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The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs in an attempt to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same sex and opposite sex partners so long as the HIV-positive partner maintains an undetectable viral load.
The spread of HIV/AIDS has affected millions of people worldwide; AIDS is considered a pandemic. The World Health Organization (WHO) estimated that in 2016 there were 36.7 million people worldwide living with HIV/AIDS, with 1.8 million new HIV infections per year and 1 million deaths due to AIDS. Misconceptions about HIV and AIDS arise from several different sources, from simple ignorance and misunderstandings about scientific knowledge regarding HIV infections and the cause of AIDS to misinformation propagated by individuals and groups with ideological stances that deny a causative relationship between HIV infection and the development of AIDS. Below is a list and explanations of some common misconceptions and their rebuttals.
Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.
The AIDS Clinical Trials Group network (ACTG) is one of the largest HIV clinical trials organizations in the world, playing a major role in setting standards of care for HIV infection and opportunistic diseases related to HIV and AIDS in the United States and the developing world. The ACTG is composed of, and directed by, leading clinical scientists in HIV/AIDS therapeutic research. The ACTG is funded by the Department of Health and Human Services, National Institutes of Health through the National Institute of Allergy and Infectious Diseases.
Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV). Following initial infection a person may not notice any symptoms, or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged period with no symptoms. If the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumors which are otherwise rare in people who have normal immune function. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS). This stage is often also associated with unintended weight loss.
The HIV Prevention Trials Network (HPTN) is a worldwide collaborative clinical trials network that brings together investigators, ethicists, community and other partners to develop and test the safety and efficacy of interventions designed to prevent the acquisition and transmission of HIV. HPTN studies evaluate new HIV prevention interventions and strategies in populations and geographical regions that bear a disproportionate burden of infection. The HPTN is committed to the highest ethical standards for its clinical trials and recognizes the importance of community engagement in all phases of the research process.
Lawrence Corey is professor of Medicine and Laboratory Medicine at the University of Washington, a member of the Vaccine and Infectious Disease Division and past president and director of Fred Hutchinson Cancer Research Center in Seattle, Washington. He also serves as the founding director and co-principal investigator of the HIV Vaccine Trials Network. The American physician-scientist is an internationally recognized expert in virology, immunology and vaccine development. His discoveries over the past 30 years are cited as having deepened the understanding of both the pathogenesis and treatment of diseases caused by viruses, especially human immunodeficiency virus (HIV) and herpes viruses. Corey has pioneered some of the most significant advances in the creation of safe and effective antivirals for herpes viruses and HIV, the testing of experimental vaccines for HIV and genital herpes, and the designing of new methods for diagnosing and monitoring therapies for viral infections.
HIV and AIDS is a major public health issue in Zimbabwe. The country is reported to hold one of the largest recorded numbers of cases in Sub-Saharan Africa. According to reports, the virus has been present in the country since roughly 40 years ago. However, evidence suggests that the spread of the virus may have occurred earlier. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.
With an estimated 150,000 people living with HIV/AIDS in 2016, Haiti has the most overall cases of HIV/AIDS in the Caribbean and its HIV prevalence rates among the highest percentage-wise in the region. There are many risk factors groups for HIV infection in Haiti, with the most common ones including lower socioeconomic status, lower educational levels, risky behavior, and lower levels of awareness regarding HIV and its transmission. However, HIV prevalence in Haiti is largely dropping as a result of a strong AIDS/HIV educational program, support from non-governmental organizations and private donors, as well as a strong healthcare system supported by UNAIDS. Part of the success of Haiti's HIV healthcare system lies in the governmental commitment to the issue, which alongside the support of donations from the Global Fund and President's Emergency Plan For AIDS Relief (PEPFAR), allows the nation to prioritize the issue. Despite the extreme poverty afflicting a large Haitian population, the severe economic impact HIV has on the nation, and the controversy surrounding how the virus spread to Haiti and the United States, Haiti is on the path to provide universal treatment, with other developing nations emulating its AIDS treatment system.
HIV prevention refers to practices that aim to prevent the spread of the Human Immunodeficiency Virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.
Myron Scott Cohen is an American physician-scientist who has made substantial contributions to our understanding of the transmission prevention of transmission of HIV. He is best known as chief architect of HIV Prevention Trials Network 052, a large-scale randomized clinical trial which demonstrated proof-of-concept for “treatment as prevention”: treating an HIV-infected person with antiviral drugs makes them less contagious and prevents transmission to their sexual partners. Cohen is J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology, and Epidemiology at the University of North Carolina at Chapel Hill. He is also co-chair of the National Institutes of Health's HIV Prevention Trials Network.
Cabotegravir is an investigational new drug under development for the treatment of HIV infection. It is an integrase inhibitor, with a carbamoyl pyridone structure similar to dolutegravir. In investigational studies, the agent has been packaged into nanoparticles (GSK744LAP) conferring an exceptionally long biological half-life of 21–50 days following a single dose. In theory, this would make possible suppression of HIV with dosing as infrequently as once every three months.
Julio S. G. Montaner, is an Argentine-Canadian physician, professor and researcher. He is the director of the British Columbia Centre for Excellence in HIV/AIDS, the chair in AIDS Research and head of the Division of AIDS in the Faculty of Medicine at the University of British Columbia and the past-president of the International AIDS Society. He is also the director of the John Ruedy Immunodeficiency Clinic, and the Physician Program Director for HIV/AIDS PHC. He is known for his work on HAART, a role in the discovery of triple therapy as an effective treatment for HIV in the late 1990s, and a role in advocating the "Treatment as Prevention" Strategy in the mid-2000s, led by Myron Cohen of the HPTN 052 trial.
HIV in pregnancy is the presence of HIV in a woman while she is pregnant. HIV in pregnancy is of concern because women with HIV/AIDS may transmit the infection to their child during pregnancy, childbirth and while breastfeeding. However, the risk of mother-to-child transmission of HIV may be reduced by treatment of the HIV infection with antiretroviral therapy (ART). This lifelong therapy may be initiated in women before, during, and after pregnancy. After delivery, children are also given the medication temporarily as a prophylactic measure to reduce the risk of infection. Because HIV may also be spread through breast milk, mothers in the United States who are infected are encouraged to avoid breastfeeding. However, in developing countries such as South Africa, where the risk of death of the infant associated with avoiding exclusive breastfeeding is higher than the risk of contracting HIV, exclusive breastfeeding in a mother who is virally suppressed is encouraged.
Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, death and transmission was first proposed in 2000 by Garnett et al. The term is often used to talk about treating people that are currently living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) to prevent illness, death and transmission. Although some experts narrow this to only include only preventing infections, treatment prevents illnesses such as tuberculosis and has been shown to prevent death. The dual impact on well being and its 100% effectiveness in reducing transmission makes TasP the most important element in the HIV prevention toolkit. In relation to HIV, antiretroviral therapy (ART) is a three or more drug combination therapy that is used to decrease the viral load, or the measured amount of virus, in an infected individual. Such medications are used as a preventative for infected individuals to not only spread the HIV virus to their negative partners but also improve their current health to increase their lifespans. Other names for ART include highly active antiretroviral therapy (HAART), combination antiretroviral therapy (cART), triple therapy and triple drug cocktail. When taken correctly, ARVs are able to diminish the presence of the HIV virus in the bodily fluids of an infected person to a level of undetectability. Undetectability ensures that infection does not necessarily have an effect on a person's general health, and that there is no longer a risk of passing along HIV to others. Consistent adherence to an ARV regimen, monitoring, and testing are essential for continued confirmed viral suppression. Treatment as prevention rose to great prominence in 2011, as part of the HPTN 052 study, which shed light on the benefits of early treatment for HIV positive individuals.
Viral load monitoring for HIV is the regular measurement of the viral load of individual HIV-positive people as part of their personal plan for treatment of HIV/AIDS. A count of the viral load is routine before the start of HIV treatment.
Diane Havlir is a Professor of Medicine and Chief of the HIV/AIDS Division at the University of California, San Francisco. Her research considers novel therapeutic strategies to improve the lives of people with HIV and to support public health initiatives in East Africa. She was elected to the National Academy of Medicine in 2019.
Kimberly A. Powers is an American epidemiologist who is an associate professor of epidemiology at the UNC Gillings School of Global Public Health. She combines epidemiology, statistics and mathematical modelling to understand the transmission of infectious diseases. In 2011 her work on antiretroviral therapy for the management of human immunodeficiency virus was selected by Science as the breakthrough of the year. During the COVID-19 pandemic, Powers looked to understand the spread of SARS-CoV-2.
Sarah Fidler is an immunologist, researcher and professor in HIV Medicine at Imperial College London and consultant physician in HIV for St Mary's Hospital, London.
The Swiss Statement, or the Swiss Consensus Statement, was an announcement published in January 2008 by the Swiss Federal Commission for AIDS/HIV outlining the conditions under which an HIV-positive individual could be considered functionally noncontagious. While lacking the backing of complete, fully randomized clinical studies, the Commission felt the contemporary evidence for non-contagiousness for people on antiretroviral treatment was nonetheless strong enough to warrant official publication. The Statement generated significant controversy, with some defending it as based on adequate existing scientific evidence and as beneficial for people with HIV, and others maintaining that it was misleading and promoted risky sexual practices.
References
- 1 2 3 4 5 6 7 8 Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. (August 2011). "Prevention of HIV-1 infection with early antiretroviral therapy". The New England Journal of Medicine. 365 (6): 493–505. doi:10.1056/NEJMoa1105243. PMC 3200068 . PMID 21767103.
- ↑ Matassa M (May 12, 2011). "Initiation of Antiretroviral Treatment Protects Uninfected Sexual Partners from HIV Infection (HPTN 052)" (PDF). Archived from the original (PDF) on January 11, 2012. Retrieved January 3, 2012.
- ↑ "Q&A: The HPTN 052 Study: Preventing Sexual Transmission of HIV with Anti-HIV Drugs". www.niaid.nih.gov. Retrieved 2015-12-21.
- ↑ Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. (September 2016). "Antiretroviral Therapy for the Prevention of HIV-1 Transmission". The New England Journal of Medicine. 375 (9): 830–9. doi:10.1056/nejmoa1600693. PMC 5049503 . PMID 27424812.
- ↑ "HPTN 052 HIV Prevention Study Demonstrates Sustained Benefit of Early Antiretroviral Therapy" (PDF). July 20, 2015. Archived from the original (PDF) on February 22, 2016. Retrieved December 21, 2015.
- 1 2 Cohen MS, McCauley M, Sugarman J (June 2012). "Establishing HIV treatment as prevention in the HIV Prevention Trials Network 052 randomized trial: an ethical odyssey". Clinical Trials. 9 (3): 340–7. doi:10.1177/1740774512443594. PMC 3486723 . PMID 22692805.
- ↑ Cohen J (December 2011). "Breakthrough of the year. HIV treatment as prevention". Science. 334 (6063): 1628. doi: 10.1126/science.334.6063.1628 . PMID 22194547.