More than 35 million people are living with HIV/AIDS worldwide. This disease is an epidemic that affects other countries differently. For example, the prevalence of HIV in the Eastern and Southern Africa is high. These regions make up almost 50 percent of the total number of people living with HIV in the world. Access to HIV care in these parts of the world are scarce, leaving their population without much protection and an increasing number of new infections.
Other countries like Europe and Central Asia have seen a recent a drastic increase of new infections. Within the past couple of years, these regions saw a 57 percent increase in annual new HIV infections. Overall, there are 1.5 million people who live with HIV in Europe and Central Asia. To curb this rise, the European Centre for Disease Prevention and Control (ECDC) evaluated their method for combating HIV.
The Continuum of HIV Care
The ECDC developed a framework called the continuum of HIV care, which monitors the success of their HIV response. This framework involves looking at data from over 48 countries across Europe and Central Asia. The ECDC’s most recent report, the ECDC Dublin Declaration, looks at four aspects of HIV prevention, which it categorizes into stages:
- S1 – The estimated number of all people who live with HIV (PLHIV).
- S2 – The number of all PLHIV who have a diagnosis.
- S3 – The number on PLHIV who have a diagnosis and who are on ART.
- S4 – The number of PLHIV on ART who show signs of viral suppression.
The ECDC’s Findings
The ECDC saw an increase in the number of countries reporting data on all four stages of the continuum, from 40 percent to 66 percent. As more countries participate in the continuum, the ECDC can develop a better analysis of the state of HIV. Here’s the breakdown of their findings:
- 37 countries from Europe and Central Asia reported data for both Stage 1 and Stage 2.
- An estimated 1,199,000 people live with HIV, and 75 percent of those individuals have received a diagnosis.
- 1 in 4 people with a diagnosis is not receiving treatment for the disease.
- 31 countries from Europe and Central Asia reported data for both Stage 3 and Stage 4.
- 599,500 people with a diagnosis are using antiretroviral drugs, and only 88 percent show signs of viral suppression.
What the ECDC Learned
Efforts to monitor and predict the spread of HIV is only as great as the number of countries participating. As a result, the ECDC has trouble estimating the number of people living with HIV (Stage 1) and those who are virally suppressed (Stage 4). The organization hopes to support countries in using their modeling tool to develop better estimates of who has HIV and how many people show signs of viral suppression.
With more data, the ECDC can identify which countries need help fighting the infection, as well as improve testing, treatment, and HIV care. Hopefully, efforts by organizations like the ECDC and UNAIDS will be able to slow down and reverse the spread of HIV.
Nothing is more important than getting tested for HIV as soon as possible. If you test positive, an early diagnosis can increase your chances of managing the virus. Early HIV intervention is a crucial step in protecting your health. HIV can be a tricky disease that likes to hide. This makes the virus difficult to treat before it attacks the immune system.
In a study to better control the disease’s progression within the body, the Rockefeller University tested and treated monkeys infected with an HIV-like virus. Find out the results of their research and what this could mean for patients with HIV.
New Form of HIV Therapy
The Rockefeller University and the National Institute of Health wanted to find a way to tackle HIV while it lays dormant within the body. The virus often hides like this to avoid being eradicated. It waits for the perfect opportunity, like when treatment is interrupted, to attack the immune system.
Using macaque monkeys and a model of HIV, the researchers were able to simulate the effects of the HIV virus in humans. 13 monkeys were tested over a two-week period of they were injected with the virus. While the model, which is known as the simian-human immunodeficiency (SHIV), is not a 1 to 1 recreation of the virus, it helps explore ways to control the virus.
The new treatment uses two anti-HIV antibodies to give a boost to the immune system. These antibodies were discovered in individuals with a rare ability to fight the infection. New drugs (3BNC117 and 10-1074) were developed and they enable the body to take control of the virus and hold off its effect for a long period of time. However, the researchers suggest that this all works because the treatment was given soon after infection.
“This form of therapy can induce potent immunity to HIV, allowing the host to control the infection,” says Michel Nussenzweig, head of the Laboratory of Molecular Immunology and an Investigator with the Howard Hughes Medical Institute. “It works by taking advantage of the immune system’s natural defenses, similar to what happens in some forms of cancer immunotherapy.”
The Success of Early HIV Intervention
The monkeys showed significant improvement after taking the new drugs. After treatment was initially given, HIV levels dropped until they were nearly undetectable. The positive progress of the subjects continued 5 to 22 months later as the monkey regained control of the virus. The virus then dropped again and stay at low levels for another 5 to 13 months.
Further studies need to be done to see if this treatment is feasible in humans. During the study, the scientists also investigated cytotoxic T cells. When they decreased these cells in the monkeys’ bodies, SHIV levels increased. It proved that these cells may have helped the monkeys fight off the virus.
Their next test is to see if the drugs are still effective after long-term infection and without early HIV intervention. They are going to have the monkey exposed to the virus for about two to six weeks before treating them. Hopefully, the results will remain positive.
HIV is a worldwide epidemic. From country to country, the virus has a significant impact. This makes it harder to provide the resources to fight against the virus. In sub-Saharan Africa, there were 24.7 million people living with HIV in 2013. Even worse, the number of new HIV infections are up to 1.5 million. Only 39% of adults receive antiretroviral treatment.
There are several key groups affected by HIV within this region of the world. Unfortunately, research has shown that many of the countries in Africa, mainly Southern Africa, are the worst affected by the disease. The government continues to encourage and offer more testing for the population but many individuals are unaware of their status, leaving the country at continued risk.
The groups who are the most at risk included young women, children, sex workers, men who have sex with men, and drug users. There are several factors putting these groups in danger. Condom distribution varies from country to country. It is also not uncommon to find younger women in relationships with older men. More than 4 in 10 new infections are young women around the 15-24, who are participating in unsafe sexual behavior.
Hypertension and Living With HIV
A new problem has risen in the region of sub-Saharan Africa. Scientists are discovering a high prevalence of hypertension among rural Africans. New research reveals that about 12 percent of people living with HIV in Tanzania have hypertension when they are diagnosed. Furthermore, an additional 10 percent of the population will develop Hypertension during the first months of antiretroviral therapy.
Tanzania has approximately 1.4 million people living with the virus. However, the country has done well to curb the spread of disease. New infection dropped by more than 20% between the years of 2010 and 2015. This is due in part to the increase of antiretroviral drugs in the area.
The researchers note that the development of hypertension in these patients is likely in relations to normal cardiological risk factors like age, body mass index, and renal function. The effect that antiretroviral drugs have on the body may play a role, though.
How Scientists Plan to Address the Issue
The prevalence of HIV and hypertension is 1.5 times higher than both Europe and the United States. This is trouble for a region that is already dealing with this epidemic. Dr. Emilio Letang, Swiss TPH and Barcelona Institute for Global Health (ISGlobal) has a few suggestions to combat the combination of both conditions.
“We have seen that such routine screening is a feasible and effective strategy to diagnose hypertension within an HIV programme. Moving forward, however, we need to make sure that leveraging such synergies does not compromise the efficiency of existing HIV programmes,” says Dr. Emilio.
Prof. Dr. Christoph Hatz, Chief Medical Officer at Swiss TPH continues by stating that “In many countries across sub-Saharan Africa, there is still a lack of access to drugs against major non-communicable diseases. In order for such integrated care programmes to work successfully, ensuring better availability and affordability of drugs as well as implementing comprehensive preventive and curative measures will be key.”
Drugs are often a double-edged sword. While their purpose is to cure or alleviate symptoms caused, many of them come with complications. This is often the case with drugs for severe conditions such as HIV drugs.
Furthermore, HIV is one of the most troublesome diseases in the world. Medications help fight off the virus but they can also have adverse effects on the body. One of the most common drugs for HIV is abacavir. The side effects of this drug are rare but a certain portion (5 to 8 percent) of patients do experience an intense allergic reaction to it.
Abacavir is known to cause hypersensitivity syndrome. This is a life threating reaction which can cause fever, rash, nausea, vomiting, diarrhea, and abdominal pain. If patients have a particular human leukocyte antigen (HLA), these symptoms usually appear within the first two to six weeks of taking the HIV drug.
The HLA protein is a substance that induces an immune response. These proteins are located on the surface of a cell and often communicate with T-cells. If an entity other than a co-binding peptide binds to an HLA protein and changes it, the protein will deem it foreign. This signals the T-cells, and cause an immune response. Often, the abacavir drug appears as an unknown entity when it tries to bind to the cells.
Researchers Take a Closer Look at HIV Drug
A test was performed at North Carolina State University. Researchers used a computer model to get a closer look at the abacavir drug reaction on a molecular level. They wanted to see the drug’s interaction with the HLA proteins.
“There are 15,000 variants of HLA, and everyone carries some of these variants,” says Denis Fourches, assistant professor of chemistry at NC State. “HLA-B*57:01 is one of the first variants studied in the context of a drug-induced immune reaction. We know that it binds with abacavir, but little was understood about exactly what was happening structurally at the molecular level, especially in terms of the relationship with the co-binding peptide. This is a very complex system.”
The computer was able to create 3D models of the HLA protein, abacavir, and the co-binding peptides. Researchers simulated the docking process with and without co-binding peptides. They also ran simulations of the process with 13 other HIV drugs that have similar effects.
“The models allowed us to identify key atomic interactions that cause abacavir and other drugs to bind to the HLA variant protein and ultimately trigger the immune response,” Fourches says. “When you can forecast and understand the elements of the drug that enable the binding to occur, you may be able to create new active compounds that do not have that problem.”
The research team at NC state hopes that his in-depth look at binding process will provide them a better understanding of how the immune system reacts to drugs. With this knowledge, they can predict the side effects of medications. In the future, they can also build better drugs. Hopefully, they will avoid life-threatening situations.
The advancements in HIV treatment have made it easier to stall the progression of the virus. However, a new study suggests that the news of these treatments is having an unintended consequence. More gay men are engaging in risky behavior because they believe that antiretroviral medicines will keep them safe. However, the continuation this kind of behavior only increases their risk despite taking proper prevention methods.
The Risk to Gay Men
Gay Men are already more likely to contract HIV than others. In 2015, gay and bisexual men accounted for 67 percent of all new diagnoses. Anal sex is the highest risk factor for HIV transmission. Receptive anal sex puts more men at risk than insertive anal sex. This is because of the rectums thin lining, which allows HIV to enter the body more easily. The transmission of HIV can happen from semen or pre-seminal fluid.
The Danger of Relying Solely on Medicinal HIV Treatment
Study leader Seth Kalichman of the University of Connecticut and his team analyzed a survey spanning 19 years. Participants at a gay pride event noted their sexual habits. Here is what they found:
- An increase in condomless sex among men.
- A rise in the number of sexual partners that men engaged with.
- Condomless receptive anal sex has doubled in HIV-negative men.
- Condomless insertive anal sex has tripled in HIV-negative men.
We are seeing a considerable increase in unsafe sex because gay men perceive antiretroviral drugs to be enough. However, after looking at the survey data, they found there wasn’t much of a reduction of new HIV infections in major cities. In fact, certain countries with HIV testing programs and antiretroviral drugs have seen infection grow among gay men. The risk remains when unsafe behavior increases.
Kalichman concludes that “The current study adds to the mounting evidence that substantial changes have occurred in community-held beliefs that condomless anal sex is safer in the era of HIV treatment as prevention.”