What It Feels Like: Living With Hiv
Tiko Kerr did not have any symptoms when he received an HIV positive diagnosis in 1985. He had heard that a virus was threatening the health of his community and, wanting to do his part, decided to get tested. He describes hearing his diagnosis as feeling like it was the end of the world.
Human immunodeficiency virus attacks the bodys immune system. In untreated patients, HIV is transmitted through bodily fluids such as blood, semen, or breast milk not through touch, sharing food, or kissing, according to the WHO. New medications can help patients achieve a state of viral suppression, which prevents the transmission of HIV through bodily fluids. Viral suppression is a key component of UNAIDS goal to eliminate HIV by 2030.
In 2018, there were approximately 2,242 new cases of HIV in Canada, or six new diagnoses per 100,000 Canadians, according to the Public Health Agency of Canada. This was an increase over the 1,960 new cases in 2016, or 5.4 new cases per 100,000 Canadians and was the fourth consecutive year that HIV transmission rates had increased. It is estimated that approximately 62,050 people in Canada live with HIV.
Kerr is part of a new documentary, Undetectable, which explores the lives of HIV survivors. Tiko Kerr talks about being diagnosed with HIV in the 80s, becoming a vocal advocate for access to HIV medication and his hopes for the future.
Better Treatment And Longer Lives
Today, people are generally treated with a single, once-a-day, fixed-dose tablet that combines multiple drugs. It is much easier to manage, and has fewer side effects.
And the standard of care to suppress the virus is for a patient to begin treatment as soon as possible after diagnosis, and to take it continuously for the rest of his or her life.
This strategy also revolutionized how we think about HIV prevention. Five years ago we learned that as soon as patients start taking these medicines and suppresses HIV replication, they are much less likely to transmit HIV to someone else.
In 2012, the US Food and Drug Administration approved the first medication to protect those who do not have HIV from infection, called pre-exposure prophylaxis . Today, the Centers for Disease Control and Prevention and the World Health Organization recommend PrEP, in combination with behavioral interventions, for populations at high risk of acquiring HIV, such as men who have sex with men and couples where one partner is HIV-infected.
Origin And Epidemic Emergence
Several of the theories of HIV origin accept the established knowledge of the HIV/SIV phylogenetic relationships, and also accept that bushmeat practice was the most likely cause of the initial transfer to humans. All of them propose that the simultaneous epidemic emergences of four HIV groups in the late 19th-early 20th century, and the lack of previous known emergences, are explained by new factor that appeared in the relevant African regions in that timeframe. These new factor would have acted either to increase human exposures to SIV, to help it to adapt to the human organism by mutation , or to cause an initial burst of transmissions crossing an epidemiological threshold, and therefore increasing the probability of continued spread.
Genetic studies of the virus suggested in 2008 that the most recent common ancestor of the HIV-1 M group dates back to the Belgian Congo city of Léopoldville , circa 1910. Proponents of this dating link the HIV epidemic with the emergence of colonialism and growth of large colonial African cities, leading to social changes, including a higher degree of non-monogamous sexual activity, the spread of prostitution, and the concomitant high frequency of genital ulcer diseases in nascent colonial cities.
Social changes and urbanization
Colonialism in Africa
This theory was later dubbed “Heart of Darkness” by Jim Moore, alluding to the book of the same title written by Joseph Conrad, the main focus of which is colonial abuses in equatorial Africa.
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How Is Hiv Detected
When a person contracts HIV, his or her immune system produces antibodies, which are proteins that recognize the virus. The most commonly used HIV tests detect the presence of these antibodies. There are rapid tests that can provide results in 20 minutes2, but it usually takes 68 weeks after someone has been exposed to the virus for enough HIV antibodies to accumulate for accurate detection through testing . This period represents one of the most dangerous for HIV transmission, since a person can receive a negative test result and yet be highly infectious, capable of rapidly spreading the virus through unsafe behaviors. The Centers for Disease Control and Prevention now recommends that HIV testing be provided to anyone 1364 years old as part of routine medical care and that this screening be performed annually for anyone at high risk for HIV infection . NIDA is collaborating with the Substance Abuse and Mental Health Services Administration and others to expand rapid HIV testing to drug treatment facilities to better identify HIV infections and to more efficiently engage patients in comprehensive treatment for both drug addiction and HIV infection.
What Are Vaccines And What Do They Do
Vaccines are products made from very small amounts of weak or dead germs that can cause diseases. They help your immune system fight infections faster and more effectively.
When you get a vaccine, it sparks your immune response, helping your body fight off and remember the germ so it can attack it if the germ ever invades again. And since vaccines are made of very small amounts of weak or dead germs, they wont make you sick.
Vaccines are usually administered by a shot, but sometimes can be administered by mouth or nasal spray. They are widely used to prevent diseases like polio, chicken pox, measles, mumps, rubella, influenza , hepatitis A and B, and human papillomavirus .
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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
Current State Of Brazil Towards The Unaids 90
Brazils response has been progressing steadily towards achieving UNAIDS 90-90-90 treatment target. In 2012, there were an estimated 708,000 PLWHIV in Brazil: 69% diagnosed 64% on ART and 86% virally suppressed. As of 2017, the number of PLWHIV was about 866,000: 84% diagnosed 75% on ART and 92% virally suppressed . Brazil reached the viral suppression 90% goal in 2015, only followed by Chile in Latin America.
Brazils continuum of care cascade, 20122017. People leaving with HIV groups are represented by vertical bars of different colors: total persons in purple persons diagnosed in green persons on ART in pink treated persons with suppressed HIV viremia in blue. Numbers at the top of each bar are in thousands. Percentages at the bottom of each bar are relative to the total number of the previous category
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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.
Newer Drugs And Drug Classes
In recent years, newer classes of antiretroviral drugs have been developed to attack the virus in different ways. Some prevent the attachment of HIV to host cells , while others block the integration of viral coding into the host cell’s nucleus .
In addition, newer versions of PIs, NRTIs, and NNRTIs have been created that offer better pharmacokinetics , fewer side effects, and better drug resistance profiles.
One such example is an updated version of Viread called tenofovir alafenamide . Rather than delivering the drug directly, TAF is an inactive “prodrug” that is converted by the body into tenofovir. This cuts the dose from 300 mg to 25 mg with the same clinical results while reducing the risk of kidney problems associated with Viread use.
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Spread To The Western Hemisphere
Further isolated occurrences of this infection may have been emerging as early as 1966. The virus eventually entered gay male communities in large United States cities, where a combination of casual, multi-partner sexual activity and relatively high transmission rates associated with anal intercourse allowed it to spread explosively enough to finally be noticed.
Because of the long incubation period of HIV before symptoms of AIDS appear, and because of the initially low incidence, HIV was not noticed at first. By the time the first reported cases of AIDS were found in large United States cities, the prevalence of HIV infection in some communities had passed 5%. Worldwide, HIV infection has spread from urban to rural areas, and has appeared in regions such as China and India.
Talk To A Healthcare Provider
If a person has HIV, theyâll probably experience one or more of these skin conditions and rashes.
However, getting diagnosed in the early stages of HIV, starting treatment soon after, and adhering to a treatment regimen will help people avoid the more severe symptoms. Keep in mind that many skin conditions associated with HIV will improve with antiretroviral therapy.
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When And Where Did Hiv Start In Humans
Studies of some of the earliest known samples of HIV provide clues about when it first appeared in humans and how it evolved. The first verified case of HIV is from a blood sample taken in 1959 from a man living in what is now Kinshasa in the Democratic Republic of Congo. The sample was retrospectively analysed and HIV detected. There are numerous earlier cases where patterns of deaths from common opportunistic infections, now known to be AIDS-defining, suggest that HIV was the cause, but this is the earliest incident where a blood sample can verify infection.9
Winning The Arms Race
For one variant to take over, it has to beat out others, either by transmitting more effectively or by being able to make more copies of itself once it reaches a new host.
“If it transmits well but doesn’t replicate well in its new host, it’s not as likely to win out in the end, because it’s got a dead-end path,” said Dr. Bruce Walker, an immunology professor at Harvard Medical School and the Massachusetts Institute of Technology.
Mutations that offer a survival advantage “can get into more people and create more viruses to infect more of the species,” he said.
In a normal person, whose immune system clears the virus in about a week, there’s not much time for mutations to accumulate, said Walker, also director of the Ragon Institute of MGH, MIT, and Harvard, an interdisciplinary immune research center.
But in an immunocompromised person, the virus might linger for months, studies show.
Testing on one 45-year-old American with an immune condition that caused blood clots, showed his body was infected with COVID-19 for more than five months. A 58-year-old German man who’d just had a kidney transplant was hospitalized for six months in 2020 with a lingering case. And 60-year-old American with lymphoma, a type of blood cancer, struggled with COVID-19 for more than five months before eventually seeking hospice care.
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Medical Care And Case Management
- Expert management of HIV Infection and complications related to AIDS
- Primary medical care
- Coordination with your physician and medical case management
- Specialty referrals
- Mental health counseling
- Harm reduction/Safer sex education
- Risk-reduction counseling and education: Includes assistance with substance use, disclosure, interpersonal concerns, and other risk behaviors
- Tobacco cessation counseling
- Nutritional assessments, counseling, and assistance
- Support group for gay and bisexual men living with HIV
Hiv And Aids Medication
There is no cure for HIV and AIDS, but medicines can help. Many people with HIV live long and relatively healthy lives.
HIV damages your immune system by attacking blood cells that help fight infection.
Acquired Immune Deficiency Syndrome is the condition that develops if HIV is not treated.
The medications used to fight HIV are called antiretrovirals. They work to stop the virus multiplying. This helps to protect your immune system from damage caused by HIV.
The medications used to treat HIV and AIDS may be similar.
If your immune system has already been damaged, treatment can help stop further damage and even allow the immune system to partly repair itself.
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What Else Do I Need To Know About Taking Hiv/aids Medicines
It’s important to take your medicines every day, according to the instructions from your health care provider. If you miss doses or don’t follow a regular schedule, your treatment may not work, and the HIV virus may become resistant to the medicines.
HIV medicines can cause side effects. Most of these side effects are manageable, but a few can be serious. Tell your health care provider about any side effects that you are having. Don’t stop taking your medicine without first talking to your provider. He or she may give you tips on how to deal with the side effects. In some cases, your provider may decide to change your medicines.
Accelerating Antiretroviral Drug Development
Established in the early years of the HIV/AIDS pandemic, the NIAID-supported National Cooperative Drug Discovery Group Program for the Treatment of AIDS provided a framework for scientists from academia, industry, and government to collaborate on research related to the identification and development of new drugs. NIAID-supported researchers developed cell culture and biochemical test systems that allowed researchers to more easily screen drug candidates, and NIAID also played a key role in the development of animal models for preclinical testing.
In the early 1990s, additional NRTI drugs gained FDA approval. The development of AZT and other NRTIs showed that treating HIV was possible, and these drugs paved the way for discovery and development of new generations of antiretroviral drugs.
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Durable Hiv Suppression With Triple
While the effects of two-NRTI therapy were better than those of single-drug therapy for many people with HIV, they were of limited duration. A major advance came in 1996, when researchers found that triple-drug therapy could durably suppress HIV replication to minimal levels, while creating a high genetic barrier against development of drug resistance.
The possibility and success of triple-drug therapy, also called highly active antiretroviral therapy, or HAART, was partially due to the appearance of a new antiretroviral drug classthe protease inhibitors. In December 1995, saquinavir became the first protease inhibitor to receive FDA approval. In 1996, results from an NIAID-sponsored trial showed that a three-drug regimen of saquinavir, ddC, and AZT was more effective than two-drug therapy with ddC and AZT.
One of the key studies demonstrating the efficacy of triple-drug therapy was ACTG 320, also supported by NIAID. This study found that a three-drug combination of the protease inhibitor indinavir and two NRTIs reduced viral loads to very low levels for up to one year in people who had previously been taking single-drug therapy. ACTG 320 also showed that adding at least two new drugs when switching therapy is more effective than adding a single new drug.
Unresolved Questions About Hiv Origins And Emergence
The discovery of the main HIV / SIV phylogenetic relationships permits explaining broad HIV biogeography: the early centres of the HIV-1 groups were in Central Africa, where the primate reservoirs of the related SIVcpz and SIVgor viruses exist similarly, the HIV-2 groups had their centres in West Africa, where sooty mangabeys, which harbour the related SIVsmm virus, exist. However, these relationships do not explain more detailed patterns of biogeography, such as why epidemic HIV-2 groups only evolved in the Ivory Coast, which is one of only six countries harbouring the sooty mangabey. It is also unclear why the SIVcpz endemic in the chimpanzee subspecies Pan troglodytes schweinfurthii did not spawn an epidemic HIV-1 strain to humans, while the Democratic Republic of Congo was the main centre of HIV-1 group M, a virus descended from SIVcpz strains of a subspecies that does not exist in this country. It is clear that the several HIV-1 and HIV-2 strains descend from SIVcpz, SIVgor, and SIVsmm viruses, and that bushmeat practice provides the most plausible cause of cross-species transfer to humans. However, some loose ends remain.
It is not yet explained why only four HIV groups spread considerably in human populations, despite bushmeat practices being widespread in Central and West Africa, and the resulting human SIV infections being common.
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