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.
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