born with a condition termed microcephaly. The reasons for this terrible birth defect are not well understood and it seems that it is the northeast area of Brazil that has been most prone to this devastating complication. Hopefully, new epidemiological data will shed light on the reasons that microcephaly has not occurred to nearly the same extent in other parts of Brazil or in Colombia and other countries where transmission of Zika has taken place on a large scale.We need to be justly concerned about the mosquito-borne transmission of flaviviruses in general and of Zika, dengue, and Chikungunya viruses in particular, since the latter are now endemic in many parts of the Carib-bean, Africa, India, and elsewhere. And we should also hope that the novel hormonally-based strategies aimed at sterilization of the Aedes aegypti mosquitos that transmit these viruses will be successful.Perhaps it is not surprising, given their transmission routes and acuity compared to HIV, that multiple differ-ences exist between the flaviviruses and HIV in terms of strategies aimed at control of these diseases. The most important medical advances in regard to HIV have undoubtedly been in the area of antiretroviral (ARV) drug development, and there is little doubt that the ARVs have saved the lives of millions of people around the world [2]. At the same time ARVs have also proven useful in pre-exposure prophylaxis (PrEP), which is a concept whereby the same drugs that work in treatment can also be used to reduce the likelihood of infection [3, 4]. Furthermore, the development of ARVs has also spawned the principle known as Treatment as Preven-tion, whereby it is hoped that the successful treatment of HIV-infected persons will lower their levels of plasma viremia to non-detectability, with the consequence that successfully-treated persons will no longer be infectious for their sexual contacts [5]. These advances have even propelled the World Health Organization to propose a plan termed ‘90–90–90’ aimed at ending the HIV epi-demic by the year 2030. This concept articulates that we will identify 90% of the world’s HIV infected population, and then go on to use ARVs to treat 90% of those who test positive, and thereby successfully reduce viral load to non-detectability in 90% of the latter.Although most observers agree that these are laudable goals, they question whether the identification of 90% of the world’s HIV infected subjects will be possible when estimates suggest that 40% of infected people are una-ware of their HIV status and it is known, for example, that many persons who are at high risk for acquisition of HIV are often themselves reluctant to take an HIV test. Perhaps we will need to find ways of incentivizing people to be tested for HIV if we are to achieve the first 90 in the WHO scheme [6]. It will probably also be necessary to find ways of incentivizing care-givers as well so that they routinely offer the test and “insist” that it be used.In contrast, most observers agree that the best way to control Zika, dengue and Chikungunya probably revolves around the development of safe and effective preventive vaccines. For example, how could we contemplate using a potential new anti-Zika drug to treat infected preg-nant women, if we did not know with certainty that such a drug did not itself cause birth defects? The same can Open AccessRetrovirology*Correspondence:  mark.wainberg@mcgill.ca 1 McGill University AIDS Centre, Jewish General Hospital, Montreal, QC, CanadaFull list of author information is available at the end of the articlePage 2 of 2Wainberg and Lever  Retrovirology  (2016) 13:80 •  We accept pre-submission inquiries •  Our selector tool helps you to find the most relevant journal•  We provide round the clock customer support •  Convenient online submission•  Thorough peer review•  Inclusion in PubMed and all major indexing services •  Maximum visibility for your researchSubmit your manuscript atwww.biomedcentral.com/submitSubmit your next manuscript to BioMed Central and we will help you at every step:probably be said for drugs that might block the replica-tion of dengue and Chikungunya, although there might be rationale for the use of such products in non-pregnant populations, and, of course, the use of antiviral com-pounds might help to limit transmission from humans to Aedes aegypti mosquitos and help to break the chain of epidemic transmission. Hopefully, vaccines and related approaches such as the use of passively transfused anti-bodies will soon be available to help control Zika infec-tion. Thus, the approaches that need to be developed to arrest flavivirus transmission may differ significantly from those that have been used to interfere with trans-mission of HIV.The tragedy of Zika for a pregnant mother, her affected infant and the wider family is not something to dismiss lightly. It is good news that this is a relatively uncommon complication but it is no less terrible for that. At the same time, we should not lose sight of the fact that the world-wide burden of HIV disease continues to expand, in part because so many people have been saved by ARVs. It is estimated that as many as 38 million people worldwide are now living with HIV. Sadly, a number almost equal to this are thought to already have died of HIV infec-tion, making the epidemic one of the worst to have ever affected humankind. There are still several million new HIV cases occurring annually, and the problem of HIV drug-resistance in developing country settings is on the rise and poses a real threat to the success of the WHO 90–90–90 goal to end the epidemic. On World AIDS Day, December 1, let us turn our attention with renewed energy toward finding ways of ending the HIV epi-demic as well as other infectious diseases that continue to take a horrible toll, often of the most vulnerable and disadvantaged.Author details1 McGill University AIDS Centre, Jewish General Hospital, Montreal, QC, Canada. 2 Cambridge University, Cambridge, UK. Received: 9 November 2016   Accepted: 9 November 2016References 1. Wainberg MA, Lever AML. How will the ebola crisis impact on the HIV epidemic? Retrovirology. 2014;11:110. 2. Walmsley SL, Antela A, Clumeck N, et al. Dolutegravir plus abacavir–lamivudine for the treatment of HIV-1 infection. N Engl J Med. 2013;369:1807–18. 3. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophy-laxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99. 4. Molina JM, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46. 5. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. 6. Wainberg MA, Hull M, Girard PM, Montaner J. A key to achieving the UNAIDS 90–90–90 target: financial incentives for HIV testing. Lancet. 2016;16(11):1215–6.

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Wainberg, M.A

Lever, A.M.L

ScholarBank@NUS

https://www.repository.cam.ac.uk/bitstream/handle/1810/284129/HIV%20and%20Zika%3a%20When%20will%20we%20be%20able%20to%20end%20these%20epidemics%3f.pdf?sequence=1&isAllowed=y

HIV and Zika: When will we be able to end these epidemics?

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