Health KyungHyang is the first media outlet to operate a multilingual edition, quickly delivering domestic health and medical news to overseas. Representatively, we have prepared a planned article called "Medical Debate with Global Scholars," communicating with leading health and medical scholars from home and abroad, from the latest treatment methods for various diseases to the direction of health and medical development in line with future medicine, providing our readers with more extensive information. The thirteenth theme is "HIV Infection Status and Latest Treatment Guidelines in Each Country." <Editor's Note>

Medical progress is bringing hope to the treatment of many diseases, including HIV infection. HIV is a virus that lives in the human body and destroys the immune system. If the immune system is damaged, the disease can progress to acquired immunodeficiency syndrome (AIDS). However, the development of powerful antiretroviral drugs that can suppress the growth of HIV has made it possible to prevent the progression to AIDS and extend the lifespan of people living with HIV.

In addition to its effectiveness, HIV treatment has also evolved to consider the quality of life of people living with HIV. As a result, it is now possible to take a single-dose medication that combines two drug components, instead of taking at least three or more drugs at the same time (3-drug therapy). This has made it possible for people living with HIV to enjoy a much more convenient life, while maintaining the effectiveness of treatment.

However, social perception of people living with HIV has not improved. Many people still do not actively seek testing and treatment due to social stigma and discrimination. This is why there are growing calls that even if better treatments are developed, it will be useless if the perception of people living with HIV does not change.

- It seems that HIV testing rates, incidence rates, and social perceptions vary by country. What is the status of your country?

Professor Choi Jun-yong (Hereafter Choi Jun-yong): South Korea has not been regularly releasing data on its progress towards achieving the 95-95-95 targets set by the United Nations. However, according to data from the Korean HIV/AIDS Cohort Study and the Medical Institution HIV Infection Counseling Program, as of 2021, 95% of diagnosed HIV-positive people in South Korea had experience with antiretroviral therapy, and in 2019, 90% of those receiving treatment had their viral loads suppressed. However, there is a lack of data on how many percent of infected people have been diagnosed. One study in 2015 reported that about 60% had been diagnosed.

The social stigma and discrimination against people living with HIV is still a serious problem. According to the 2017 "Korea HIV Stigma Index Survey", people living with HIV in Korea experience severe external stigma, social exclusion, and isolation. They also experience severe internal stigma, which they find difficult to bear on their own. When asked about the emotions they felt about their HIV status in the past 12 months, 75% of respondents said they felt "blaming themselves." Many people living with HIV also experience discrimination in the healthcare environment.

HIV is not transmitted through saliva or other bodily fluids in everyday life. People with HIV who are receiving regular treatment have such low levels of active virus that it cannot be detected in the blood, and the virus cannot be transmitted during sex without a condom. I hope that the stigma and prejudice against people with HIV in Korean society will be overcome as soon as possible.

Professor Cheng Chien-yu (hereafter Cheng Chien-yu): The HIV testing rate in Taiwan was 3.4% per year (55,000 out of 160 million people), and the incidence rate has decreased from 2.0% to 1.5% in the past five years. Although access to HIV testing has improved and awareness and understanding of HIV infection have increased, some people still believe that HIV infection is a death sentence and there is no treatment. Social prejudice against people with HIV has also decreased, but there are still concerns about discrimination in areas such as employment and healthcare.

Professor Ping Ma (Hereafter Ping Ma) : According to the China CDC, as of the end of 2022, there are 1.22 million people living with HIV in China. Of these, over 95% were infected through sex. Infections due to drug abuse are declining every year.

- What efforts are being made to eradicate HIV infection at the national level? Can you introduce any government policies or successful public service campaigns?

Choi Jung-yong: The Korean Centers for Disease Control and Prevention (KCDC) has established an AIDS prevention and management plan and has pursued a number of strategies to achieve its vision of "zero new infections, zero deaths, and zero discrimination." They provide treatment support for HIV-positive people in Korea and continue to carry out education and publicity activities to improve AIDS awareness. Through the medical institution infection counseling program, psychological counseling and medication adherence counseling are provided to infected people, which has led to improved depression, anxiety, and medication adherence rates among infected people. In addition, the KCDC is pursuing a number of policies, including the introduction of anonymous testing and the operation of a support center for foreign infected people.

Cheng Chien-yu: The Taiwan Centers for Disease Control (TCDC) is implementing a comprehensive HIV/AIDS prevention and control program that covers three aspects: prevention, treatment, and care and support.

In terms of prevention, TCDC provides educational materials through schools, local LGBT centers, medical institutions, and social media to promote safe sex and condom use. These materials include information about HIV transmission, prevention methods, and the importance of early diagnosis and treatment.

In terms of treatment, TCDC provides free antiretroviral treatment to all HIV-positive people. This treatment is highly effective in suppressing the virus and preventing the development of AIDS. TCDC also uses a monitoring system to ensure that HIV-positive patients are taking their medication properly.

In terms of care and support, TCDC provides psychological support programs to help HIV-positive patients cope with the emotional challenges they face. These programs include individual and group counseling, as well as support groups for family members and friends of HIV-positive people. TCDC also actively carries out public awareness campaigns to address social stigma and discrimination against HIV-positive people. These campaigns aim to educate the public about HIV and to promote a more inclusive and supportive society for HIV-positive people.

Ping Ma : Since 2004, the Chinese government has implemented a policy called "Four Free and One Care," which includes:

▲Free HIV testing ▲Free antiretroviral treatment ▲Living allowances for economically disadvantaged people ▲12 years of free compulsory education for HIV-positive children

In addition, the government has enacted legal regulations to protect the rights of people living with HIV, and the National Health Insurance Corporation (NHIB) has included all single-tablet combination antiretroviral drugs in the scope of health insurance coverage. Thanks to this, people living with HIV can use the latest antiretroviral drugs, including Dovato, without any burden. Many social organizations supported by the government are conducting various campaigns to eliminate discrimination, reduce stigma, and improve awareness in schools and communities.

- What is the latest HIV treatment? If there are any meaningful HIV-related clinical trials underway in your country, please explain them together.

Choi Jun-yong : The most effective treatment for HIV infection is combination antiretroviral therapy (cART). This treatment involves the administration of two or three antiretroviral drugs in combination to suppress HIV replication and allow for long-term survival. In particular, while in the past it was necessary to take several pills, the convenience of taking the medication has increased to the point where it can be successfully treated by taking only one pill a day. While it is still not possible to cure HIV infection, people with HIV can live a healthy life by taking medication regularly. In addition, a treatment that allows people with HIV to stop taking medication after receiving an injection once every two months has recently been developed.

In Korea, many researchers are conducting basic research and clinical research on HIV infection. Through the Korea HIV/AIDS Cohort Study, which is being conducted by multiple hospitals, they are providing clinical epidemiological data on HIV infection in Korea.

Cheng Chien-yu : In Taiwan, seven single-tablets are used as first-line treatments, and clinical trials are currently underway to treat patients with multidrug resistance. This includes long-acting injection therapy that is given once every 6 months.

Ping Ma : In China, research on HIV/AIDS is being actively conducted. Pharmacologists are focusing on developing new antiviral drugs such as long-acting formulations, while basic science researchers are working on developing treatments for HIV/AIDS and vaccines that can prevent HIV infection. In addition, obstetrics and pediatrics experts are working with infectious disease experts to eliminate mother-to-child transmission. Clinical experts are working hard to provide the best treatment for patients in the field. There are also experts conducting comparative studies on Dovato and Biktarvy.

- What are the benefits of the latest HIV treatment for patients?

Dr. Choi Jun-yong : The biggest benefit is that patients can live a normal life and stay healthy if they take their medication properly. Additionally, if the virus is suppressed through consistent treatment, it will not be contagious. However, if the medication is not taken properly, drug-resistant viruses can develop, leading to treatment failure. While a cure is still not possible, it can be said that HIV infection treatment has made remarkable progress over the past 40 years.

Cheng Chien-yu : The latest antiretroviral drugs are more effective at suppressing HIV replication. They also have fewer side effects and a lower risk of drug resistance, making them safer for patients to take. Additionally, the latest HIV treatments only require patients to take one pill a day, which can improve adherence. If the long-acting injection therapy that is currently under development is actively applied to clinical practice, patients will no longer have to take medication every day.

Ping Ma : HIV can be effectively suppressed to reduce the amount of virus. This can also help to reduce the risk of virus transmission. Additionally, the latest treatments require patients to take only one pill a day, which is much less burdensome than the previous treatments. The risk of side effects is also lower, so patients can live their daily lives more comfortably. Most importantly, these treatments can improve the quality of life and extend the lives of people living with HIV, allowing them to live longer and healthier lives.

- How do you think the trend of HIV infection and treatment will change in the future?

Choi Jun-yong : In Korea, we will see the introduction of a treatment that requires patients to take a shot once every few months and do not need to take pills. We also expect the development and use of new treatments with new mechanisms that are effective against drug-resistant viruses. Long-term use of medications can cause side effects such as increased cholesterol, weight gain, osteoporosis, and kidney disease. We expect the use of new treatments that can reduce these side effects. Although a cure is not being developed visibly, research is ongoing.

Cheng Chien-yu : I expect that more innovative treatments, such as long-acting injection therapy, will be developed. I also expect that the HIV infection rate will gradually decrease in the future, but we should also consider strategies to prepare for new challenges such as the number of new infections, co-infection, and drug resistance.

Ping Ma : The trend of future treatment will focus on the development of treatments that can address the more comprehensive needs of people living with HIV, as well as HIV prevention. In terms of prevention, we will need to focus on educating high-risk populations about the importance of HIV testing, prevention methods, and safe sex. We will also need to develop new vaccines and other preventive strategies.

In addition, personalized medicine that takes into account genetic factors and individual drug responses will become more common. The development and introduction of injectable drugs, such as injectable drugs, can make it easier to administer medications, so patients can focus on continuous treatment. Furthermore, technological advances will play a more important role in the long-term management of HIV infection, such as patient monitoring and individual medication adherence.

- In the fight against HIV infection, what is the crucial role of society and experts?

Choi Jun-yong : In terms of society, we need to work to eliminate stigma and discrimination against people living with HIV. Stigma and discrimination are important obstacles to overcoming HIV infection. Social prejudice must be resolved so that many people living with HIV can be diagnosed and treated early. This will also help to reduce HIV transmission in society.

Experts need to scientifically monitor the HIV infection status and problems in Korea and continue research to overcome HIV infection. Recently, the number of cases of infection through injection drug use has been increasing slightly. We need to be aware of this and develop a plan before the trend grows. As the number of foreign infected people is also increasing, it is necessary to reorganize the management system. There is also a need for measures to address the chronic diseases of people living with HIV, who are becoming increasingly elderly. Patients who need dialysis, patients who need multiple procedures or surgeries, and patients who need long-term care are increasing. We need to quickly establish and implement measures for this.

Cheng Chien-yu : To overcome HIV, a comprehensive and multifaceted approach is needed involving a variety of stakeholders, including government, healthcare professionals, communities, and individuals.

First, in terms of prevention education, it is important to raise awareness by providing accurate information to the public, such as the importance of HIV prevention and regular testing. In addition, comprehensive sex education programs should be included in the school curriculum so that people can accurately understand HIV and safe sex from an early age.

To diagnose HIV infection early and receive active treatment, it is also important to increase access to testing programs and treatments. Access to HIV testing should be increased as part of health services, and HIV-infected people should be guaranteed free treatment with antiretrovirals.

Community participation is also important to address social stigma and discrimination against HIV. Community networks can be established for HIV-infected patients to provide ongoing counseling and support services, educational materials, and various projects that promote understanding and empathy for HIV. The government should establish legal mechanisms to protect the rights of HIV-infected people, and develop and implement public health policies related to HIV prevention, HIV testing, and HIV treatment.

Ping Ma : Governments and experts should work together to promote HIV education and awareness programs. This includes the importance of HIV prevention, testing, treatment, reducing social stigma, and adherence to treatment. Governments should ensure access to testing and treatment so that people living with HIV can access them without burden. Governments should also actively support HIV-related research and development activities by experts.

Efforts should also be made to address social stigma and discrimination against HIV. This can be achieved through public campaigns, education, and anti-discrimination policies. It is also necessary to cooperate in the formulation of policies such as the enactment of laws that protect the rights of people living with HIV. Furthermore, we need to support international partnerships for HIV elimination. This includes promoting access to medicines, sharing best practices for HIV aids treatments, and supporting medical infrastructure.