The Basics of HIV/AIDS - The Ongoing Pandemic
What is HIV?
At the end of 2019, there were an estimated 38 000 000 people living with HIV.
HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) are linked.
The HIV virus damages cells in the immune system, thereby weakening the ability of the immune system to fight common infections and disease. Without treatment or interventions, the average survival time after infection is estimated to be 9 to 11 years.
Understanding the Pathophysiology of HIV
HIV infects:
Helper T Cells – a part of the adaptive immune system that ‘help’ other immune cells by releasing cytokines, small proteins that help to polarise the immune response.
Macrophages – a part of both the innate immune system and the adaptive immune system, they are white blood cells that engulf and digest foreign bodies or substances.
Dendritic cells – messengers between the innate and the adaptive immune system.
Once these cells become infected, the body becomes more and more susceptible to opportunistic infections and cancers.
How HIV can be transmitted?
HIV is a sexually transmitted infection and occurs by contact with or transfer of blood, semen, pre-ejaculate and vaginal fluids.
Non-sexual transmission can occur from an infected mother to her infant during pregnancy or during childbirth through exposure to her blood or vaginal fluid and through breast milk.
Many misconceptions about HIV exist, which contribute significantly to the stigma and discrimination faced by HIV-positive people.
HIV is not transmissible through fluids such as saliva, sweat, tears, or urine.
Society and Stigma:
Marginalised, at-risk groups, such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing discrimination.
Discrimination includes:
Blood donation restriction on at-risk populations
Compulsory HIV testing without prior consent
Violations of confidentiality within healthcare settings
Targeted violence against those who are HIV-positive
HIV/AIDS-related stigma:
Instrumental AIDS stigma – the fear that is almost always associated with a deadly and transmissible illness.
Symbolic AIDS stigma – the way in which HIV/AIDS is used for people to express their broader views towards groups that are generally perceived to be the most at-risk from HIV/AIDS.
Courtesy AIDS stigma - stigmatisation of people connected to the issue of HIV/AIDS or HIV-positive people.
Current Treatment Options:
Generally, HIV is suppressed by combining 3 or more antiretroviral drugs, in a process known as ART (antiretroviral therapy) or HAART (highly active antiretroviral therapy).
Antiretrovirals are recommended in people of all ages, as soon as the diagnosis is made. Unfortunately, most people are diagnosed after the ideal treatment start date, though treatment is effective in more than 95% of people during the first year.
Treatment also includes preventive and active treatment of opportunistic infections.
Reasons for non-compliance to treatment include poor access to medical care, inadequate social supports, mental illness and drug abuse. These regimens are also incredibly complex (in terms of number and frequency of medication) and come with significant adverse effects.
Despite effective treatment having been developed in 1996, we must continue because of:
Lack of availability of retrovirals - of 38 000 000 sufferers, only 1/3 are receiving treatment.
. Limitations of treatments - there are many different side effects of the treatment currently.
Increase in the number of infections - which many believe is caused by 'apathy' or lack of education in young people who are unaware about the truth.
Cure?
In 2008, there was the first case of an HIV patient being 'cured', the 'Berlin patient', Timothy Ray Brown, who was functionally cured after being given a stem cell transplant from a donor resistant to HIV (due to a rare genetic mutation). He has not needed antiretroviral therapy since. However, his body is not wholly free of HIV. This, whilst not practical or desirable on a wider scale, provides proof of concept.
A functional cure is achievable.
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