As HIV prevention, testing and treatment continue to advance, HIV positive patients on a treatment plan remain healthier, living longer lives. As new information pours in, researchers scramble to further progress their understanding and approach to the disease. Methods used to slow disease progression and curb mortality rates are proving more and more successful. Yet, in spite of such advances, the struggle with HIV is still a slow, tragic war. Why might you ask?
What Is Holding Us Back from Defeating HIV?
More cases are reported every year, and it is estimated that millions have the infection without knowing it. Herein lies the danger. Those unaware HIV carriers often infect others. Spreading of the virus is one of the major roadblocks to its eradication.
Why Individuals Avoid Testing
Studies on why so many people with HIV refuse testing or treatment have come to a simple conclusion: fear. Fear is helping HIV survive the war. Whether it’s fear of the disease or the associated social stigmas, it remains the number one reason people do not get tested.
The psychology behind the behavior needs to change. Any chronic condition carries with it a strong measure of fear. HIV is no exception. However, those advances mentioned earlier are reason for hope. Hope supported by reality. Today, HIV testing can be performed at home. If the result is positive, treatments are available. What once arrived with a death sentence is now a treatable condition. Slowing the progression from HIV to AIDS is now a regular occurrence. HIV positive people can enjoy a long life and enjoy a full and happy one too. And more than every the public needs to understand this new chapter in the war on HIV.
Courage Reaps Benefits
Fear of a diagnosis is no reason to put off testing. Hope lives. Fear kills. Early detection leads to more positive outcomes, like HIV prevention, and management of the viral infection. This is the message healthcare professionals encourage. Educating the public on the facts, rather than the fears of HIV, saves lives, prevents future infections, and will help us to one day eliminate the virus for good.
The trends of social media have changed how, and how quickly, information becomes publicly known. Social media can now tell us things like where the next fashion, music, and entertainment movements will occur, along with which regions of the United States are more likely to love something that other regions will hate. One application of the information now available through social media is to map out the spread of diseases such as influenza and strands of the common cold. This application could lead to more sophisticated ways of stopping the spread of HIV, by using social media to track and possibly halt further infection.
Sean Young, at the Center for Digital Behavior at the University of California, Los Angeles, published an article this past October dealing with a possible future, where social media can predict and even change biomedical outcomes. This translates into being able to chart, predict, and maybe even ebb the transmission of preventable infectious diseases, like HIV. Social media information, such as Twitter tweets and Facebook posts, which shows the recent – or eminent – drug and sexual related activities associated with the risk of infection, can be collected and cross-referenced with known information on HIV. In addition to education of what activities and what areas are at the highest risk of infection, this cross-referencing can help medical researchers find focal points to make testing more available. It can also help researchers make the availability of treatment an easier possibility for those getting tested and learning they’re HIV positive. Surveys are also showing that those who post about this topic, or who read about HIV through their online communities, are more likely to get themselves tested.
A cautionary tale for many is that the collection of this data is done the same way corporations are currently taking information in an attempt to raise profits. This type of marketing has created a major backlash from those who fear for their privacy. Sean Young has an answer to this caution: “Since people are already getting used to the fact that corporations are doing this, we should at least support public health researchers in using these same methods to try and improve our health and well-being.” He further added, “We’re already seeing increased support from patients and public health departments.” Young hopes that a more general acceptance of this type of data collection by medical researchers will follow suit. He, like many, believes that social media and other modern technologies are the key to stopping the spread of HIV in the future.
The human immunodeficiency virus (HIV) has the ability to attach its DNA to the host’s immune system’s DNA and manipulate the host cells to continue its replication process. This ultimately kills the affected cells, destroying the host’s immune system along the way. Researchers had long ago discovered that the HIV protein integrase is responsible for the HIV’s cell’s ability to attach itself to a host cell’s DNA, but for over twenty years they were not able to learn how this process actually happened. New discoveries into this process have shown that new HIV therapies are possible, because they are now attempting to retarget the entry points of the initial HIV cells, and thus weaken the virus’s ability to replicate so rapidly.
Researchers at KU Leuven’s Laboratory for Molecular Virology and Gene Therapy have learned that two amino acids are responsible for the integrase’s integration of the viral DNA to the host DNA. “HIV integrase is made up of a chain of more than 200 amino acids folded into a structure,” says Jonas Demeulemeester, one of the doctoral researchers working on this project. These amino acids, which are all folded in on each other, manipulate themselves in such a way that only two of the amino acids come into direct contact with the host’s DNA, and this becomes the initial entry point of the HIV cell.
The process of how HIV links to a host cell’s DNA is similar to related animal-borne viruses. Using this model to look at the animal-borne viruses, the researchers were able to learn that by manipulating and re-targeting the amino acids that make up the integrase they can cause the HIV cells to enter the host’s DNA at variant points. They learned that some entry points are more susceptible to a rapid replication and destruction of the host cells, and at the same time there are “safer” entry points of the host’s DNA which cause for a very slow and manageable reproduction rate of the viral cells. Now possible new HIV therapies exist because of this discovery, as we can now target the individual amino acids within the viral DNA, hopefully manipulating them into extinction.
Imagine you start to show signs of possible HIV infection: your skin color changes, your immune system is visibly weaker than ever before, and a flu-like feeling just won’t go away. You go to your trusted healer, the traditional healer your family has seen for years, decades, possibly generations. Now, imagine this traditional healer tells you that these symptoms are not due to a blood-borne virus infecting your body, but by a curse a neighbor has placed upon you and your family. His or her treatment will not recommend antiretroviral medications, but to chant incantations and rub medical herbs into an open cut made from a razor. Although this is not heard of as a practice in any area of the United States, no matter how rural, this type of traditional healing is still very common in rural areas of Mozambique and other sub-Saharan African countries. When these traditional healers speak of curses and angered ancestors as the causes for the HIV symptoms, there is an inevitable delay between the first signs of symptoms and the administration of the first antiretroviral medicines. Prolonging this crucial timeframe shows that these traditional healers can undermine efforts of modern HIV treatments, which can harm the patient in irreparable ways, possibly causing the individual to develop AIDS before receiving the medicine he or she needs.
A study led by Carolyn Audet, Ph.D., an assistant professor of Health Policy, focused on sub-Saharan African countries. Over 60% of the rural residents in this study who started showing symptoms of HIV infection visited at least one traditional healer before consulting a trained medical professional, sometimes seeing several healers before any doctors. This caused, on average, a two-and-a-half-time longer delay for receiving the needed medicine, as over 50% of those who saw traditional healers first were initially diagnosed with having a curse placed upon them. With countries like Mozambique having over ten percent of its population infected with HIV (in the US it is roughly 0.6%), mistreatment has become an epidemic of serious concern. These delays can undermine efforts of modern HIV treatments, as many traditional healers are resistant to incorporating Western medicine into their religious and healing practices, which can seriously harm or even cause the preventable death of patients before receiving life-saving antiretroviral medicines.
HIV, like most viruses, evolves continually and at a rapid pace. Its process of replication is through constant mutation, so HIV cells can generate thousands of mutations of themselves. Some mutations die off before they take control over the virus cells of a host body, and some mutations become a dominant factor in the local virus population. Mutations that help the cells survive the longest have the best chance of dominating, and although some believe this may make HIV a stronger virus over time, there is evidence now emerging that shows the possibility that HIV may evolve – eventually – into a weaker, more treatable, and possibly ineffective virus.
The research showing this new evidence comes out of Africa. Philip Goulder, from the University of Oxford, and his team of researchers looked at the HIV epidemics in Botswana and South Africa. The epidemic started in Botswana roughly ten years before it hit South Africa, so the researchers took blood samples from roughly 2,000 HIV positive women from these two countries to compare the DNA structures of the viruses in each population. HIV cells in infected Botswanan women had developed mutations which helped them evade the immune system. Although this sounds like a bad sign, the mutations – in helping the virus evade detection – crippled the virus in many ways. Mutations in the Botswanan women slightly slowed down the replication speed of the virus cells, causing a 10% decrease in replication time. This slight variation helped the women’s immune systems keep up with the virus for a few years longer, causing a longer period between initial infection and when the virus caused AIDS to develop (meaning the immune system had been compromised completely).
This mutation only occurred over 10 years between when Botswana had its HIV outbreak and when the HIV outbreak spread to South Africa, so in a relatively short amount of time (one decade), HIV naturally evolved into a weaker virus. Goulder, of the research team looking at these mutations, says, “HIV can generate any mutation in the book, on any day,” so he’s not surprised that big mutations like this could occur so quickly. This mutation changes the time that the virus causes AIDS in untreated infected individuals to go from roughly 10 years to 12.5 years, which could mean the difference of life and death for those awaiting treatment. These mutations are already showing researchers where to focus their attacks on the virus, possibly leading to the development of an effective HIV vaccine. And, with the virus already mutating in this fashion, HIV may evolve to the point where the virus never completely compromises the natural human immune system, and where the immune system alone could maintain and control the HIV virus indefinitely.