World AIDS Day, held every 1 December, aims to not only raise awareness of HIV/AIDS and show support for those living with HIV, but also to tackle the stigma and misconceptions surrounding the condition. 1 Despite there being no cure for HIV, considerable progress has been made in treating the infection over the last 30 years. If diagnosed and treated early enough, people with HIV can now live long, healthy lives; a concept that was unimaginable when the epidemic first broke out in the 1980s.1,2 Even with this progress, the stigma, ignorance and misconceptions surrounding HIV and those living with it remain a huge issue. 1 Studies have shown that a third of those living with HIV in the UK have faced discrimination, and alarmingly 50% of these cases involve those working in the healthcare industry. 3
One way in which we can try to change how people think about HIV is to dispel the numerous myths surrounding it.
Myth: HIV is no longer an issue
- Although rarely a prominent topic in the media, the HIV epidemic is ongoing, with an estimated7 million living with HIV worldwide.1
- In the UK alone, more than 101,000 people are living with the virus, and 5,000 individuals are diagnosed each year. 1, 2
Myth: HIV and AIDS are the same
- Just because an individual is living with HIV, it does not necessarily mean they have AIDS. 2
- HIV is Human Immunodeficiency Virus.2
- This virus can be transmitted via unprotected sex, needles containing infected blood, infected blood donation and organ transplants; and from mother to child during pregnancy, birth or 4
- Once within the body, HIV attacks the CD4+ T cell population (a vital component of the adaptive immune system). 2
- Unless treated, HIV will continue to destroy these cells, compromising the immune system and thereby increasing susceptibility to pathogenic infection and certain cancers. 5, 6
- AIDS (Acquired Immune Deficiency Syndrome) occurs in the latter stage of HIV infection, and is defined by a set of symptoms rather than simply the presence of the virus.2 Characterised by very low levels of CD4+ T cells, and the presence of AIDS-related pathologies (such as tuberculosis and Kaposi’s sarcoma), the diagnosis of AIDS marks just how advanced the damage to the immune system has become. 7, 8
Myth: HIV only affects certain groups of people
- Although some groups of people are more at risk of HIV infection, anyone exposed to the virus via one of the ways previously described can become infected with HIV.4
Myth: There is no treatment for HIV infection
- Although HIV infection currently has no cure, effective antiretroviral treatment has enabled people with HIV to have the same life expectancy as the general population.9
- These antiretroviral drugs help to control the number of HIV virus particles in the blood (the viral load), thereby preventing further destruction of the CD4+ T cell population and enabling the immune system to function more effectively.10
- The earlier HIV infection is diagnosed, the better the chances are of bringing it under control.8
- In order to prevent the development of drug resistance, the World Health Organization recommends that at least three antiretroviral drugs are prescribed in combination:10
- Tenofovir – a nucleotide reverse transcriptase inhibitor (NtRTI) 11
- Acts as a nucleotide analogue that competitively inhibits reverse transcriptase, the enzyme required for replication of the viral genome11
- This inhibition prevents viral replication, therefore keeping viral load under control11
- Lamivudine or emtricitabine – nucleoside reverse transcriptase inhibitors (NRTIs) 12
- NRTIs work using a similar mechanism to NtRTIs, but require additional phosphorylation steps before they can act as analogues12
- Efavirenz – a non-nucleoside reverse transcriptase inhibitor (NNRTI) 13
- Directly binds to reverse transcriptase, thus inhibiting it in a non-competitive manner 13
- Tenofovir – a nucleotide reverse transcriptase inhibitor (NtRTI) 11
- Along with reverse transcriptase inhibitors, other classes of antiretrovirals such as integrase inhibitors, entry inhibitors and protease inhibitors may also be prescribed to help control viral load.14
- Both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) drugs may prevent infection developing.15,16
- PrEP is taken prior to HIV exposure. If then exposed to HIV, the PrEP drugs already within the body should prevent HIV infection developing. This is currently being trialled throughout England and is already widely available in Scotland.15
- If started within 72 hours of HIV exposure (preferably within 24 hours), PEP can reduce the chances of HIV developing. 16
- Two forms of HIV vaccine are being researched: 17
- Preventative vaccine – if exposed to HIV, this would prevent HIV developing
- Therapeutic vaccine – although unlikely to be a cure, this vaccine could help control viral load for those living with HIV, thus removing the need for antiretrovirals
Myth: People living with HIV are always contagious
- Research has shown that antiretroviral treatment can bring viral load down to undetectable levels; in this circumstance, as long as the individual continues to take their treatment and their viral load remains undetectable, there is there is no risk that they will transmit HIV. 18
Huge progress has been, and is continuing to be made in HIV/AIDS treatment, but in order to fight this disease on all fronts, changes in attitude within both the healthcare industry and the general population are essential.
To find out more about World AIDS Day and how you can get involved, please visit: http://www.worldaidsday.org/2018-campaign/
- World AIDS Day. 2018 campaign. Available at: http://www.worldaidsday.org/2018-campaign/. Accessed November 2018.
- Avert. What are HIV and AIDS? Available at: https://www.avert.org/about-hiv-aids/what-hiv-aids. Accessed November 2018.
- NAT. HIV in the UK statistics – 2015. Available at: https://www.nat.org.uk/we-inform/HIV-statistics/UK-statistics. Accessed November 2018.
- Avert. Myths about HIV and AIDS. Available at: https://www.avert.org/hiv-transmission-prevention/myths. Accessed November 2018.
- Deeks SG, Overbaugh J, Phillips A, et al. HIV infection. Nat Rev Dis Primers. 2015; 1: 15035.
- National Cancer Institute. HIV infection and cancer risk. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hiv-fact-sheet. Accessed November 2018.
- UCSF Health. AIDS diagnosis. Available at: https://www.ucsfhealth.org/conditions/aids/diagnosis.html. Accessed November 2018.
- Avert. Symptoms and stages of HIV infection. Available at: https://www.avert.org/about-hiv-aids/symptoms-stages. Accessed November 2018.
- NHS. What is the life expectancy for someone with HIV? Available at: https://www.nhs.uk/common-health-questions/sexual-health/what-is-the-life-expectancy-for-someone-with-hiv/. Accessed November 2018.
- Avert. Starting antiretroviral treatment for HIV. Available at: https://www.avert.org/living-with-hiv/starting-treatment. Accessed November 2018.
- NAM Aidsmap. Nucleotide RT inhibitors. Available at: http://www.aidsmap.com/Nucleotide-RT-inhibitors/page/1729429/. Accessed November 2018.
- NAM Aidsmap. Nucleoside RT inhibitors. Available at: http://www.aidsmap.com/Nucleoside-RT-inhibitors/page/1729426/. Accessed November 2018.
- NAM Aidsmap. Non-nucleoside RT inhibitors. Available at: http://www.aidsmap.com/Non-nucleoside-RT-inhibitors/page/1729428/. Accessed November 2018.
- Terrence Higgins Trust. How HIV treatment works. Available at: https://www.tht.org.uk/hiv-and-sexual-health/living-well-hiv/hiv-treatment/how-hiv-treatment-works. Accessed November 2018.
- Terrence Higgins Trust. PrEP (pre-exposure prophylaxis). Available at: https://www.tht.org.uk/hiv-and-sexual-health/prep-pre-exposure-prophylaxis. Accessed November 2018.
- NHS. Can post-exposure prophylaxis (PEP) stop me getting HIV? Available at: https://www.nhs.uk/common-health-questions/medicines/can-post-exposure-prophylaxis-pep-stop-me-getting-hiv/. Accessed November 2018.
- The history of vaccines. The Development of HIV Vaccines. Available at: https://www.historyofvaccines.org/content/articles/development-hiv-vaccines. Accessed November 2018.
18. Avert. What does undetectable mean? Available at: https://www.avert.org/living-with-hiv/antiretroviral-treatment/what-does-undetectable-mean. Accessed November 2018