HIV is a virus that attacks cells in the immune system (the body’s natural defence against illness). The virus destroys a type of white blood cell in the immune system called a T-helper cell – also referred to as a CD4 cell – and uses these cells to make copies of itself. As HIV destroys more CD4 cells and makes more copies of itself, it gradually weakens a person’s immune system. This means that someone who has HIV, and isn’t taking treatment for it, will find it harder and harder to fight off infections and diseases.
If HIV is left untreated, it may take up to 10 or 15 years for the immune system to be so severely damaged that it can no longer defend itself. However, the rate at which HIV progresses varies depending on age, general health and background (Centre for Disease Control and Prevention (CDC) (2019) About HIV/AIDS). [Accessed July 2020].
Recent Research Results
Researchers found the earliest case of HIV in a blood sample of a man from the Democratic Republic of Congo. It’s said that the most common form of the virus spread from chimpanzees to humans sometime before 1931, most likely during “bush meat trading.” While hunting chimpanzees, hunters would have come in contact with animal blood. The earliest case of HIV & AIDS was confirmed in 1968 in North America. After intensive research, HIV/ AIDS was more-or-less finally diagnosed in 1984. It took decades for the above condition to be diagnosed. At that time HIV/AIDS was perceived as a death sentence. After all his time there seems to be a light at the end of the tunnel.
Excellent news for both people with HIV/AIDS and healthcare professionals are the significant results of recent research trials. Early results from a momentous trial of an HIV prevention injection announced by the University of the Witwatersrand researchers on Tuesday have been hailed as being a “game-changer” to turn “the tide on HIV”, according to Professor Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute (WRHI), who announced the results via an online media briefing.
This study, (HPTN084) led by the HIV Prevention Trials Network (HPTN), tested an antiretroviral (ARV) injection given bimonthly comparing it to the current standard of drug prevention in the form of a daily oral pill. The injection has to be administered by a health professional. Both these options fall into the pre-exposure prophylaxis (PrEP) category for treatment to prevent HIV infection. The long-acting injection, which contains the antiretroviral drug cabotegravir, was found to be 89% more effective in the study at preventing HIV in women when compared to the daily pill, which contains a combination of the drugs tenofovir and emtricitabine.
“This is the first time the world has seen such significant HIV prevention result for women,” said Wits’ Dr Sinead Delany-Moretlwe (2020), who headed up the trial. She said that having a “well-accepted” HIV prevention option for women is critical considering this group accounts for more than half of new infections in sub-Saharan Africa and that “women bear a disproportional burden”. If taken every day, on-time and as prescribed, the oral regimen has been found to be almost 100% effective at preventing HIV. But there are myriad reasons why women have been found to struggle to adhere to daily pill-taking, including stigma from partners or family members who see their pills. This is why these findings for an injectable option are so significant, especially for local women. The HPTN 084 trial enrolled 3 223 HIV-negative women in Botswana, Eswatini, Kenya, Malawi, South Africa, Uganda and Zimbabwe. Women were allocated either to a trial arm receiving the oral drug or one receiving the injection. A total of 38 women contracted HIV over a period of about two years of follow up. Only four of these new infections were from the arm receiving the injectable, while 34 were from the arm receiving the pill.
Tenofovir disoproxil with emtricitabine is effective in reducing the incidence of human immunodeficiency virus (HIV) when taken as pre-exposure prophylaxis (PrEP). When compared with placebo, PrEP significantly reduced rates of HIV transmission among adults at medium to high risk of infection. In all study trials, participants also received standard prevention practices such as risk-reduction counselling, condom use and sexually transmitted infection (STI) screening. PrEP effectiveness is highly dependent on adherence. In clinical trials, full treatment adherence with PrEP reduced the risk of HIV infection by up to 99%. A patient must be HIV-negative at treatment initiation, and return negative HIV tests at 3-monthly intervals to continue prophylaxis treatment. PrEP should only be used for HIV-negative patients. Patients taking PrEP should be reviewed every 3 months – this review includes a treatment adherence assessment and tests for HIV and other STIs.
Tenofovir disoproxil with emtricitabine is PBS-listed as Authority required (streamlined) for HIV PrEP among eligible adults (> 18 years of age) who are at medium to high risk of HIV infection as defined by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) PrEP guidelines, and have a negative HIV test result prior to starting treatment (Pharmaceutical Benefits Advisory Committee. December 2017 PBAC Meeting – positive recommendations (accessed 22 March 2018 & Pharmaceutical Benefits Scheme. Tenofovir + Emtricitabine. Australian Government, Department of Health, 2018 (accessed 9 July 2018).
Tenofovir disoproxil (a nucleotide reverse transcriptase inhibitor) and emtricitabine (a nucleoside reverse transcriptase inhibitor) are antiretroviral medicines. They are taken in combination with other antiretroviral agents for the treatment of people with HIV infection (Australian Medicines Handbook. Adelaide: AMH Pty Ltd, 2018 [accessed 30 May 2018] & Lupin Australia Pty Ltd. Tenofovir EMT GH (tenofovir disoproxil phosphate /emtricitabine 291 mg/200 mg tablets): product information. Camberwell: Lupin Australia Pty Ltd, 2017 (accessed 25 June 2018).
HIV treatment does not cure HIV, and people with HIV still may experience complications related to HIV treatment and HIV infection. However, the current outlook for people with HIV has improved tremendously and HIV-infected people with access to medicines and medical care can live long, healthy lives. A person diagnosed at age 25 who receives good medical care is estimated to live 40 more years (HIV: In Site is a project of the UCSF Center for HIV Information. Copyright 2019, Regents of the University of California, 2011).
Is HIV always fatal?
No. It is true that people who do not receive treatment for HIV will eventually (over years) become ill and die of complications of HIV infection. With effective treatment (called antiretroviral therapy), however, most people with HIV infection will lead long and healthy lives; this is especially true if they start HIV treatment when their immune system is still relatively strong (U.S. Department of Veterans Affairs / 810 Vermont Avenue, NW Washington DC 20420. 2019) [https://www.hiv.gov/patient/basics/is-HIV-fatal.asp. Accessed 19 November 2020].