Prevention and Treatment of HIV/AIDS

Human immunodeficiency virus (HIV) is a sexually-transmitted virus that can be spread in many different ways. Some examples include contact with bodily fluids like blood, semen, and breast milk. Viruses, by nature, are not considered “alive” because they lack the ability to reproduce without the aid of a host cell. Thus, the virus targets the immune system’s white blood cells. Healthy white blood cells alert the immune system once they detect invaders like bacteria or viruses so that the body can prepare a defensive response. HIV, however, is a difficult pathogen to fight because it targets the very body cells responsible for detecting infections such as HIV/AIDS. Once HIV invades a white blood cell, it uses it to replicate viral DNA instead of  healthy DNA. As HIV infiltrate, replicate, and destroy the body’s white blood cells, infections can spread more easily throughout the immune system.1

HIV (yellow particles) taking over a white blood cell

In the beginning phase of the infection, HIV replicates viral DNA while destroying essential white blood cells. The virus remains undetected by the immune system as the body loses the capability to fight off bacterial infections, other viruses, and weak cancers. At this point, a physician would diagnose a patient with fully acquired immunodeficiency syndrome, or AIDS. HIV does not directly kill the host, but rather weakens the host’s immune system to the point where even a minor ailment poses a lethal threat.1

 

Stages of HIV Infection

The first stage is acute HIV infection. Typically, within two to four weeks of infection, people will start to experience flu-like symptoms, such as fever, runny nose, cough, and fatigue. This response is the body reacting to an invader in the immune system. At this point, there is a significant amount of HIV in the individual’s blood, and they are very contagious.1

The second stage is clinical latency. In this stage of HIV infection, there is a lowered amount of HIV in the individual’s blood. As a result, people are much less likely to infect others in this stage. The infected person is usually asymptomatic, and thus unaware of even carrying an infection. Clinical latency can last for up to a decade if left untreated. Toward the end of the second stage, the amount of HIV starts to increase again, while the white blood cell count decreases.1

The third stage is acquired immunodeficiency syndrome (AIDS), which is also the most severe phase of HIV infection. Swollen lymph nodes, diarrhea, and weight loss commonly accompany the onset of AIDS. People in this stage have such poor immune systems that they are prone to many opportunistic infections that can lead to all sorts of serious illnesses.1

 

 

Transmission

HIV/AIDS can be transmitted in many different ways. Some include engaging in certain “risky behaviors.”  Examples of risky behavior include having unprotected sex or even sharing needles.

Unprotected Sex

Having unprotected anal or vaginal sex with an HIV-infected person dramatically increases the likelihood of HIV transmission. The most risky sexual behavior, however, is unprotected receptive anal sex. Insertive anal sex is less risky than receptive anal sex, however, it can also lead to the transmission of HIV. Furthermore, although it is uncommon to be infected with HIV from oral sex, there is still a possibility. Deep, open-mouth kissing can also lead to HIV transmission if both partners have sores, cuts, or bleeding gums.2

Sharing Drug Paraphernalia

Sharing needles, syringes, water, or other types of equipment involved in drug use with an HIV-infected person is also very dangerous. HIV can live in drug paraphernalia for up to 42 days. It is advised to avoid sharing any drug equipment to avoid HIV transmission.2

Breastfeeding

Although breast milk is an uncommon type of HIV transmission, it is still very possible. Mothers infected with HIV who have not taken medication or received treatment can transmit HIV by breastfeeding their children. This issue has been mitigated by testing every pregnant woman for HIV, and if detected, giving mothers the appropriate HIV treatment prior to interacting with their children.2

 

Prevention

There are many different ways to prevent HIV/AIDS. They include abstaining from sex, using the appropriate contraceptive methods, getting routinely tested, communication with your partner, PrEP, and PEP.

Abstinence

One of the most effective ways to prevent HIV/AIDS is abstinence, or simply electing not to have sex or engage in any sort of intimate, sexual contact. This is a viable option for individuals, depending on their cultural, religious, and social lifestyles.

Contraception

If one still wants to have sex, or is in a sexually active relationship, another great way to reduce the risk of HIV/AIDS transmission is using contraception. The only form of contraception that protects against HIV/AIDS infection, or any type of STI/STD (sexually transmitted infection/sexually transmitted disease) is the condom. Both male condoms and female condoms can be used as a form of contraception against HIV/AIDS.

Getting Tested

Another way to prevent HIV/AIDS is checking if you have HIV. There are many different types of HIV tests.

  • Rapid HIV Test

The first kind is a rapid HIV test, which can usually yield results within 20 minutes. This kind of test is painless, and involves swabbing the inside of the cheek with a swab and testing this sample for the presence of HIV. Other times the doctor may recommend getting a blood test.

  • Ora-Quick In-Home HIV Test

Testing for HIV is so simple in fact, that one can test themselves in the comfort of their own home. The Ora-Quick In-Home HIV Test involves swabbing the gums and testing for HIV. This test also only takes around 20 minutes.

  • Home Access HIV-1 Test

The Home Access HIV-1 Test is a bit more invasive, but is also relatively easy and convenient. It involves pricking one’s finger for a blood sample, mailing the blood sample to a lab, and receiving results within a week.

  • Antibody HIV Test

Antibodies are the body’s chemical defense mechanism again​st a pathogen. Antibodies attach to antigens (cell specific receptors) on certain types of affected cells, so their presence indicates whether a person is infected. The human body usually takes about 28 days to produce antibodies and mount an attack on HIV pathogens. During this four-week period, antibody levels remain below a detectable level and thus this period of inactivity (the window period) is the most infectious stage (known as acute HIV infection) of the virus.

  • Antigen HIV Test

Antigen tests allow for quicker results due to the fact that they screen for virus infected cells before the immune system mounts a response and produces antibodies. Fortunately, the majority of these diagnostic tools are able to provide results within 24 hours of administration to promote early medical intervention. Detectable levels of antibodies take anywhere from four to eight weeks to produce results after the initial infection, whereas antigen tests take up to two weeks.

Testing for HIV/AIDS is not only a great way to prevent its transmission, but is also important for those who are in a relationship and still want to have active but safe sex lives.

Communication with Partner

Open and honest communication in any relationship is vital, regardless of whether or not either partner has HIV/AIDS. However, if one is HIV-positive, it is strongly recommended to communicate this news to their partner as soon as possible. Getting tested with one’s partner is another great way of knowing one another’s HIV status. Straightforward honesty regarding one’s sexual history is crucial when maintaining trust in a relationship. Upon being aware of whether or not one has HIV, one can coordinate accordingly with their partner about the type of sex they would like to have, the contraception they want to use, and the medication they were recommended to take.

Pre-Exposure Prophylaxis (PrEP)

PrEP, or pre-exposure prophylaxis, is another preventative measure against HIV. PrEP is a type of medication best suited for HIV-negative individuals who are at very high risk of being infected with HIV. It is also supposed to be taken prior to sexual intercourse. PrEP prevents HIV from latching onto white blood cells and subsequently spreading throughout the immune system. It is the most effective when taken daily, and loses a lot of its effectiveness if the user does not stick to a consistent regimen.

Using PrEP daily reduces HIV infection by over 90% for sexually active individuals, and over 70% for drug users. The risk of HIV transmission can be reduced even more by combining PrEP with contraception, communication, and routine testing.

Post-Exposure Prophylaxis (PEP)

PEP, or post-exposure prophylaxis, is a type of medication one takes if they believe they have been exposed to HIV. Taking PEP within the appropriate time frame can prevent an HIV infection. This medication can be taken after a sexual encounter with an HIV-infected partner, being sexually assaulted by someone with HIV, or sharing drug paraphernalia. PEP is a medication that is administered in emergency situations, and is most effective after taken within 72 hours of exposure.

If one believes they have been infected with HIV, it is strongly advised to book an appointment with a general practitioner immediately, or go to an emergency room physician to inquire about PEP.

 

Treatment

Although HIV/AIDS affects a significant amount of people, advances in science, medicine, and technology have made this disease treatable. Some of these treatment methods include ART and other types of useful medication.

Antiretroviral Therapy (ART)

ART, or antiretroviral therapy, is a regimen of HIV medication utilized to treat HIV. After someone has been diagnosed with HIV, it is usually within their best interest to start ART immediately. There are many benefits of ART, such as a longer lifespan, lowered levels of the virus, and reduction in HIV transmission. However, ART does have some side effects. It is important for the patient to discuss the pros and cons of ART with their healthcare provider before deciding to take this path of treatment. Those who are pregnant, are in the AIDS phase of HIV infection, have HIV-caused illnesses and infections, or have been recently infected by HIV are strongly encouraged to start ART. It is absolutely crucial if one chooses ART, to adhere to taking the medication as a daily routine. The effectiveness of ART significantly decreases if it is not taken exactly as prescribed. Therefore, ART works best when taken consistently. That way, the medication can do its job by preventing HIV from multiplying. Once ART has reduced HIV multiplication, the immune system will have some time to recover so it can regain the ability fight against bacteria, other viruses, infections, and cancer.

Other Medications

The following lists pertain to a handful of medications commonly used to combat HIV infection. They are all typically taken in combination with two or more other medications.

  • TRUVADA

This medication is considered a nucleoside analog reverse transcriptase inhibitor (NRTI). NRTI’s work by disrupting the creation of new, viral, genetic material. A subunit of DNA, a nucleotide, is replaced with a similar compound. However, since the chemical structures of the nucleotide and the compound replacing it are slightly varied, the formation of chemical bonds is disabled. The HIV virus is unable to check for and correct mistakes, subsequently, viral reproduction is halted. A person must weigh 77 pounds or more to take this medication.

This medication is a combination therapy (two medications in one pill; in this case, emtricitabine and tenofovir disoproxil fumarate), and is always used in combination with several other medications as it is not a complete treatment on its own. It also operates using a particular mechanism. It prevents proliferation of HIV, lowers viral load, and decreases the amount of HIV in the blood (may also increase CD4 cell count if used with other medications). A study published on March 3rd, 2015 in the Journal of Infectious Diseases shows that Truvada® is less effective in females and that they need to take double the amount that males do to get the same effects.8

  • TENOFOVIR

This is a NRTI (and component of Truvada®) used to block the enzyme reverse transcriptase. Over 1,900 people with HIV failed to respond to Tenofovir in an international study. On January 28th, 2016, researchers announced that the failure of this key ingredient in HIV medication is indicative of growing drug resistance.9

  • AZT

AZT aims to slow down and prevent damage to the immune system, thus reducing the risk of developing further illnesses. This is a NRTI approved by the U.S. Public Health Service on the grounds that it may be used to prevent mother-to-child transmission of HIV.

  • COMPLERA

In 2011, Complera (an all-in-one fixed dose combination tablet) was approved by the FDA, offering yet another option for HIV patients.

These are only a few of many different medications that have been developed to treat HIV/AIDS.

Recent Developments

The following facts list some of the most recent statistics and discoveries that have been linked to new developments in HIV/AIDS preventions and treatments:

  • Depo Provera, an injectable hormonal contraceptive, shows a moderate increased risk (40%) of acquiring HIV.10
  • By the end of 2015, 17 million people afflicted with HIV were receiving ART globally.
  • New HIV infections fell by 35%, AIDS related deaths fell by more than a quarter, and 7.8 million lives were saved by the international efforts to prevent the spread of HIV between 2000 and 2015.11
  • People living with HIV (PLHIV) and taking ART often interact directly with antiretroviral drugs which are successful at prolonging survival in HIV patients but have also recently been linked to a higher incidence of cardiovascular disease. The study published January 19, 2016 in the International Journal of STD and AIDS showed that across the world a large portion of people living with HIV die from cardiovascular and liver disease as compared to uninfected individuals.
  • In 2016, the World Health Organization stated that the majority (54%) of people who are considered eligible for treatment were receiving it.
  • On February 25, 2016 at the annual Conference on Retroviruses and Opportunistic Infections (CROI), researchers reported that a man taking the HIV-prevention pill Truvada contracted HIV—marking him the first reported infection of someone regularly taking the drug.

Many patients using older suppressive antiretroviral therapy regimes may be considered eligible candidates for regimen simplification. The following provides a list of circumstances where this might take effect: if these patientsare receiving treatments that are no longer recommended as preferred, are receiving treatments that were not fully understood in terms of drug interactions at the time, or are being prescribed a regimen that was approved prior to the availability of newer options that offer easier administration or greater tolerability. The primary consideration behind this involves improving the patient’s quality of life, maintaining long-term regimen adherence, avoiding toxicities that may result from long-term use, and reducing the risk of a type of failure in the treatment of HIV called virologic failure.

Virologic failure means that the antiretroviral therapy (ART) failed to decrease and maintain a person’s viral load to less than 200 copies/mL. Prospective studies of HIV-infected individuals show that patients with reduced dosage frequency have higher levels of adherence, and that patient satisfaction is higher with regimens that include fewer pills and reduced dosing frequency. Unlike treatments of the past, many offered today require only one daily dose and place no dietary restrictions on the patient. Ideal candidates for such simplification are those who are on their first regimen and lack a history of treatment failure; these patients are less likely to harbor a drug-resistant form of the virus. Generally, there are three major forms of simplification possible:

  • Within-Class Substitutions: This ensures the patient is not exposed to different drug classes, potentially preserving those classes for future treatment. It usually involves using a newer drug, a co-formulated drug, or a formula that has a lower pill burden, lower frequency, or less toxicity.
  • Out-of-Class Substitutions: Just as the name implies, this type of regimen simplification involves substituting drugs in a current regimen for more effective drugs from a different class.
  • Reducing the Number of Active Drugs in a Regimen: This process involves switching a patient from a suppressive treatment plan to one containing fewer active drugs. The major motivation behind this approach stems from drug-related toxicity and lower overall treatment costs.

To summarize, there have been amazing innovations in the technology for prevention and treatment of HIV/AIDS.

 

Concluding Remarks

HIV/AIDS is a very serious sexually-transmitted infection. It is caused by a virus entering the body, taking over healthy white blood cells, compromising the immune system, and preventing the body from defending itself against bacteria, viruses, infections, and even cancers.

Some ways to prevent HIV/AIDS include abstinence, contraception, routine testing, communicating with one’s partner, PrEP, and PEP.

In addition, science and technology have paved the way for effective treatments such as ART. Sticking to a daily medication regimen has proved to relieve many of the symptoms of HIV/AIDS, improve the lives of many people, and reduce the transmission and infection of HIV/AIDS.

 

References

  1. “Stages of HIV Infection | HIV Risk Reduction Tool | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention.
  2. CDC. “What Are HIV and AIDS?” HIV.gov, 21 Feb. 2018.
  3. Parenthood, Planned. “What Is HIV / AIDS & How Do You Get It?” Planned Parenthood.
  4. “PrEP for HIV/AIDS.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Aug. 2018.
  5. “PEP for HIV/AIDS.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Aug. 2018.
  6. “HIV Treatment: The Basics Understanding HIV/AIDS.” National Institutes of Health, U.S. Department of Health and Human Services, 22 Mar. 2018.
  7. 7. Cottrell, Mackenzie L., et al. "A Translational Pharmacology Approach to Predicting Outcomes of Preexposure Prophylaxis Against HIV in Men and Women Using Tenofovir Disoproxil Fumarate With or Without Emtricitabine."Journal of Infectious Diseases 214.1 (2016): 55-64.
  8. TenoRes Study Group. "Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: a multicentre retrospective cohort study." The Lancet Infectious Diseases 16.5 (2016): 565-575.
  9. Ralph, Lauren J., et al. "Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies." The Lancet Infectious Diseases 15.2 (2015): 181-189.
  10. "HIV/AIDS Fact Sheet." World Health Organization. World Health Organization, July 2016. Web. 11 Oct. 2016.

Last Updated: 24 October 2018.

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