The beginning of the AIDS crisis put a dark cloud over the sexual revolution. Few people knew much about it other than it was the “gay disease.” Now we know it starts with HIV (Human Immunodeficiency Virus) and is spread through bodily fluids. HIV affects CD4 cells (T-Cells) that are specific to the immune system. HIV can destroy so many CD4 cells the body loses the ability to fight off infections. At this stage HIV leads to AIDS (Acquired Immunodeficiency Syndrome). AIDS leads to a progressive failure of the body’s immune systems leaving it vulnerable to diseases and infections. Unlike other viruses, HIV never leaves your body and cannot be cured. So much has happened since the dark age of HIV ignorance to the age of enlightenment we have today. Let’s take a look at where we started, where we are today and what you can do to prevent it.
The 1970’s and 80’s
In the 70’s HIV makes its way to the United States. Doctors suspect various other illnesses until the early 1980’s. In 1982 this new disease is called AIDS. By 1984 they identify HIV (then known as HTLV-III or LAV) as the cause of AIDS. They would discover not only were gay men affected, it could be contracted through heterosexual sex, sharing contaminated needles and blood transfusions. The mid to late 1980’s saw discrimination of people with AIDS, famous people lost, projects like the AIDS quilt and the CDC’s first public service announcement. By the late 80’s AZT (azidothymidine) is being used to suppress the effects of HIV but its tendency to mutate makes it drug resistant. Trials are done on humans in a rush for a cure. Awareness and education about prevention starts to reduce the numbers of those affected. Early detection becomes an important factor, testing becomes a focus. By the end of the 80’s the US alone reaches 100,000 reported cases of AIDS.
People become resistant to AZT causing the number of AIDS cases to keep rising and it spreads faster worldwide. By the mid 90’s the CDC announces AIDS has become the leading cause of death in the US for those aged 25-44. They discover using several drugs together overcomes the resistance problem. This starts the development of HAART or Highly Active Antiretroviral Therapy. The number of new cases decreases for the first time and is no longer the leading cause of death in the US. Continuing to use a “hit early, hit hard” strategy, scientists work to develop a reliable way to manage HIV and prevent it from triggering AIDS. Antiretrovial (ART) drugs continue to be developed like nucleoside reverse transcriptase inhibitors (NRTI) that prevent transcription of HIV’s RNA to DNA so it can’t replicate itself, non-nucleoside reverse transcriptase inhibitors (NNRTI) which inhibits an enzyme that controls the replication of the RNA to DNA and protease inhibitors that block an enzyme to create a defective and less infections virus. New drug Combivir combines two drugs together making combined therapy easier and introduces the fixed-dose combinations still used today.
The New Millennium
The focus on managing HIV leads to infected people living longer lives. Improvements in testing help with early detection while more is learned about combining drugs to offset drug resistance. Worldwide HIV and AIDS are still widespread but there is a push to make the drugs more affordable and accessible to struggling countries. Domestically, steps are taken to improve access to testing and treatment for low- and middle-income people. HIV becomes a focus of the Global Health Initiative. The HIV travel and immigration ban is lifted. Integrase Inhibitors are developed which prevents the integration of viral DNA into the DNA of the infected cell. The first one a day pill is developed replacing the need to take several pills several times a day. As we head into the 2010’s a study finds that PrEp (pre-exposure prophylaxis) can help people with a higher risk of HIV exposure with a daily pill that could prevent HIV infection by preventing the virus from establishing a permanent infection. Post-exposure prophylaxis (PEP) has individuals taking a short course of antiretroviral medication to reduce their chances of being infected. About 1.1 million people were living with HIV by the end of 2010 and about 15,500 people with AIDS died in 2010 alone. It is estimated that about 50,000 people are infected with HIV in the United States every year.
Today and Beyond
Unfortunately, all treatments to cure HIV have failed so far, including gene therapy and the recent HPTN 052 trial that uses treatment as prevention. ARTs continue to be used by a majority of those eligible. By 2013 a UNAIDS study finds AIDS-related deaths are down 30% since their peak in 2005 but another study finds numbers are rising in adolescent AIDS-related deaths. Also in 2013 the first vaccine using a “dead” form of HIV-1 showed promise in its first clinical trials and further clinical trials are planned in 2014. This type of vaccine has been used for a variety of other diseases like cholera, polio, hepatitis A and others in the past, but had yet to prove itself in the use against the HIV-1 virus. There have also been reports that co-infecting a patient with GBV-C (the virus formally known at hepatitis G that does not cause the human disease) is thought to slow down the progression of HIV but there are too many variables for it to be conclusive. Attention is taken to the long term care of people living with HIV as they get older. They will have health issues specifically affected by their HIV status.
What You Can Do
Prevention starts with limiting your contact with potential contaminant like semen, blood, vaginal fluid and breast milk of an infected person. Unprotected sex with someone who has HIV puts you at risk so using condoms minimizes chances of infection. Learn to use a condom correctly for vaginal, anal and oral sex. You can’t get infected through hugs, shaking hands or touching an object they touched but it can be shared through cuts and sores in the mouth. If not in a relationship with a single partner, make sure to always share the last time you were both tested (every six months or more often if necessary) and your current status. Don’t share needles or equipment with others. Testing is important for pregnant mothers, as an HIV positive mother can infect their child through childbirth and breastfeeding. Blood transfusion and organ donor risk is minimal nowadays as testing is rigorous. If you are, or involved with, an HIV-positive partner, use condoms and avoid sharing anything that comes in contact with bodily fluids. An HIV-negative person can take PrEp medication to help prevent infection while a positive partner will find ART meds will help to reduce chances of transference. If you are HIV-positive taking medication consistently will ensure a longer healthier life. Talk to a health care professional about HIV regimen and other vitamins and supplements that might help. Check out websites like the CDC, AIDSinfo and others to learn more about protecting yourself. Awareness, education and consistence work on all accounts. Don’t forget, National HIV Testing Day is on June 27th.
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Follow on Twitter @Technogeisha