The red ribbon has long been a universal symbol of World AIDS Day, observed annually at the start of December. This global initiative raises awareness and addresses stigma surrounding HIV and AIDS, a topic that remains under-discussed despite its relevance to public health.
What Is HIV And How Is It Different From AIDS?
HIV stands for human immunodeficiency virus. It is a type of virus that compromises the immune system, specifically white blood cells. The white blood cells are play an important role in protecting the body from harmful bacteria and other microorganisms.
HIV infection leads to severely weakened immunity, making it difficult for the body to fight even simple infections and potentially increasing the severity of common illnesses.
Meanwhile, AIDS stands for acquired immunodeficiency syndrome. AIDS is the advanced stage of HIV infection, characterised by a group of symptoms associated with extremely weakened immunity, particularly in infected individuals who are not undergoing treatment.
HIV can then progress to acquired immunodeficiency syndrome (AIDS) – an advanced stage of HIV infection. Characterised by significantly weakened immunity and opportunistic infections, AIDS typically manifests in those not receiving timely treatment.
Global Impact of HIV
The World Health Organisation (WHO) reported that nearly 40 million people were living with HIV infection globally in 2023, with approximately 630,000 deaths were attributed to HIV-related causes.
In Asia, the HIV burden varies:
- Singapore reported approximately 9,500 cases of HIV at the end of 2023
- Malaysia documented 85,283 cases of HIV
- Philippines saw the number of new HIV cases increase by six folds, from 4,400 in 2010 to 28,000 in 2023. It faces the fastest-growing HIV epidemic in the Asia-Pacific region.
Read also: The Philippines’ HIV Epidemic Moving In The Wrong Direction
How Is HIV Infection Treated?
The cornerstone of HIV management is antiretroviral therapy (ART). ART typically involves a combination of several drugs that suppress HIV to undetectable levels.
Effective ART reduces viral load, minimises the risk of secondary infections, and prevents HIV transmission.
Classes of Antiretroviral Drugs
There are several common classes of antiretroviral drugs that target different parts of the viral replication process to control the spread of HIV.
An ART cocktail combines a number of these drugs to bring about greater response to the treatment.
1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
NRTIs block the reverse transcriptase enzyme, stopping the reverse transcription process and preventing HIV from replicating.
Examples: Zidovudine, Lamivudine, Abacavir, Tenofovir, Emtricitabine
2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs also block HIV from using the reverse transcriptase enzyme, preventing the virus from integrating itself into human DNA. Stopping this step stops the virus from multiplying and spreading.
Examples: Efavirenz, Etravirine, Nevirapine, Rilpivirine
3. Protease Inhibitors (PIs)
PIs block protease, an enzyme that is required for HIV to replicate itself.
Examples: Ritonavir, Lopinavir/ritonavir, Atazanavir, Darunavir
4. Integrase Inhibitors
These drugs block integrase, a protein that allows the virus to integrate its DNA into the host cell’s DNA. Without this step, HIV cannot replicate.
Examples: Dolutegravir, Raltegravir, Cabotegravir
5. CCR5 Antagonists
CCR5 antagonists block a the CCR5 receptor on the surface of cells, preventing the virus from binding and entering healthy cells.
Example: Maraviroc
6. Others
Other medication classes include capsid inhibitors and monoclonal antibodies. Researchers are continually developing more ART options targeting different mechanisms of HIV replication.
The choice of ART is carefully decided by the attending doctor. This can depends on several patient factors, including:
- Viral load
- T-cell count
- HIV strain type
- Severity of the HIV infection
- Co-existing chronic medical conditions
- Potential drug interactions with other medications
Taking Antiretroviral Therapy (ART)
To improve adherence, ART often comes as fixed-dose combination pills containing two or more drugs from the same or different classes, taken once daily. This simplifies the drug regimen for patients greatly.
Examples of fixed-dose ART tablets:
- Abacavir/lamivudine tablet (both NRTIs)
- Dolutegravir/rilpivirine tablet (integrase inhibitor and NNRTI)
- Emtricitabine/rilpivirine/tenofovir disoproxil fumarate tablet (two NRTIs and one NNRTI)
- Bictegravir/emtricitabine/tenofovir alafenamide tablet (integrase inhibitor and two NRTIs)
Recent advancements such as long-acting injections have also been approved for HIV treatment.
@medicalchannelasia HIV, the virus that causes AIDS has killed over 40 million people worldwide. Today, however, nearly as many people are living with HIV as have died from it – with modern treatments, an HIV diagnosis is no longer a death sentence! Today, on World AIDS Day 2023, Dr Deano Reyes @Doc Deano (@Pulse Clinic Manila) is here to share a hopeful message in the treatment landscape of HIV/AIDS, and an important message on HIV treatment and reducing stigma ❤️ #medicalchannelasia #hivaids #hiv #aids #art #antiretroviral #hivtreatment #worldaidsday #aidsawareness #learningisfun #learnontiktok #doctorsoftiktok #lgbt ♬ original sound – Medical Channel Asia
Cabotegravir is administered monthly or every two months. It is often combined with rilpivirine, with both injections given intramuscularly. These long-acting medications, administered monthly or every two months, cater to individuals who prefer less frequent dosing or face challenges with daily oral medication.
Injectable treatments can provide added privacy and convenience, dealing with stigma, or managing conditions like swallowing difficulties or gastrointestinal issues.
While injections reduce the pill burden, they require strict adherence to clinic visits, which may be challenging. Regular appointments could be an inconvenience especially for those with work and personal commitments.
*Do note that availability of medication can differ from region to region. Do check with your local healthcare provider to understand the treatment options available.
Have a pressing question for a doctor? Medical Channel Asia has launched a community forum page where you can get questions answered by a medical specialist. Visit the community forum here.
Preventing HIV Infection
Prevention is better than cure, especially for HIV infection. Other than practising safe sex and being cautious when handling used needles, HIV infection can be prevented using medications through two ways, which are pre-exposure prophylaxis and post exposure prophylaxis.
Pre-Exposure Prophylaxis (PrEP)
PrEP is a preventive medication regimen for people at high risk of HIV, such as those with HIV-positive partners, individuals with multiple sexual partners and inconsistent condom use, and those with who use drugs.
Oral PrEP is most effective when taken consistently each day. It is reported that consistent use of PrEP reduces the risk of getting HIV from sex by about 99%, and from injection drug use by at least 74%.
Examples: Emtricitabine/tenofovir (oral medication), and cabotegravir (injection)
Read more: HIV Treatment: The Future and PreExposure Prophylaxis
Post-Exposure Prophylaxis (PEP)
PEP is a short-term antiretroviral treatment taken after potential HIV exposure. If one have had a high risk exposure within the last 72 hours (any unprotected anal or vaginal sex) with a partner who is HIV positive or is in a HIV-risk group, consult a doctor immediately. PEP may be recommended by a doctor if the risk of exposure is high.
The treatment is not 100% effective and there are cases of people who are still infected with HIV despite receiving PEP. It is an emergency prevention measure and should not be a substitute to regular preventive methods like condom use.
Examples of PEP: 30 day regimen of emtricitabine/tenofovir. Rilpivirine or dolutegravir may be added for triple-drug therapy.
Key Takeaways
- HIV is no longer a death sentence. With advancements in ART and preventive measures like PrEP and PEP, people with HIV can lead full, healthy lives.
- Prevention is of utmost importance. Practice safe sex, handle needles with caution, and screen regularly if you are at high risk.
- For those living with HIV, consistent adherence to ART, routine monitoring, and keeping up to date with vaccinations can minimise risks of complications.
With ongoing research and global collaboration, we edge closer to a world free of HIV stigma and the devastating impact of AIDS.
