if HIV originally came from chimps who got it from eating a smaller monkey and it’s not transmitted by air etc like the cold. Why are we having such a hard time eradicating it in human hosts?
In: Biology
Remember HIV and AIDS are different things. HIV is a virus that, once contracted, is incurable. It isn’t possible to ever clear the infection. As other people have said, we now have HAART highly active antiretroviral therapy, which works to suppress viral reproduction to undetectable levels. Previous treatments didn’t do this. This means that if you’re on HAART and compliant, you cannot infect others, as per the Swiss statement.
AIDS is the resulting immunodeficiency from HIV attacking the T cells that help stimulate an immune response. Once your CD4 T cells are depleted all forms of immunity are compromised and you become very vulnerable to opportunistic infections that wouldn’t affect healthy people, including some cancers of viral origin. The majority of people with HIV die because of these infections.
The reason we can’t clear the virus is that it is a retrovirus, which means when it enters a cell, to replicate it effectively writes itself into the cell’s DNA. When the cell makes proteins for itself to use normally, it accidentally replicates the HIV virus as well. Obviously we can’t go in and rewrite a cell’s DNA (no, CRISPR won’t work) so the virus just sits in there and replicates forever until the cell dies. HAART stops the enzyme that lets HIV make itself compatible with the cell’s DNA (for example).
Understanding why HIV is still such a global problem is like trying to comprehend how the global economic market works. It is infinitely complex, affected by a multitude of factors, behaves differently everywhere and no matter how many models you make of it, you will never be able to properly predict it. It’s not the first world countries that are driving transmission: we are lucky enough to have access to PrEP and PEP (pre and post exposure prophylaxis, prevention) and highly effective HAART. it’s areas with limited access to testing, treatment, prevention methods and education where HIV is growing rapidly. The test for HIV is complex, and as someone rightly said it’s undetectable for 2 weeks post exposure and mostly asymptomatic until the immune system is depleted. Diagnosis is expensive and requires trained personnel. You need educated healthcare workers, a simple medical facility, consumables. On the most basic level, you need a patient to come in to be tested and then RETURN to get their results, THEN have access to any/sufficient LIFELONG medication, education to tell them how to use it, compliance so they use it correctly every day for the rest of their lives, THEN test all their contacts to see who else is infected. This is totally aside from community stigma in HIV positivity that is a huge barrier for people to test at all.
Malnutrition severely increases the morbidity and mortality of HIV, both by not have enough to eat, or having secondary malabsorption issues, often from intestinal parasites. >300 million are estimated to have intestinal worms that enhance malnutrition and make children especially more vulnerable to disease progression.
One third of the world’s population is infected with TB. HIV and TB each increase the severity of the other. HIV can be masked by the presence of TB, so it’s even more difficult to diagnose. Management of TB and HIV are separate services even though they are frequently comorbid, so again, each enhances the infectivity of the other. TB is prevalent in many of the same areas as HIV, compounding the problem.
Girls in developing countries are infected young, often between 14-16. They are infectious from the beginning of their sexual activity, increasing transmission. Maternal transmission also occurs, though testing in antenatal clinics is rapidly decreasing this.
Aside from ALL of that, with the rise of HAART the prevalence of HIV infection is going to rise artificially because HIV positive people are simply able to live longer now. However, lifelong access to and compliance with medication is absolutely critical. As people stop taking their medication, their circulating viral load increases and they become infectious again.
There is no one wanting HIV to spread, it’s not a plot by big Pharma. They already have 40 million people that need daily medication for the rest of their lives, a number that is only increasing—not even counting the PrEP and PEP they sell. They’re laughing all the way to the bank already. Efforts to give access to HAART to every HIV positive person will double their sales as 50% of those aren’t virally suppressed.
There is good news about HIV though, though the situation is still a significant global concern. Several African countries have reached the WHOs 90-90–90 goal: 90% positive people know their status, 90% of those are on HAART and 90% of those are virally suppressed. Annual infections are decreasing by 1-2%pa, and there were <1 million deaths last year from HIV. However, spending has plateaued and we stand in a precarious position.
HIV and AIDS are incredibly complex diseases. Prevalence, incidence, care access and factors enhancing transmission are different in every region in every country in the world. That complexity is reflected in the approach we need to take. There is no one-size-fits-all solution, which is hard for policy makers to grasp. HIV is one of the biggest healthcare challenges of our time. It’s a global problem that requires an unflinching, unselfish global commitment to control, let alone eliminate.
To add on to what others are saying, a lot of HIV is spread by people who don’t know it. Symptoms don’t show up for months. Even then a lot of people don’t get tested.
The largest group of people with HIV are living in Sub-Saharan Africa, and for a lot of reasons it’s hard to eradicate it there. Folks tend to be poorer, they don’t have access to or use condoms compared to more developed areas, and they don’t have access to regular and affordable health care.
Even in the developed world it’s hard to get people to use condoms. We also don’t fund needle exchange programs properly (basically giving addicts clean needles so they’re not sharing disease-infested used ones).
Lastly, PrEP and PEP are still inaccessible and underused. PrEP is a drug that, if taken daily, prevents HIV. It’s basically birth control for HIV. PEP can be taken without 72 hours of exposure to HIV (think Plan B) but can costs $500.
We’re making great strides but we still have a long way to go. The good news is that if you have it and take medication you can become undetectable, meaning you can’t spread it.
A lot of the answers here are scientific in nature, and the scientific aspects of the virus definitely make it harder than other viruses to handle. However, a key aspect of the HIV crisis is the fact that it was pretty much only queer men and intravenous drug users who first got the virus and these folks were generally considered expendable, so for years very little was done in terms of policy to stop the spread of the virus. More men died in New York alone during the AIDS crisis than in the entire Vietnam War, for example. At that time – a crucial point in the course of the epidemic – American policymakers in particular (but not exclusively) were avoiding addressing the problem entirely. It’s obviously hard to say how the trajectory of the pandemic could have been different if an adequate response had been made, but generally if significant action is taken to limit an epidemic at the onset, its effects can be mitigated significantly.
With current medication cocktails, the levels of HIV in a human can be reduced to undetectable levels. The problem is, even at those levels, there is no way to really kill it out of your system. if you stop taking the antiretroviral drugs they will likely start replicating and become detectable again.
Like many diseases, there may come a time when we can prevent people from getting it with some form of vaccine, but it is unlikely it can be completely eliminated from someone that has it.
Because the health services in some countries mean that an infected person can still pass on the disease even after being diagnosed and in many cases they aren’t diagnosed for years after having caught it.
Not to sound harsh, Blame some gays. I have a gay friend, who says it is like a badge of honor and they have even been invited to infection parties similar to what parents send their kids to for chicken pox. What the fuck is all I could say. Apparently this is a thing..
EDIT:
It’s called bug chasing
[wiki](https://en.m.wikipedia.org/wiki/Bugchasing)
Are you asking about preventing transmission, or actually treating it/developing a vaccine, because those are different things. The reason why it’s hard to prevent transmission is because people can be HIV positive for years and not know it, and thus inadvertently spread it to other people during that time, and then those people will be infected, not know, and spread to *more* people and so on. It’s easy to not know you’re HIV+ because there are basically no symptoms until your immune system is seriously compromised, which, as I said before, can take years. In western countries, transmission rates are down because of the availability of cheap, reliable, and accurate tests, public awareness, and easy access to things like condoms or clean needles. In a lot of other countries, HIV tests are hard to come by, and there’s little or no access to things that reduce transmission rates and not much money for public awareness.
A big issue is that it’s actually quite difficult to contract HIV in a single instance if the infected individual has had it for a while.
Jab yourself with an infected needle and the odds of getting it are less than 1%.
Oral and unprotected sex is even less than that.
So when people see that they think “oh it’s fine the risk is super low”.
But the individuals who are most at risk are not having sex once, they’re doing it many times and with multiple people. And those risks are not accounting for if you’re already compromised due to other STI’s or illnesses. So for many at risk people those probabilities of contraction are actually much higher.
When someone gets newly infected their infectiousness goes through the roof as the virus rapidly multiplies in the new host body to establish itself. So basically one person gets infected by blind chance then they have sex with other people and very quickly spread it to someone else, then those individuals very quickly spread it to more people and so on.
A lack of education and understanding of how the virus works, and the fact that it’s currently a lifelong condition, are why the virus doesnt eradicate itself.
Once the virus enters the cell it hijacks structures to make viral products which are incorporated into the nucleus and DNA. In simple terms, the viral product becomes part of the DNA which then makes more, escaping the cell to repeat the cycle. Medical technology doesn’t exist that can mass target the types of cells HIV infects or remove the virus once its incorporated into the DNA.
Treatment for HIV is multi pronged: Targeting the ability of the virus to stick to the outer layer of the cell; limiting the ability to make functional viral products; and (Im not 100% sure on this last one) altering the ability of the cell to eject formed viral products.
The ‘cure’ for HIV is functional. The cell can’t make activated viral products which can be measured in blood. The infected cells still have HIV incorporated into the DNA.
Designing medications to target one type of cell, the rate or ability of a cell to transport products in or out, or cellular structure is difficult.
The amount of research is incredible, current advances allow HIV users to live full active lives. Prep is a new preventative medication high risk users can take before having sex, decreasing (but not eliminating) the ability of the virus to enter someone unaffected by HIV. Some countries offer it over the counter, others by prescription. .
1. Sex education globally is a patchwork at best. For example, my 30 yo male friend from China received no sex Ed in school, and is one of countless thousands of Chinese citizens living with HIV.
2. Incubation period means a person can have multiple partners for months before the first symptoms emerge alerting them that something may be wrong, and the early symptoms are similar to the flu, so many shrug it off and keep on going.
3. Follow the $$. I’m sure you’re aware that the healthcare industry is deeply flawed. This is not to diminish the outstanding strides that have been made in the last decade or so.
4. Timeline: While significant strides have been made in the battle against HIV, we delayed even talking about it for a solid 6 yrs after we found it, so the delay in public discussion, funding, and research, has long term implications in terms of the international spread.
Latest Answers