Where does Korea stand in ‘90-90-90’ program to eliminate AIDS?

A middle-school girl with AIDS has spread the autoimmune disease to 20 men after prostituting herself on social media in Busan this month, fueling an AIDS scare nationwide.

Acquired immune deficiency syndrome (AIDS) refers to a set of symptoms and illnesses that occur at the final stage of human immunodeficiency virus (HIV). HIV is a virus that attacks the immune system that if left untreated, will ultimately destroy a person’s immune system, leading to death.

Korea Centers for Disease Control and Prevention (KCDC) data recently showed the number of Korean AIDS patients jumped annually across all age groups although the figure has been decreasing worldwide.

Source: Rep. In Jae-keun

The number of newly diagnosed AIDS patients in Korea amounted to 1,062 cases last year, indicating a 30 percent increase from 740 people diagnosed in 2007. The number of male patients in their teens and 20s has notably increased with data showing a total of 33 boys from 10 to 20 years old infected with AIDS, an increase from 12 boys in 2006, while the number of males affected in their 20s doubled from 149 people to 352 from 2006 to 2016.

Commenting on the phenomenon, Lee Ja-Cob, an assistant professor at Hallym University Kangnam Sacred Heart Hospital, notes on the surprising correlation between outlawing prostitution and the rise of AIDS patients.

“In the past, prostitutes were considered service workers and issued health certificates. Getting a health certificate required sex workers to pass a mandatory AIDS or sexually transmitted disease test,” Lee explained. “As prostitution became illegal, the grounds for mandatory AIDS testing has disappeared, making it hard to rule out the possibility that prostitutes have AIDS.”

Coupled with the social phenomenon of becoming sexually active at a younger age, the rate of HIV infection has increased especially in youth, as data has shown. The number of Korean teenagers with AIDS grew more than four-fold in the past decade, according to a lawmaker of the ruling Democratic Party of Korea Friday.

“There should be an institutionalized solution that requires HIV tests for people in these so-called ‘blind spots’ of our society,” the professor said. “I am not advocating the legalization of prostitution. The situation is similar in Thailand where prostitution has spread AIDS out of control. We may face a similar future if we do not come up with a solution.”

Despite the increasing number of people infected with AIDS, much of the discussion over information and treatment circulates through anonymous internet boards due to the stigma associated with the disease.

A survey of 104 HIV-infected people conducted by the Korea HIV Stigma Index Joint Research Group in July showed 75 percent of the surveyed felt self-reproach, 64 percent felt guilt, and 51 percent felt a sense of shame.

90-90-90 principle in eliminating AIDS

UNAIDS, the joint United Nations Program on HIV/AIDS, calls for ending the AIDS epidemic that will have killed more than 39 million people around the world by 2030 with what they call the “90-90-90” principle.

The 90-90-90 rule is an ambitious, yet achievable target that will help end the AIDS epidemic, according to the organization. It aims to have 90 percent of HIV patients know they have HIV, 90 percent of all those diagnosed getting sustained antiretroviral therapy, and 90 percent taking medicine making sure the disease is undetectable, or in other words, not transmittable.

“When this three-part target is achieved, at least 73 percent of all people living with HIV will be virally suppressed,” UNAIDS writes in their proposal. “Modelling suggests that achieving these targets by 2020 will enable the world to end the AIDS epidemic by 2030, which in turn will generate profound health and economic benefits.”

Reaching the 90-90-90 goal and thereby having 73 percent of HIV patients unable to transmit the disease will be the point where the AIDS epidemic will come to a slowing stop.

Data regarding the number of Korean HIV patients aware of having the disease is unavailable “since it is difficult to collect data on the number of people who have HIV and are unaware of it,” according to a KCDC official.

For HIV-diagnosed patients getting sustained antiretroviral therapy, Korea has “one of the highest rates in the world” with 94.3 percent, according to the KCDC official.

Data regarding how many people have the disease virally suppressed have not been compiled yet, according to the agency.

Meanwhile, a ten-year study spanning from 2006 to 2015, which included 1,356 Korean HIV-infected patients -- 778 male and 54 female -- shows HIV treatment adherence to be 64.5 percent. The most common reason for skipping medication was “simply forgetting” (60 percent) among study participants. Other reasons included side effects (8 percent), not eating a meal (6 percent), and fear of revealing the diagnosis to others (5.8 percent).

Gilead dominates $28.3 million AIDS therapy market

The increasing number of HIV/AIDS patients, especially among young people, has led to the growth of the HIV drug market. IMS Health Data indicated the HIV treatment market to be around 32 billion won ($28.3 million) in the first half of this year, reporting a 70 percent increase from 21.3 billion won in the same period last year.

Stribild (top) and Triumeq pills

The most dominant AIDS therapies are Gilead Science’s Stribild and GlaxoSmithKline’s Triumeq, with Gilead far outpacing GSK in sales volume.

Stribild is a fixed-dose combination product that recorded the largest sales in the first half of this year with 10 billion won, according to local reports. The American biopharma giant’s previous AIDS therapies, Truvada and Genvoya, released earlier this year, also brought in 5 billion and 2.3 billion won, respectively, in the same period, bringing Gilead’s total sales in the AIDS market to around 17.3 billion won.

GSK’s Triumeq is a once-daily pill that can be taken with or without meals, making it accessible and convenient for patients who must face a stigma with the disease. The new therapy recorded explosive sales with 7.9 billion won ($6.9 million) in the first quarter, exceeding expectations and leading industry insiders to speculate the drug to surpass Stribild sales in the second half of this year. GSK’s older treatment Tivicay also recorded 500 million won, bringing the company’s total to 8.4 billion won.

"People in their 20s to 40s account for 76 percent of Korean HIV/AIDS patients where prejudice and bias against HIV are severe compared with foreign countries,” a GSK official said. “Unlike other drugs, Triumeq shows efficacy with just one pill a day with or without meals.”

Also in the market are Janssen’s Prezcobix recording around 900 million won in sales, MSD Korea’s Isentress with 4.3 billion won, and Bristol-Myers Squibb’s Evotaz with 800 million won.

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