THE HIV virus targets the immune system leaving an infected individual vulnerable to all kinds of illnesses. A cold, fought in a matter of days by a healthy immune system, may be lethal to someone with HIV. Awareness of the condition, how it is transmitted and of hopeful therapies has increased dramatically in the last 50 years.
The World Health Organization (WHO) are a leading force in advising prevention and treatment of HIV. In 2013, they published guidelines for the use of antiretroviral (ARV) drugs which consolidated clinical and programmatic guidance. Since then, many countries have seen a decrease in HIV prevalence after taking on the advice and implementing the recommendations. The HIV virus infects macrophages that engulf and digest pathogens, dendritic cells that survey the body and catch out foreign particles that may cause harm.
Critically, it infects T helper cells that regulate immune response by activating many other immune cells that work together to fight an infection. ARVs work by stopping the virus from replicating in and taking over a host cell, which causes the disease.
This gives the immune system time to repair itself and work on suppressing the virus. Combined doses are used as the virus is incredibly flexible, quickly becoming resistant to a single drug. For the treatment to be effective, it is advised that medication be taken consistently by the individual for the rest of their life. In 2014. 36.9 million people were living with HIV and there are now more than 20 approved ARVs available. In July 2015, the World Health Organization released new guidelines advising earlier treatment and a treat-all policy to harness the prevention potential of the drugs. Using pilot schemes in five low to middle income countries, it has been shown that scaling up administration of antiretroviral drugs is economically and logistically feasible. Out of all the countries leading by example and initiative, Brazil had the highest rate of testing and treatment uptake.
However, to reach global goals, more diagnosed people need to be moved onto treatment quickly. This inspired a policy where patients are administered ARV at any Helper T cell count, in the hope that less damage has been done to the immune system so suppression is more successful. Nevertheless, long-term follow up is yet to happen which may reveal some adverse side effects to widespread, early use of the drug. Rapid development of the drugs has dramatically reduced side effects such as bone loss and organ damage.
However effective they are, if the drugs are administered for a lifetime as recommended, these side effects may become apparent. There is no doubt that HIV treatment needs to be scaled up and see an increase in availability, particularly for socially isolated groups. However, further research needs to be done before the drug can be used as a preventative measure.