Dr Catherine Chima-Okereke a Specialist Adviser to the Care Quality Commission (CQC) UK is African Voice Newspaper guest writer in this final part on HIV/AIDS.
Is there hope for a vaccine to cure HIV/AIDS?
Being a very wary person, my personal opinion is that this will not happen in the near future. Firstly, HIV mutates (changes its genetic material) very frequently. It also reproduces at a lightning-fast rate; a single virus can generate billions of copies in just one day. It will therefore be very difficult to produce a vaccine that will ‘catch’ the various mutations, and it will keep reproducing and mutating! However, I hereby describe the recent developments from the 23rd International AIDS Society conference, also known as AIDS 2020, where the latest research towards the development of an HIV cure and vaccine is presented.
A Brazilian man who has spent 15 months off antiretroviral without, so far, HIV being detected in any test may represent the first case of a functional cure without the risks of a stem cell transplant. However, experts caution against reading too much into this case, as it involved only a single individual and extensive testing for traces of HIV at various sites in the man’s body have not yet been carried out.
Leading researchers debated whether gene therapy or immunotherapy is more likely to lead to an HIV cure. There is proof of concept for a gene therapy approach in the cases of two men who have been cured following stem cell transplants from donors with a mutation in the gene for CCR5. However, some experts believe that an immune therapy approach is more likely to deliver long-term remission of HIV and could be delivered at scale, noting that immunotherapies are already being used to treat cancers.
The combination of injectable antiretroviral therapy soon after infection and vesatolimod (a novel immune-activating drug) quickly suppressed the amount of virus in the blood and delayed antibody responses to the virus in a monkey study, suggesting a possible role for the drug, vesatolimod, in a cure strategy.
Scientists working towards a cure are trying to better describe the ‘latent reservoir’ of HIV DNA in elite controllers – Elite controllers are individuals living with HIV who control HIV multiplication without taking antiretroviral therapy. They are trying to understand why these individuals are able to naturally control of the virus. They reported that elite controllers have low levels of intact provirus (virus able to replicate), and these are associated with having receptor molecules on the surface of their immune cells that are less responsive to HIV infection.
The biotech firm Moderna is devising an HIV vaccine that induces cells to make their own virus-like particles; these look like HIV to the immune system. They hope this will ‘educate’ the system to recognise the broadest possible number of variants of HIV, and the parts of them that are most universal. Data presented from a challenge study – in which the vaccine was tested against viral infection in animals – included some disappointing and some encouraging results.
Is it possible to be infected with HIV/AIDS without been involved in sexual activity?
Yes. Although most people who get HIV get it through anal or vaginal sex; others get it by sharing needles, syringes, or other drug injection equipment; it is possible to be infected without being involved in sexual activity. HIV can be transmitted through contaminated blood or tissue products, such as transmission of blood that has not been screened for infections.
A mother who is HIV positive and not on treatment can transmit HIV to her child either during pregnancy, delivery or during breastfeeding. This is why it is important to test for HIV and start the positive people on treatment.
A mother who is HIV positive and not on treatment can transmit HIV to her child either during pregnancy, delivery or during breastfeeding. This is why it is important to test for HIV and start the positive people on treatment.
Is it true that HIV/AIDS patients can now live a normal life?
Absolutely. HIV is a chronic medical condition like diabetes, high blood pressure, etc. If diagnosed early, and the person started on treatment; as long as they take their HIV drugs regularly, they can live a normal life.
What is PrEPProtects about?
At present, there is no cure for HIV. For years, the most common prevention method for HIV has been the use of condoms. Now one can prevent HIV infection by taking HIV medications in the form of Pre-Exposure Prophylaxis (PrEP). This helps to lower the chance of infection for people who are HIV-negative. Both men and women can use it. PrEP is often prescribed for people who are at high risk of HIV, such as men that have sex with men, transgender individuals, people whose sex partners have HIV and not on treatment, etc.
What is PrEP? How does it work?
PrEP stands for pre-exposure prophylaxis. It is a pill an HIV negative individual, who is at risk of acquiring HIV, can take to protect themselves from acquiring HIV infection.
There are a few ways of taking PrEP medications, but the more common method is taking one tablet a day, every day.
How effective is it?
Skipping a dose or not taking PrEP regularly lowers the pill’s ability to protect the individual. If PrEP is taken:
• Every day, the level of protection is around 99%
• 4 days a week, the level of protection is around 96%
• 2 days a week, the level of protection is around 76%
It can take 7-20 days from the time the individual takes the first pill until it becomes most effective.
Why is HIV/AIDS a stigma within the African community?
I travel to my home country, Nigeria, from time to time. From my experience, stigma against HIV positive individuals still exist because of lack of information both for the healthcare providers and for the people in the community. Most people know that there is now treatment for HIV. Others are aware that treatment can be used for prevention of HIV and that HIV positive individuals on treatment are less infectious; however, most people still think that anyone who tested positive for HIV can still infect them whether or not the HIV positive person is on treatment.This limited knowledge and paucity of information by the community and health service providers fuels the stigma against HIV positive individuals.
As a result, HIV positive people are treated differently from others.
Knowing that someone is HIV positive not only causes being denounced by others; it can even result in violence against the HIV positive individual. Husbands can divorce or separate from their HIV positive wives. In most cases, such husbands infected their wives with the virus in the first place; but they often refuse to be tested. Many women are often diagnosed either during routine tests in pregnancy by health workers or when they test the child after delivery. This brings me to the problem of economic dependence, which is another factor that causes discrimination against HIV positive people. HIV-positive women often impose stigma upon themselves because of their economic dependence on men, either as daughters, partners or spouses. The fear of separation, divorce or violence against them often prevents these women from disclosing their HIV status.
Summary
HIV infection is a chronic medical condition. If detected early and the person started on HIV treatment, they can lead a normal live. If an HIV positive individual is on HIV treatment, and the viral load (virus in the blood) is undetectable, they cannot transmit HIV infection. Education and training will reduce the stigma against people living with HIV. This will also encourage others to get tested and if positive, started on HIV treatment.
Dr Catherine Chima-Okereke is Consultant/Director of Herefordshire Integrated Sexual Health & HIV Services. She has worked in the U.K. health industry for over thirty years. She worked in the NHS from February 1991 to March 2019 and has been in senior management since 2003. Catherine is now applying her wealth of clinical and management experience in the independent sector – Solutions4Health. She has broad clinical experience – Medicine, Obs/Gynae, Genitourinary Medicine (GUM), Contraception, HIV Medicine, Mental Health & Forensic Medicine.
Kindly follow us on twitter:@AfricanVoice2
