Talking about World AIDS Day

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HIV and AIDS remain one of the most destructive pandemics in history. Over 36.3 million deaths and 37.7 million infected and living with the disease have been recorded. On World AIDS day, on the 1st of December, the fight against the virus continues. This day commemorates those who have passed due to the virus and support to those living with the disease continue.

HIV and AIDS have become more manageable with the use of drugs. According to the World Health Organisation, it will soon be classed as a chronic disease.

What is HIV?

The virus known as HIV attacks the T-cells in the immune system and is transmitted through bodily fluids. This includes blood, semen and breast milk. It mostly spreads through unprotected sex, through drug users sharing needles and through birth.

Over time, HIV destroys a multitude of CD4 cells making the body too weak to fight infections and diseases. This eventually leads to AIDS (Acquired Immunodeficiency Syndrome).

World AIDS Day and the fight against HIV

The fight against the disease remains a top priority by leading researchers in Western regions who have access to greater resources, labs and insight into the treatment of the disease. World AIDS Day seeks to underline the ongoing struggle against HIV and AIDS, as well as the inequality that is rife in the availability of effective treatment.

Sub-Saharan countries rank the highest in HIV infections. Countries such as Namibia, Lesotho, Botswana, Eswatini (all with a population density under 3 million) ranking in the top 5. In densely populated countries such as Nigeria, HIV cases remain relatively low in comparison to the population. This is likely due to the lack of access to testing sites, reluctance to test for HIV and resistance to taking medicines owing to stigmas. Yet here, access to preventatives and treatment are the rarest.

A short history of HIV

The HIV “family-tree” and its origins is a matter of great debate. The virus reportedly dates back to the 1940s. It finds its origins in the Democratic Republic of Congo in a breed of chimpanzees that had a virus called SIV (simian immunodeficiency virus). Humans caught the virus after killing and consuming this bushmeat, or through cuts and bleeds whilst hunting.

HIV lay predominantly low and largely undetected until it reared its head in the early 80s among the gay community in parts of America. It was also found among drug users who used needles, then later in heterosexual partners. The Pasteur Institut labs in Paris then discovered that HIV transmuted to AIDS around 1983-1984. The vicious cycle continued in women where the virus was transmitted to children. These children suffered immensely from birth and died pre-teen as was later seen in Nkosi Johnson of South Africa.

In 1985, Africa had 2, 323 reported AIDS cases while America had 31 741 cases, Asia 84 and Europe 3, 858. In the years that followed HIV had a Hiroshima effect in Africa. It wiped out millions. It is still the leading cause of death in Africa, which has the highest prevalence of people living with HIV in the world.

Funding in research and the establishment of multi-billion dollar foundations to help Africa, have proved fruitless in finding a solid cure. Copious amounts of drugs, antiretroviral medicines, preventative medicines, rapid test-kits, condom rings and all manner of other preventative medical gizmos make their way to Africa to help ease the strain of the virus.

Developing an HIV vaccine

After four decades of this virus killing and causing suffering, the world waits with bated breath for an HIV vaccine, while the option of a cure fades. The research into vaccines has been slow and tricky.

The reason for this is that most of the surface of the virus is densely coated with sugar molecules that do not trigger an immune response. The parts that are exposed are highly variable. However, new hope has risen early in 2021 as various vaccine trials have started to bear fruit. As with SARS-CoV-2, the virus that causes COVID-19, HIV uses spike proteins to gain entry to its host cells. As a result of the rapid mutation of the genes that make the spike, HIV has millions of different strains. This means that HIV is not really one virus, but is in fact dozens of viruses with much in common.

Successful vaccine trials

One of the biggest advances in AIDS vaccine research was the RV144 trial. It was a controversial, landmark treatment in Thailand that tested a new vaccine on 16,000 Thai volunteers. Taking place over three years, from 2003 to 2006, RV144 was only the fourth HIV vaccine efficacy trial that was ever completed. In 2009, the published results revealed a small reduction in HIV infection, with a reported efficacy rate of approximately 32%. While this isn’t the 50% rate needed for the Thai government to support approval, it was the first evidence of effectiveness for any type of HIV vaccine.

Off the back of this research, South African scientists have adapted the Thai RV144 virus to develop a vaccine. This vaccine is being used in the current HVTN 702 trial being conducted in South Africa. The study kicked off in 2016, and is likely approaching its end in the next 2 or 3 years. Each patient receives a series of injections at five different time points. These include DNA vaccines that rally the body’s defenses against the virus. Also included is an injection where a protein is added that gives the immune system an extra boost.

At the end of the trial, the success of the vaccine will be evaluated based on the number of new HIV infections in two different cohorts. Patients who received the working vaccine will be compared to those who received the  placebo. The trial is aiming for a 50-60% efficacy rate. If this can be achieved, it would be a huge advancement in the fight against HIV, bringing new hope to humanity who has been struggling against this virus for decades.

Sources:

https://www.history.com/topics/1980s/history-of-aids
https://www.who.int/news-room/fact-sheets/detail/hiv-aids
https://www.medicalnewstoday.com/articles/clinical-trial-brings-an-effective-hiv-vaccine-a-step-closer
https://desmondtutuhealthfoundation.org.za/blog_post/hiv-vaccine-trial-is-underway/