HIV – truth and myths
Why should we stop being afraid of an HIV diagnosis in the XXI century
Almost 40 years have passed since scientists discovered the human immunodeficiency virus in 1983. Today, the diagnosis of "HIV infection" is not a verdict, but thanks to the discovery of highly active antiretroviral therapy, the disease itself has passed into the category of controlled.
However, the fears and prejudices associated with HIV and its terminal stage, AIDS, are still alive today. The reason is a lack of knowledge. This is what leads to the fact that people who have received a positive test perceive the diagnosis tragically, and society stigmatizes HIV-infected people. In the material of TASS – about the history of the virus, the search for drugs and dangerous myths.
The history of one virus
The terrible virus that came from monkeys was actively talked about in the 80s of the last century. It is assumed that he appeared in the Congo back in the 60s, and then spread from the African continent to America and went around the world. In the early 80s, when it became known about the first cases, no one understood what was happening to people and how to treat them.
In 1981, the first scientific article describing AIDS was published, and in 1983, scientists from two countries - from the Pasteur Institute in France and the National Cancer Institute in the USA – independently discovered the human immunodeficiency virus that causes acquired immunodeficiency syndrome (AIDS). Already in 1985, the first licensed HIV test appeared. Soviet people were among the last to learn about AIDS: the first case of the disease was registered in the USSR in 1986.
The virus was rapidly spreading across the planet: by 1991, ten million people had been diagnosed with it, and by the beginning of the XXI century, AIDS had claimed the lives of 21.8 million people.
Scientists have established that HIV is a retrovirus that affects the cells of the immune system and makes the body vulnerable to external agents attacking the immune system. Immunodeficiency, which develops as a result of HIV infection, leads to an increased risk of a number of diseases that a healthy immune system can resist. HIV-infected people get tuberculosis a hundred times more often than healthy people. In addition, they are more likely to develop oncology and opportunistic infections – diseases caused by opportunistic viruses, bacteria or protozoa. These, for example, include herpes, candidiasis and human papillomavirus.
For many years, information about the deadly danger of the disease has caused panic and generated myths. At the same time, the obvious danger of the disease has forced scientists around the world to rally and start looking for an effective therapy.
Today, when more than 38 million people live with HIV infection in the world, such therapy exists and is available in many countries. We are talking about antiretroviral therapy (ART). And, although the drug for a complete cure from the virus has not yet been invented, thanks to modern medicines, the disease has passed into the category of fully controlled. An HIV-positive person, taking medications prescribed by a doctor, lives a normal life.
The Path to one Tablet
The path to creating effective medicines was not easy. At first, as in the case of the COVID-19 pandemic, scientists tried to use those medicines that already existed on the market. Then hopes were pinned on an anti-cancer drug, but they were not justified.
The era of antiretroviral therapy began with the registration of a new drug in 1987. It has been included in clinical recommendations for the treatment of patients for many years, but over time it turned out that the virus is able to spontaneously mutate in the body and quickly acquire resistance to the drug.
The search for effective therapy continued. In the early 1990s, it became clear that one pill was not enough to treat this disease: scientists began to develop combinations of various drugs. New drugs from the group of nucleoside reverse transcriptase inhibitors (NIOT) have appeared. These antiretroviral drugs are structurally similar to organic compounds that are part of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA) – they can competitively block a certain HIV enzyme and slow down the synthesis of viral DNA.
The fact is that all the genes of this virus are stored in RNA, and in humans – in DNA. Therefore, in order to reproduce, the virus must rewrite its genes from one format to another using reverse transcriptase. Drugs from the NIOT group interfere with this process: they do not allow the virus to transfer genes from RNA to DNA.
However, in 1993, at the international AIDS conference, scientists announced research data, according to which, the combination of drugs of this group alone does not have a long-term effect. Around the same time, a new group of drugs began to be used – protease inhibitors acting on another enzyme of the virus. And in 1996, another class of antiretroviral drugs appeared – non-nucleoside reverse transcriptase inhibitors (NNRTIs). Like NIOTES, drugs of this class block the virus enzyme, interfering with the construction of HIV RNA, that is, the reproduction of the virus.
Scientists have found that the combination of drugs from several groups of drugs stops the reproduction of the virus in the body, because the drugs affect different enzymes of the virus, blocking its reproduction at different stages.
This discovery formed the basis of a new three-component therapy for HIV infection, developed in 1996. It still remains the basis of most of the well-known ARVT schemes. It includes two NIOT drugs and a third, which differs in its action.
Since 1997, HIV has become a controlled chronic infection, and people who receive medications stop dying from AIDS. The viral load of people taking antiretroviral therapy has been reduced to an undetectable level, they can create families with HIV-negative partners, give birth to healthy children, which was impossible to imagine back in the 80s. And now a new goal has appeared in the treatment of such patients: to provide people living with HIV with the most convenient drugs that will not affect their lives, will reduce the risk of developing resistance (immunity to therapy) and the appearance of side effects to a minimum.
Every year there are more and more new drugs and even new groups of drugs, the toxicity of therapy is constantly decreasing. So, in 2007, another new class of drugs appeared – integrase inhibitors that block the introduction of HIV into the DNA of the host cell. Currently, this class has five different drugs.
Another great achievement of pharmaceuticals was the development of drugs of the "two or three in one" type, in which drugs of different groups are combined. In 2006, the first combined drug, which contains a three-component scheme in one tablet, entered the market. Today there are about 30 such combined drugs on the market.
These medications are effective for several reasons. First of all, such a scheme is much more convenient: a person drinks only one tablet a day and can choose a comfortable time for taking it, there is no need to adjust the whole day to the therapy schedule. In addition, the risk of forgetting to take one pill is much lower, and the percentage of patients who adhere to treatment is higher. When a person takes several pills several times a day, there is always a chance of accidentally not drinking one of the drugs in the scheme or skipping therapy completely, and this increases the risk of developing drug immunity.
Another important point: the half-life of the drug from the body in the case of "one tablet once a day" schemes is longer, so even if a person for some reason cannot take the drug, then the next day he will have a sufficient concentration of the active substances of the drug in the body to maintain adherence. And, of course, most new drugs cause fewer side effects.
By 2014, the large-scale use of ART helped prevent about 7.8 million deaths. Treatment tactics are also changing: if at first doctors prescribed therapy to patients with a high viral load, now, according to new WHO clinical recommendations, everyone should receive treatment as soon as possible after the diagnosis of HIV infection.
At the present stage, medicine faces new challenges: to achieve complete liberation from the virus. In addition, the world medical community is waiting for the appearance of the first long-acting injection therapy drugs. Their development began in the 2010s. They will allow you to replace the daily intake of pills with injectable medication once every two months, which will further simplify treatment.
Modern ART consists of one combined drug or several monopreparations. In Russia, multicomponent therapy is more often prescribed. Combined drugs are mainly received by children, as well as patients who have difficulties with taking therapy or resistance to schemes consisting of monopreparations.
True or false
Faced with a diagnosis for the first time, people search for information on the Internet and find unverified and outdated data, and sometimes outright lies. The movement of HIV dissidents spreads information about the futility of treatment: in their opinion, therapy leads to health problems and even deaths.
The problem is that there is not much available information about highly active antiretroviral therapy or it is written in a complex scientific language. As a result, people still believe the myths associated with HIV and ART. Upon closer examination, these myths are easily debunked.
1. HIV-positive people cannot have relationships with HIV-negative people because they can infect loved ones.
Sometimes people are afraid to approach an HIV-infected person, hug him. In fact, HIV does not spread by airborne droplets and through common household items. The human immunodeficiency virus is transmitted exclusively through blood, semen, maternal breast milk and other biological fluids. Faced with oxygen, the virus dies.
At the same time, if an HIV-infected person takes prescribed medications correctly, when an undetectable viral load is reached, he will not infect a partner even with unprotected sex. Sometimes it is possible to achieve complete undetectability of the virus in two weeks of therapy, but it is believed that a person does not transmit HIV only six months after the first analysis with an undetectable load. However, even in this case, you should not abandon the means of barrier contraception: they protect against many other diseases.
2. HIV-positive people cannot have children.
Today, many couples with HIV positive status have healthy children. According to statistics, if an HIV-positive woman follows the recommendations of doctors during pregnancy, the chances of giving birth to a healthy baby are 98-99%. In the absence of antiviral prophylaxis in a pregnant woman during childbirth and during the first time of the child's life, HIV is transmitted in 20-40% of cases. If a pregnant woman is diagnosed with HIV for the first time, she is immediately prescribed antiretroviral drugs to prevent perinatal transmission of the virus: to a woman – during pregnancy and childbirth, to a child – during the first four weeks of life. In addition, the newborn is transferred to artificial feeding immediately after birth to minimize the risk of infection.
3. People die from HIV.
Today, world medicine considers HIV to be a chronic infection that can be controlled. Experience has shown that if you take modern medications, HIV-positive people live as long as an average ordinary person.
People with HIV infection can take antiretroviral drugs and lead a normal lifestyle while scientists come up with a drug that can stop the virus once and for all.
4. HIV is spread only within traditional risk groups.
The last, but most important myth. HIV has gone beyond the traditional risk groups – people who inject drugs, representatives of the LGBT community and sex workers. More than 60% of new infections are associated with heterosexual contacts. Therefore, everyone should take responsibility for their health and the health of their loved ones: use barrier contraceptives and regularly, once every six months or a year, take an HIV test. Often, the transmission of the virus occurs precisely because of ignorance of their status and the untimely start of taking antiretroviral drugs.
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