The Link Between Hiv And Siv
HIV is a type of lentivirus, which means it attacks the immune system. In a similar way, the Simian Immunodeficiency Virus attacks the immune systems of monkeys and apes.1
Research found that HIV is related to SIV and there are many similarities between the two viruses. HIV-1 is closely related to a strain of SIV found in chimpanzees, and HIV-2 is closely related to a strain of SIV found in sooty mangabeys.2
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Various studies completed throughout the 2010s found that treatment with antiretroviral therapy reduced the risk of spreading the infection with HIV-negative partners this was the case for both homosexual and heterosexual couples.
The HIV Prevention Trials Networks HPTN052 study found that only one case of transmission from a HIV patient to their partner in 886 couples over two years this was approximately 96% lower than the placebo group.
The studys results were so conclusive regarding the effectiveness of antiretroviral treatment to prevent transmission between partners, the study was stopped early and all participants were invited to join the drug group. In 2011, the Science journal named this study breakthrough of the year.
These findings were corroborated by the Partners study. There were no cases of transmission from a HIV-positive patient, who was undergoing antiretroviral therapy and had an undetectable viral load, to their HIV-negative partner within 972 gay couples and 548 heterosexual couples.
The first, four-year phase of this study, which was completed in 2014, studied heterosexual and gay couples, whereas the second seven-year phase focused only on homosexual couples and was published in the Lancet in June 2019.
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 anti-retrovirals, 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
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Second Patient Achieves Hiv Remission After Stem Cell Transplant
In March 2019, University College London and Imperial College London announced that a patient known as the London patient had also been cleared of HIV following a stem cell transplant to treat Hodgkins lymphoma.
The donor, like the donor in the first, Berlin patient case, had two copies of the CCR5-delta32 genetic mutation. The patient stopped ART 16 months following the transplant and his blood viral load remained undetectable 18 months later.
University of Cambridge Professor Ravindra Gupta, who led the study while working at UCL, said: By achieving remission in a second patient using a similar approach, we have shown that the Berlin Patient was not an anomaly, and that it really was the treatment approaches that eliminated HIV in these two people.
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Us Pharmaceuticals Are Uniquely Shielded From Competition
Few can argue with the fact that HIV drugs are expensive. In fact, according to the Centers for Disease Control and Prevention, a person living with HIV who starts treatment early will be faced with lifetime costs of roughly $250,000, and thats just for the pills alone.
The costs can hardly be surprising given that a standard three-in-one option, like Triumeq , has an average wholesale price of over $3,400 per month. Other combinations well exceed this.
Despite this, you dont often hear much in the way of a public outcry against the price of antiretroviral drugs. This is likely due to the fact that many get their HIV drugs paid for, at least in part, by insurance or various governmental, institutional, or manufacturer subsidies.
But some rightly wonder how antiretroviral drugs can carry such a hefty price tag in the United States when generic versions sold overseas cost as much as 2000% less than what American consumers pay.
By way of comparison, a generic form of Triumeq was introduced in South Africa in 2017 at a wholesale price of roughly $75 per year. That is less than the wholesale price paid per day in the United States.
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Canadian Flight Attendant Theory
A Canadian airline steward named Gaëtan Dugas was referred to as “Case 057” and later “Patient O” with the alphabet letter “O” standing for “outside Southern California”, in an early AIDS study by Dr. William Darrow of the Centers for Disease Control. Because of this, many people had considered Dugas to be responsible for taking HIV to North America. However, HIV reached New York City around 1971 while Dugas did not start work at Air Canada until 1974. In Randy Shilts‘ 1987 book And the Band Played On , Dugas is referred to as AIDS’s Patient Zero instead of “Patient O”, but neither the book nor the movie states that he had been the first to bring the virus to North America. He was incorrectly called “Patient Zero” because at least 40 of the 248 people known to be infected by HIV in 1983 had had sex with him, or with a person who had sexual intercourse with Dugas.
When To Start Hiv Treatment
Its now recommended that everyone diagnosed with HIV starts treatment straight away after being diagnosed.
In the UK, national guidelines set out standards for HIV treatment. They currently recommend that anyone with HIV who is ready to commit to treatment should start it regardless of their CD4 count .
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Patients Cured Of Hiv Infection
The so-called “Berlin patient” has been potentially cured of HIV infection and has been off of treatment since 2006 with no detectable virus. This was achieved through two bone marrow transplants that replaced his immune system with a donor’s that did not have the CCR5 cell surface receptor, which is needed for some variants of HIV to enter a cell. Bone marrow transplants carry their own significant risks including potential death and was only attempted because it was necessary to treat a blood cancer he had. Attempts to replicate this have not been successful and given the risks, expense and rarity of CCR5 negative donors, bone marrow transplant is not seen as a mainstream option. It has inspired research into other methods to try to block CCR5 expression through gene therapy. A procedure zinc-finger nuclease-based gene knockout has been used in a Phase I trial of 12 humans and led to an increase in CD4 count and decrease in their viral load while off antiretroviral treatment. Attempt to reproduce this failed in 2016. Analysis of the failure showed that gene therapy only successfully treats 11-28% of cells, leaving the majority of CD4+ cells capable of being infected. The analysis found that only patients where less than 40% of cells were infected had reduced viral load. The Gene therapy was not effective if the native CD4+ cells remained. This is the main limitation which must be overcome for this treatment to become effective.
A Time Before Treatment
HIV treatment is something that was on everyones minds in the 1980s, confusion was rife and there was very little known about the virus. Sydney Star Observer first published a piece on the disease in 1981, reporting a new disease affecting gay men in the US describing a range of illnesses and infections.
The first diagnosis of AIDS in Australia wasnt for another year in St Vincents Hospital Sydney, and the formation of the AIDS Action Committee again not until another year later in 1983. At this time the gay community struggled to communicate what little was known about the virus to one another as they struggled with a much more adverse Health system.
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History Of Hiv And Aids Overview
KEY POINTS:
The history of the HIV and AIDS epidemic began in illness, fear and death as the world faced a new and unknown virus. However, scientific advances, such as the development of antiretroviral drugs, have enabled people with access to treatment to live long and healthy lives with HIV.
Here, we go through the key historical moments that have defined the HIV epidemic over the past 30 years.
The Trouble With Monotherapy
Research for other treatments continued and as new drugs were approved they were selected for treatment and used in isolation. The efficacy of the drugs ranged wildly from person to person and this determined which drug you would be prescribed.
Treatment with a single drug or Monotherapy proved problematic as HIV with its high mutation rate can become resistant to a particular drug if used over a period of time. Copies of this resistant strain of the virus could then multiply and then resume attacking the bodys immune system.
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Excellent Treatment Is Available But Not Everyone Gets It
While the World Health Organization recommends starting all 36 million people living with HIV worldwide on treatment, many people in developing world still dont have access to adequate treatment.
The situation is much better in the United States, but there are dramatic disparities in HIV infection prevention, diagnosis and treatment. Here, one in eight Americans living with HIV does not know their HIV status. Without a diagnosis, these people will not get necessary treatment and are more likely to develop AIDS and to spread HIV.
African Americans, Latinos, gay and bisexual men, and transgender people are still bearing a disproportionate burden of this disease in the United States. They are more likely to become HIV-infected and less likely to see a doctor regularly, and, thus, to receive treatment. For example, African Americans comprise 12% of the US population but 44% of all new HIV infections. African Americans are also more likely to die from HIV than other racial groups.
Theres a disparity between men and women as well. Women with HIV have the same health concerns as men with HIV, but they often face additional hurdles in managing their disease and other chronic health conditions due to family responsibilities, trauma and violence, poverty, gynecological issues and childbearing.
Start Treatment As Soon As Possible After Diagnosis
- HIV medicine is recommended for all people with HIV, regardless of how long theyve had the virus or how healthy they are.
- Talk to your health care provider about any medical conditions you may have or any other medicines you are taking.
- Let your health care provider know if you or your partner is pregnant or thinking about getting pregnant. They will determine the right type of HIV medicine that can help prevent transmitting HIV to your baby.
What if I delay treatment?
- HIV will continue to harm your immune system.
- This will put you at higher risk for developing AIDS. Learn more about AIDS and opportunistic infections.
- This will put you at higher risk for transmitting HIV to your sexual and injection partners.
What are the benefits of taking my HIV medicine every day as prescribed?
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Highly Active Antiretroviral Therapy
In 1996, highly active antiretroviral therapy was introduced for people with HIV and AIDS. HAART â often referred to as the anti-HIV “cocktail” â is a combination of three or more drugs, such as protease inhibitors and other anti-retroviral medications. The treatment is highly effective in slowing the rate at which the HIV virus replicates itself, which may slow the spread of HIV in the body. The goal of HAART is to reduce the amount of virus in your body, or the viral load, to a level that can no longer be detected with blood tests.
Drug Combo Sends Deaths Plummeting
It was spring of 1996 when Beth Bye says she returned from the dead. The Wisconsin woman hadn’t actually died, but with her body ravaged in the late stages of AIDS infection, she had run out of options, and death was, indeed, near. AIDS-related dementia and blindness had crept in — signs that her doctor told her meant time was short. She made funeral arrangements and considered moving to a hospice for her remaining days.
Then, as if to say “not so fast,” medical science handed her another option. New drugs called protease inhibitors, first approved in 1995, were about to revolutionize the treatment of patients infected with the AIDS virus. These drugs usually are taken with two other drugs called reverse transcriptase inhibitors. The combined drug “cocktail” has helped change AIDS in the last three years from being an automatic death sentence to what is now often a chronic, but manageable, disease.
Within two months of beginning the triple cocktail treatment, also known as highly active antiretroviral therapy , Bye’s viral load — a measure of new AIDS virus produced in the body — dropped to undetectable levels. Her red and white blood cell counts normalized, an important sign that the immune system was starting to work again. Suddenly she could do simple things she had long given up, such as walk the dog for 2 miles. Bye, now 40, was even able to return to her teaching job and currently works 30 hours a week.
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What Are The Possible Side Effects Of Biktarvy
All medicines have possible side effects. Its a good idea to talk to a doctor, nurse or pharmacist about what to expect before you start taking any medication, and how to manage any side
effects which occur.
A full list of side effects, including less common side effects, can be found in the patient information leaflet that comes with Biktarvy.
Side effects can be described as:
- Common a side effect that occurs in at least one in a hundred people who take this drug.
- Rare a side effect that occurs in fewer than one in a hundred people who take this drug.
Common side effects of Biktarvy include depression, abnormal dreams, headache, dizziness and tiredness.
Biktarvy is not suitable for people with severely reduced kidney function.
People with HIV may gain weight after starting antiretroviral treatment. Clinical trials of new drugs introduced since 2003 show that people taking Biktarvy are at higher risk of substantial weight gain.
Did Hiv Start In Africa
Using the earliest known sample of HIV, scientists have been able to create a ‘family-tree’ ancestry of HIV transmission, allowing them to discover where HIV started.
Their studies concluded that the first transmission of SIV to HIV in humans took place around 1920 in Kinshasa in the Democratic Republic of Congo .10
The same area is known for having the most genetic diversity in HIV strains in the world, reflecting the number of different times SIV was passed to humans. Many of the first cases of AIDS were recorded there too.
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Where Did Aids Come From
Scientists have traced the origin of HIV back to chimpanzees and simian immunodeficiency virus , an HIV-like virus that attacks the immune system of monkeys and apes.
In 1999, researchers identified a strain of chimpanzee SIV called SIVcpz, which was nearly identical to HIV. Chimps, the scientist later discovered, hunt and eat two smaller species of monkeysred-capped mangabeys and greater spot-nosed monkeysthat carry and infect the chimps with two strains of SIV. These two strains likely combined to form SIVcpz, which can spread between chimpanzees and humans.
SIVcpz likely jumped to humans when hunters in Africa ate infected chimps, or the chimps infected blood got into the cuts or wounds of hunters. Researchers believe the first transmission of SIV to HIV in humans that then led to the global pandemic occurred in 1920 in Kinshasa, the capital and largest city in the Democratic Republic of Congo.
The virus spread may have spread from Kinshasa along infrastructure routes via migrants and the sex trade.
In the 1960s, HIV spread from Africa to Haiti and the Caribbean when Haitian professionals in the colonial Democratic Republic of Congo returned home. The virus then moved from the Caribbean to New York City around 1970 and then to San Francisco later in the decade.
International travel from the United States helped the virus spread across the rest of the globe.
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Talking To Your Doctor
If you have any concerns about your treatment or other aspects of your health, its important to talk about these. For example, if you have any symptom or side effect which may be from your treatment, or if you are finding it difficult to take your medication every day, one of your healthcare team will be able to help.
Building a relationship with a doctor may take time. You may feel very comfortable talking to your doctor, but some people find it more difficult, particularly when talking about sex, mental health, or symptoms they find embarrassing. Its also easy to forget things you wanted to talk about.
Preparing for an appointment can be very helpful. Take some time to think about what you are going to say. You might find it helpful to talk to someone else first, or to make some notes and bring them to your appointment.
For detailed information on this drug, visit the Biktarvy page in the A-Z of antiretroviral medications.
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