Today’s post is by “Obi,” a Nigerian doctor conducting his field experience at Planned Parenthood as part of his MPH program. He was a general practitioner in his home country with main interest and expertise in maternal and child health.
Since the discovery of Human immunodeficiency virus (HIV) as the cause of Acquired Immune Deficiency Syndrome (AIDS) in 1983, it continues to pose a huge threat worldwide to the health of millions of people. Data from the World Health Organization (in 2013) revealed that worldwide 35 million people were living with HIV, there were 2.1 million new cases and 1.5 million deaths.
The development of multi-drug combination therapy known as Highly Active Antiretroviral Therapy (HAART) for treatment of HIV/AIDS in 1996 was one of the major successes of modern medicine leading to a dramatic drop in the death rate by 50 to 80% between 1996 and 2006. This period is known as “the decade of HAART.” This changed the view of HIV/AIDS from a fatal and catastrophic disease to what is now a manageable chronic illness.
After this initial success, the next step was to find a cure and/or an effective preventive method. Currently the best way to avoid HIV/AIDS is to take conscious steps to avoid contracting the virus in the first place. This has been the aim of a lot of efforts all around the world teaching safe sexual health practices and healthy lifestyle behaviors. However, changing human behavior is quite difficult.
Due to the rapid and constant mutation of HIV, the human immune system finds it very difficult to defend against it and scientists have found developing an effective vaccine very problematic. Also, HIV is able to create reservoirs in its hosts leading to latency of the disease, which is the main reason HAART can’t eliminate the virus but only reduce its load in the human body to very low levels. For this reason HIV positive patients are unable to stop HAART therapy to avoid dramatic increase in their viral load.
Despite all these issues, promising advances in therapy are being made. Drugs like Prostratin, which are able to reactivate latent HIV and therefore increase the effectiveness of HAART therapy, are being developed. There are also a small group of people who are known to be immune to HIV due to the absence of the cell receptor necessary for HIV to infect cells known CCR5. This knowledge was used in the case of Timothy Ray Brown, the first case of a cured HIV positive patient. Although the therapy used on Timothy is very risky and expensive and therefore can’t be applied on a large scale, it has given researchers ideas on how to modify a patient’s immune system to resist HIV.
Continuing research in this field, including various promising results from numerous clinical trials show that there is hope for an effective cure for HIV. Tests in the lab have shown promise at a cellular level and the aim is to replicate these results at the macro level. This process may take years but with each passing year we get a better understanding of the virus and the disease mechanisms which would bring us closer to developing a cure and possibly a vaccine. Until then, maintaining a healthy lifestyle approach and engaging in healthy sexual behaviors (using condoms) will be the mainstay of HIV prevention.