Whats The Hiv Window Period
As soon as someone contracts HIV, it starts to reproduce in their body. The persons immune system reacts to the antigens by producing antibodies .
The time between exposure to HIV and when it becomes detectable in the blood is called the HIV window period. Most people develop detectable HIV antibodies within 23 to 90 days after transmission.
If a person takes an HIV test during the window period, its likely theyll receive a negative result. However, they can still transmit the virus to others during this time.
If someone thinks they may have been exposed to HIV but tested negative during this time, they should repeat the test in a few months to confirm . And during that time, they need to use condoms or other barrier methods to prevent possibly spreading HIV.
Someone who tests negative during the window might benefit from post-exposure prophylaxis . This is medication taken after an exposure to prevent getting HIV.
PEP needs to be taken as soon as possible after the exposure it should be taken no later than 72 hours after exposure but ideally before then.
Another way to prevent getting HIV is pre-exposure prophylaxis . A combination of HIV drugs taken before potential exposure to HIV, PrEP can lower the risk of contracting or transmitting HIV when taken consistently.
Timing is important when testing for HIV.
Hiv Hides In The Body
Scientists had hoped giving strong treatment medications so soon after birth would get rid of the virus or prevent it from spreading and doing damage.
The fact that the HIV virus eventually turned up in the âMississippi babyâ isn’t unexpected, says Robert Siliciano, MD, PhD, professor of medicine in the infectious diseases department at Johns Hopkins University School of Medicine. It supports the theory that HIV cells stay in the body, just out of view in a hidden “reservoir.”
“Curing HIV infection is going to require strategies to eliminate this reservoir,” he says.
Why Is It So Hard To Find A Cure For Hiv
Due to the complex nature and structure of HIV, locating and quantifying the amount of virus in the body is very difficult.
HIV evades the immune system by staying dormant in infected T-cells until they are activated to respond to infections. This state is called latent infection. Some of these cells may live for decades without becoming activated. Cells that are latently infected are described as the `HIV reservoir`.
Detecting and eliminating these cells are the biggest challenges facing cure research.
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A Handful Of Stem Cell Cures
Only a small number of people have been cured of HIV after stem cell transplants. The first, Timothy Ray Brown, formerly known as the Berlin patient, received two transplants to treat leukaemia in 2006. His oncologist, Dr Gero Hütter, came up with the idea of using stem cells with the CCR5-delta32 mutation, speculating that it might cure both cancer and HIV.
As described at the 2008 Conference on Retroviruses and Opportunistic Infections , Brown first underwent intensive chemotherapy and whole-body radiation, and he developed near-fatal graft-versus-host disease. He stopped ART at the time of his first transplant, at age 40, but his viral load did not rebound. Researchers extensively tested his blood, gut and other tissues, finding no traces of replication-competent HIV. At the time of his death in September 2020, due to a recurrence of leukaemia, Brown had been free of HIV for more than 13 years.
A second man, Adam Castillejo, dubbed the London Patient, was also cured after receiving a stem cell transplant to treat Hodgkin lymphoma. As described at CROI 2019, he too received cells from a donor with the CCR5-delta-32 mutation, but he had less aggressive conditioning chemotherapy and developed milder graft-versus-host disease. A year and a half after the transplant, with no evidence of viable HIV, he stopped ART in September 2017, and he has now been HIV-free for more than four years.
Initiation Of Antiretroviral Therapy
Antiretroviral drug treatment guidelines have changed over time. Before 1987, no antiretroviral drugs were available and treatment consisted of treating complications from opportunistic infections and malignancies. After antiretroviral medications were introduced, most clinicians agreed that HIV positive patients with low CD4 counts should be treated, but no consensus formed as to whether to treat patients with high CD4 counts.
In April 1995, Merck and the National Institute of Allergy and Infectious Diseases began recruiting patients for a trial examining the effects of a three drug combination of the protease inhibitor indinavir and two nucleoside analogs. illustrating the substantial benefit of combining 2 NRTIs with a new class of antiretrovirals, protease inhibitors, namely indinavir. Later that year David Ho became an advocate of this “hit hard, hit early” approach with aggressive treatment with multiple antiretrovirals early in the course of the infection. Later reviews in the late 90s and early 2000s noted that this approach of “hit hard, hit early” ran significant risks of increasing side effects and development of multidrug resistance, and this approach was largely abandoned. The only consensus was on treating patients with advanced immunosuppression . Treatment with antiretrovirals was expensive at the time, ranging from $10,000 to $15,000 a year.
Treatment as prevention
What It All Means
All of these results are incredibly hopeful. They show that new approaches to HIV treatment are becoming increasingly effective and that researchers are slowly getting closer to finding a true cure.
That being said, its important to remember that the successes of the Berlin patient, London patient, and New York patient occurred under very special circumstances. The procedures were intended to treat cancer, and they came with a large price tag and an even larger risk. After the Berlin Patient, many of the attempts to replicate his treatment ended with the virus coming back, or with HIV+ patients dying from their cancer. Brown himself almost died immediately following his procedure because of the toll it took on his immune system.
In terms of the major developments using the CRISPR method, gene editing is still a very new technology. While eliminating HIV in mice was certainly a major feat, were still a while away from being able to safely use the CRISPR method on humans.
These discoveries also do not change the current situation for most of the 38 million people currently living with HIV, the majority of whom are in sub-Saharan Africa. Roughly a quarter of all people living with HIV still lack access to daily HIV medication despite them now being safe and lower cost.
The dangerous and costly procedures that resulted in patients being cured are not yet a realistic solution to the AIDS pandemic, as promising as the results may be.
Protect Yourself From Hiv/aids
FREE HIV testing on June 27 at select Walgreens locations and FREE HIV, HCV and STI testing on June 28th at most local health department clinics. Please call to schedule an appointment. for a list of HIV, STD, Hepatitis C, and PrEP providers.
HIV and AIDS in South Carolina
- In South Carolina, almost 15,000 of your neighbors including about 200 children and teens are living with HIV infection or AIDS.
- Throughout the United States, more than 1 million residents are living with HIV or AIDS, and nearly one-fifth do not know they have it.
- Each year, more than 56,000 new cases are diagnosed. An estimated 600,000 U.S. citizens have already died from the virus.*
- Worldwide, more than 60 million people, including millions of children, have been infected since the early 1980s. As many as 25 million people have died from AIDS.**
*U.S. Centers for Disease Control and Prevention.** Joint United Nations Programme on HIV/AIDS
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Pushing The Envelope In Hiv
Dr. Yvonne J. Bryson, a pediatric infectious disease specialist at UCLAs David Geffen School of Medicine, described the new case study Tuesday at the virtually held annual Conference on Retroviruses and Opportunistic Infections.
The New York patient, as the woman is being called, because she received her treatment at New York-Presbyterian Weill Cornell Medical Center in New York City, was diagnosed with HIV in 2013 and leukemia in 2017.
Bryson and Persaud have partnered with a network of other researchers to conduct lab tests to evaluate the woman. At Weill Cornell, Dr. Jingmei Hsu and Dr. Koen van Besien from the stem cell transplant program paired with infectious disease specialist Dr. Marshall Glesby on patient care.
This team has long sought to mitigate the considerable challenge investigators face in finding a donor whose stem cells could both treat a patients cancer and cure their HIV.
Traditionally, such a donor must have a close enough human leukocyte antigen, or HLA, match to maximize the likelihood that the stem cell transplant will engraft well. The donor must also have the rare genetic abnormality conferring HIV resistance.
This genetic abnormality largely occurs in people with northern European ancestry, and even among people native to that area, at a rate of only about 1 percent. So for those lacking substantial similar ancestry, the chance of finding a suitable stem cell donor is particularly low.
Does Hiv Go Away
HIV doesnt go away on its own. It inserts itself into your DNA so your cells think that its a part of you. There can be many years without symptoms after initial infection, but HIV can still be damaging your immune system even if you dont feel sick.
There may be periods while on medication where the virus is not detectable by an HIV test. In these cases, HIV can be hiding in your body, undetected. It can wake up and start destroying your cells again in the future.
This is why continuing to take HIV medication, even if you dont feel sick or the virus is undetectable, is extremely important. Without treatment, HIV will weaken your immune system until you cant fight off other serious illnesses.
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How Is Niaid Addressing This Critical Topic
NIAID researchers and grantee institutions advance understanding of disease mechanisms and cooperate to move novel HIV prevention and treatment strategies from basic research into clinical practice. With the generous help of clinical research volunteers, investigators at NIH and around the world create opportunities for the discovery, development and evaluation of technologies and tools that can play a role in decreasing HIV transmission, improving the health of people with HIV, and ultimately ending the pandemic.
How Do I Know If I Have Hiv
The only way to know for sure if you have HIV is to get tested. Testing is relatively simple. You can ask your health care provider for an HIV test. Many medical clinics, substance abuse programs, community health centers, and hospitals offer them too.
To find an HIV testing location near you, use the HIV Services Locator.
HIV self-testing is also an option. Self-testing allows people to take an HIV test and find out their result in their own home or other private location. You can buy a self-test kit at a pharmacy or online. Some health departments or community-based organizations also provide self-test kits for a reduced cost or for free.
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A Woman Is Cured Of Hiv Using A Novel Treatment
Shes the third person ever to be cured. Researchers announced that the new approach holds the potential for curing more people of racially diverse backgrounds.
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Complete Cure Or Long
Researchers are still working to learn why these cures after stem cell transplantation were successful while other attempts have failed. Using stem cells with a double CCR5-delta-32 mutation seems to be key. At CROI 2012, researchers described two HIV-positive men in Boston who received stem cell transplants for cancer treatment from donors without the mutation. Both experienced viral rebound after stopping ART, though this was delayed.
Some have posited that the graft-versus-host reaction might play a role in eradicating HIV, but the five patients who were cured received different pre-transplant conditioning regimens and some experienced mild or no graft-versus-host disease.
Even as each new case provides more answers, stem cell transplants remain far too risky for people who do not need them to treat life-threatening cancer. Seeing the host as foreign, the donor immune cells can attack the recipients tissues and organs, which may necessitate immunosuppressive therapy. While waiting for donor cells to engraft, patients are highly susceptible to infections. Whats more, the procedure is medically intensive and costly and would be impossible to scale up to treat the millions of people living with HIV worldwide.
But some advocates question why these rare cures, which wont help most people living with HIV, get so much more attention than natural or post-treatment controllers, one of whom was also described at the conference.
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What Treatments Are Helping People Live Longer
A collection of antiretroviral therapies has moved HIV into the chronic disease realm and given young people who are newly infected a close-to-normal life expectancy. In fact, more than half of people living with the virus now are over 50 years old, says Michael Virata, MD, director of HIV clinical services at YNHHs Saint Raphael Campus.
Really, the basic goal is to treat people with highly active drugs that combat the virus, so we get them to the point where they have undetectable levels of it, he says.
Patients may be given some combination or cocktail of three drugs, and doctors are moving toward two-drug combinations. We are even moving into a realm of longer-acting agents so that people wont have to take a pill every day, Dr. Virata says.
Some medicines will be delivered through such methods as injections that could protect people for weeks. In the past, there was controversy over when to treat newly diagnosed patients, but current guidelines recommend starting medications quickly. There are centers around the U.S. where, the day they diagnose you, they hand you your first doses of medication, Dr. Virata says.
There have been breakthroughs beyond the medications as well. For example, people with HIV with end-stage kidney disease are now being successfully transplanted, says Dr. Villanueva. And there are studies that show successful kidney and liver transplants from HIV-positive deceased donors.
Is There A Vaccine For Hiv
Currently, there are no vaccines to prevent or treat HIV. Research and testing on experimental vaccines are ongoing, but none are close to being approved for general use.
HIV is a complicated virus. It mutates rapidly and is often able to fend off immune system responses. Only a small number of people who have HIV develop broadly neutralizing antibodies, the kind of antibodies that can respond to a range of HIV strains.
The first HIV vaccine efficacy study in 7 years was underway in South Africa in 2016. The experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand.
A 3.5-year follow-up after vaccination showed the vaccine was 31.2 percent effective in preventing HIV transmission.
The study involves 5,400 men and women from South Africa. In 2016 in South Africa, about contracted HIV. The results of the study are expected in 2021.
Other late-stage, multinational vaccine clinical trials are also currently underway.
Other research into an HIV vaccine is also ongoing.
While theres still no vaccine to prevent HIV, people with HIV can benefit from other vaccines to prevent HIV-related illnesses. Here are the CDC recommendations:
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What Can Women Do
- Talk about it. Learn the facts about HIV, and share this lifesaving information with your family, friends, and community. Let’s Stop HIV Together, part of Act Against AIDS, has many resources for raising awareness about HIV and includes many video testimonials from people living with HIV.
- Start Doing It – getting tested for HIV . Knowing your HIV status gives you powerful information to help keep you and your partner healthy. If you are pregnant or planning to become pregnant, get an HIV test as soon as possible.
The most effective way to prevent HIV is to abstain from sexual activity and injection drug use. However, if you are sexually active or use injection drugs, today there are more tools available to prevent HIV. You can:
- Use condoms the right way every time you have sex. Learn the right way to use a male condom or a female condom.
- Limit your number of sexual partners.
- Never share needles.
- Talk to your doctor about pre-exposure prophylaxis , taking medicine daily to prevent HIV infection, if you are at very high risk for HIV.
- Talk to your doctor about post-exposure prophylaxis if you think you may have been exposed to HIV within the last 3 days through sex, sharing needles and works, or a sexual assault.
What Issues Do People With Hiv Face As They Age
Aging with HIV is a fairly new area of study. People who are 50 and who have been living with HIV for a long timetheir bodies may be, by some estimates, like that of a 60-year-old, says Dr. Villanueva. They may develop cancer, diabetes, heart disease, and other conditions earlier than they would if they werent HIV-positive.
Dr. Virata says HIV is thought to cause a chronic inflammatory state in the body, which can accelerate aging. We’re trying to understand what the process is and figure out how we can address it, he says.
Researchers are studying whether early interventions could decrease complications for patients as they grow older. Dr. Virata points to a large global study looking at the use of statins as an intervention. It’s a long-term study, but we’re anxiously waiting to see what the results of that research project will show, he says. Contributing to the problem, he says, is that some of the medications used to treat HIV can be toxic in the body.
More implementation science, research, and intervention strategies are needed, Dr. Barakat says. Were still learning about and determining the best strategies to enhance opportunities as far as testing and prevention.
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