- However, HIV can be controlled with proper medical care, according to research. People with HIV who receive effective HIV treatment can live long and healthy lives.
- Treatment reduces the viral load (concentration of the virus in the blood), which not only protects the person from progressing to an advanced stage of the disease but also reduces the risk of the virus spreading to others.
- It is critical to get tested for HIV in the early stages of the infection to limit immune system damage.
- Successful treatment aims to reduce the HIV load to a level that is harmless to the body. Some of the viruses, however, may survive.
Trials to develop a safe and effective HIV cure are currently underway.
Why is HIV still not a curable disease?
Antiretroviral therapy can currently be used to treat HIV, but it only delays the onset of AIDS and does not provide a cure.
Three reasons why an HIV cure remains elusive include:
- Retrovirus and mutation:
- HIV is a retrovirus that transmits its genetic material through a single strand of RNA.
- The genetic material in HIV RNA is introduced into a living cell and transcribed into DNA by the enzyme reverse transcriptase, which then integrates into the host's DNA inside the nucleus.
- Once this occurs, the new viral DNA sequence can be transcribed into viral RNA, allowing the virus to spread throughout the body.
- Recent advances in evolutionary understanding have identified these frequent mutations as a major contributing factor in the immune system's failure to eradicate the virus. Furthermore, each mutation makes it more difficult for treatments to recognize the virus.
- The combination of the process and mutations results is one reason that HIV is exceedingly difficult to treat, let alone cure, with a single drug.
- T cells:
- Another major impediment in finding an HIV cure is the fact that HIV attacks CD4+ cells, also known as helper T cells.
- These T cells are critical for the proper functioning of the immune system.
- HIV impedes the immune system in two ways—by invading and then commandeering the cell for its viral purposes.
- It reduces the number of functional T cells (because HIV infects them), and it ruptures the cellular membrane, killing the cell.
- HIV takes advantage of the presence of T cells in the body to infiltrate the body.
- Without the protection of CD4+ T cells, the infected person is more likely to contract an opportunistic infection or a fatal form of cancer.
- Latent reservoirs:
- Not all HIV-infected cells are active at the same time. Some infected cells do not produce new copies of the virus during the early stages of HIV infection.
- As a result, latent, dormant HIV cells can persist in lymphoid tissues and other immune system reservoirs for months, if not years.
- Because these HIV-infected cells are not circulating in the blood, current antiretroviral treatments are unable to eliminate them.
- This is a problem for HIV patients because these cells can become active at any time. According to studies, this is the main barrier to curing HIV/AIDS.
According to recent research, HIV blocks a pathway and thus avoids the immune response designed to cure the viral infection. During a viral infection, our immune system produces a powerful molecule called interferon that inhibits virus infection and replication.
Interferon activates an assembly line of molecules in our cells through the interferon signaling pathway, causing the body to produce antivirals that aid in infection clearance. However, HIV inhibits the interferon signaling pathway in some way.
As a result, when patients receive antiretroviral therapy, our immune system does not completely clear HIV.
How can a person get HIV?
Human immunodeficiency virus (HIV) has only one function to replicate itself.
When HIV enters a person’s bloodstream, it seeks out and infects immune cells with its genetic code. It hijacks these cells, first converting them into factories that produce more copies of the virus, and then kills them.
Although these HIV-hijacked immune cells are busy replicating the virus, they are unable to perform their primary function, which is to protect the body from other viruses, bacteria, and infections that can cause illness. HIV weakens the immune system to the point where it can no longer fight off other illnesses.
Mode of transmission
Two things must come into contact with each other for HIV to spread from one person to the next:
- A bodily fluid that contains live HIV
- Direct access to a person's bloodstream (port of entry)
Common entry points into a person's bloodstream include:
- An unusual opening in the skin such as a cut or puncture wound
- A mucous membrane such as the vagina or anus
The following body fluids potentially contain an infectious amount of HIV:
- Breast milk
- Rectal fluid
- Vaginal fluid
A person can potentially get HIV through the following:
- Anal sex
- Injecting drugs with shared needles or other equipment used to share drugs
- Vaginal sex
What are the symptoms of HIV?
The symptoms of the human immunodeficiency virus (HIV) are described below:
This phase, also known as a primary infection, typically occurs a few days to a few weeks after a person is exposed to HIV.
Symptoms of acute HIV infection usually go away on their own after a few days or weeks, roughly the same amount of time it takes to recover from a cold or flu.
Many people go through this acute stage of HIV infection with no symptoms at all.
- Chronic infection can last a decade or more if HIV treatment is not started and indefinitely if HIV medications are taken.
- During the chronic HIV infection phase, a person may have no symptoms. This is because HIV slowly degrades the immune system over time.
- If the virus is not treated, it will continue to take over and destroy the immune cells, transforming them into HIV factories.
- When a person begins HIV treatment, the medications prevent HIV from replicating itself. This allows the immune system to recover or, if treatment is initiated early enough after exposure, to avoid the majority of the damage that can be caused by HIV.
A person on treatment for HIV can remain in the chronic stage indefinitely. Because of HIV medications, many people with HIV have a lifespan that is comparable with those who do not have HIV.
Advanced HIV disease
When people with HIV go without HIV treatment for an extended period (usually 10 years or more), they usually enter the advanced infection phase, which can be fatal. This is the stage at which an individual is diagnosed with acquired immunodeficiency syndrome (AIDS).
Symptoms of advanced HIV disease vary greatly because HIV is not usually the cause of symptoms. Instead, those symptoms are caused by another infection or disease that has taken root in the body due to the immune system's inability to protect it.
Common signs and symptoms include:
- Kaposi's sarcoma is a type of cancer caused by a virus that can affect the skin, stomach, and lungs.
- Meningitis is a swelling around the brain caused by viruses, bacteria, or fungi.
- Thrush (also known as candidiasis) is a fungal infection of the mouth and throat that causes pain when swallowing.
- In wasting syndrome, people lose more than 10 percent of their body weight.
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How is HIV diagnosed?
After a person is exposed to HIV and decides to be tested, the doctor then requests several of the listed tests at regular intervals to monitor the course of therapy.
- Antibody testing:
- Can miss very early HIV infection and should be repeated if there is a high risk of HIV infection
- P24 protein testing:
- Could be used to detect early HIV infection and is now used in most HIV screening tests as a combined antigen/antibody assay
- HIV western blot:
- Used to confirm an HIV infection when an antibody screening test is positive
- Multispot HIV-1/HIV-2 test:
- A rapid enzyme immunoassay was used for the detection and differentiation of HIV-1 and HIV-2 antibodies
- Viral load testing:
- Determines the amount of virus in a patient's bloodstream and is used to determine when to begin and track therapy and HIV progression
- CD4 T cell testing:
- Used to determine when to begin and monitor therapy, HIV progression, and immune system status
- Genotypic resistance testing:
- Used to determine whether a specific strain of HIV is resistant to the therapy a person is using and whether the therapy should be changed
AIDS was a very common and fatal syndrome in the 1980s and 1990s. There were few treatments available; medications that did exist required taking up to 20 pills per day, and many of them had serious side effects.
A person with HIV can now be on treatment that consists of taking only one pill per day, with few (if any) side effects, that keep their immune system healthy for decades.
Can we achieve an AIDS-free world?
People with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) now have more support and understanding although this is not universal. The life expectancy of people with HIV/AIDS has increased dramatically over time.
- Between 1988 and 1995, the death rate was 78 percent, but it fell to about five percent between 2005 and 2020.
- People with HIV can now expect to live normal lives if antiretroviral drugs are started early.
- They can expect to be able to live normal lives. The World Health Organization recommends that people infected with a virus should be given a cocktail of antiretroviral medications.
- Drugs such as tenofovir, emtricitabine, lamivudine, and efavirenz are used in combination to combat the patient's viral load or amount of virus in the body.
- According to research, HIV-positive people with undetectable viral loads do not spread the virus to others.
The Joint United Nations Programme on HIV/AIDS (the United Nations agency in charge of coordinating the global fight against the epidemic) emphasizes that although significant progress has been made, there is still much more to be done.
The next step for HIV researchers is to develop a reliable vaccine. Studies and tests are already underway. Although preliminary results are promising, there is no timetable for a widely available HIV vaccine.
Because of the way the virus replicates in the infected host's body, a cure may take time.
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10 Things to Know About HIV Suppression: https://www.niaid.nih.gov/diseases-conditions/10-things-know-about-hiv-suppression
Symptoms of HIV: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv
About HIV: https://www.cdc.gov/hiv/basics/whatishiv.html
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