Human immunodeficiency virus and acquired immune deficiency syndrome in Asia: an update

Prevalence estimates of human immunodeficiency virus (HIV) infection in Asia are diverse, ranging from <0.1% to 1.1%. In Asia, approximately 4.7 million people are living with HIV and 310,000 are newly infected each year. The fastest growth of the epidemic throughout Asia is among men who have sex with men (MSM). Drug resistance varies from 4%-5% in an Asian cohort to 10% in an acutely infected MSM cohort in Bangkok. A rise (4%-14%) in the prevalence of syphilis is associated with the HIV epidemic in Asia. Tuberculosis is among the most common coinfections; however, HIV testing of tuberculosis patients is not routine. Coinfection with HBV, HCV, and triple coinfection varies from 8.7%-11%, 5%-18%, and 0.4%-3% respectively. Although the World Health Organization 2013 guidelines to start antiretroviral therapy (ART) early are implemented, most patients present late, with low CD4 counts, resulting in a high mortality during the first year of ART. While integrase inhibitor-based treatments are preferred first-line treatments in high income countries, efavirenz-based treatments remain preferred treatments in resource-limited countries. HIV-1 viral load testing is not available in most of these countries, making low-cost point-of-care testing accessibility an urgent priority. Effective ART coverage to prevent new HIV infections among children in Asia remains low. To provide life-long ART for children, better use of current first-line regimens and access to pediatric second-line formulations are important. To end AIDS in Asia by 2030, committed policy with innovative strategies to enhance “reach recruit, treat and retain” combined with effective prevention strategies are required.