International Journal of Collaborative Research on Internal Medicine & Public Health

HIV/AIDS: A Continuing Medical Challenge with Advancements in Treatment and Care

Stefan John^{* *}Correspondence: Stefan John, Department of Pathology, Institute of Cancer Research, USA, Email:

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Introduction

HIV/AIDS remains a critical health issue that continues to affect millions of people worldwide. Since its discovery in the early 1980s, Human Immunodeficiency Virus (HIV) has caused significant morbidity and mortality. While effective treatments have transformed HIV from a terminal illness to a manageable chronic condition, the global burden of the disease remains heavy, especially in sub-Saharan Africa and low-resource settings.

HIV attacks the immune system, primarily targeting CD4 T cells, which are crucial for defending the body against infections. Over time, untreated HIV infection can progress to AIDS (Acquired Immunodeficiency Syndrome), a stage where the immune system is severely weakened, and individuals become vulnerable to a range of opportunistic infections and certain cancers. Although there is currently no cure for HIV, advances in medical research,particularly Antiretroviral Therapy (ART), have led to significant improvements in patient outcomes, extending life expectancy and improving quality of life.

Despite these advances, the global fight against HIV/AIDS is far from over. The disease continues to disproportionately affect marginalized groups, including Men who have Sex with Men (MSM), sex workers, and people who inject drugs, as well as individuals in low-income regions, especially subSaharan Africa. Addressing the ongoing challenges of HIV/AIDS requires a comprehensive approach that includes prevention, treatment, and addressing the social and structural factors that contribute to the spread of the virus.

Understanding the pathophysiology of HIV is crucial in comprehending the challenges posed by the disease. Upon infection, HIV enters the body through mucosal membranes and targets CD4+ T cells, which play a central role in the immune response. The virus binds to the CD4 receptor and a co-receptor on the T cell (CCR5 or CXCR4), leading to viral entry and replication within the host cell. As the virus replicates, it produces new virions that spread throughout the body, progressively damaging the immune system.

In the absence of treatment, HIV leads to a gradual depletion of CD4 cells, compromising the body's ability to fight infections. As the immune system weakens, individuals become more susceptible to opportunistic infections such as tuberculosis, pneumonia, and fungal infections, as well as certain cancers like Kaposi’s sarcoma and lymphoma

The transition from HIV to AIDS typically occurs when the CD4 count falls below 200 cells/mm³, and the individual experiences one or more opportunistic infections or AIDS-related cancers. Without intervention, this progression can lead to death. The goal of treatment is to suppress the virus to undetectable levels, preventing immune system deterioration and reducing the risk of opportunistic infections.

One of the most significant achievements in the treatment of HIV has been the development of Antiretroviral Therapy (ART), a combination of drugs that work to suppress the virus and prevent progression to AIDS. ART does not cure HIV but allows individuals to live long, healthy lives by reducing the viral load to undetectable levels and restoring immune function. ART is usually a combination of three or more medications from different classes, including:

These drugs inhibit reverse transcriptase, an enzyme crucial for the replication of HIV's RNA into DNA. • These drugs also inhibit reverse transcriptase but in a different manner than NRTIs. • These drugs inhibit the protease enzyme, preventing the HIV virus from maturing and becoming infectious. • These drugs block the enzyme integrase, which the virus uses to integrate its genetic material into the host’s DNA. • These drugs prevent HIV from entering CD4+ cells. Maraviroc, for example, blocks the CCR5 co-receptor that HIV uses to enter cells.

The introduction of combination ART, also known as Highly Active Antiretroviral Therapy (HAART), in the late 1990s revolutionized the treatment of HIV. By reducing the viral load to undetectable levels, ART helps to preserve the immune system, reduce transmission risk (through sexual contact or from mother to child), and improve the overall health and quality of life of people living with HIV.

However, despite its success, ART is not without challenges. Long-term adherence to a complex regimen of multiple medications can be difficult, particularly in resource-limited settings where access to treatment is inconsistent. Additionally, drug resistance, side effects, and the high cost of some medications remain barriers to achieving optimal treatment outcomes for all individuals with HIV. While ART has significantly improved the prognosis for people living with HIV, there are still major challenges that need to be addressed. Over time, HIV can develop resistance to certain antiretroviral medications, rendering them less effective. Resistance is more likely when patients do not adhere strictly to their ART regimen. The emergence of drug-resistant strains can complicate treatment, requiring changes to medication regimens and more expensive, second-line drugs. Successful ART requires consistent adherence to a daily medication regimen. Missed doses can lead to a resurgence of viral replication, progression of disease, and the development of resistance. In resource-limited settings, adherence can be hindered by factors such as poverty, lack of access to healthcare, stigma, and education. HIV disproportionately affects certain populations, including men who have sex with men, people who inject drugs, sex workers, and people in low-income regions. Social and structural factors, such as stigma, discrimination, and lack of access to healthcare, exacerbate health disparities and hinder efforts to provide care. Some ART regimens have side effects, including gastrointestinal issues, liver toxicity, kidney problems, and cardiovascular risks. Long-term ART use can also lead to metabolic changes, such as fat redistribution (lipodystrophy) and increased cholesterol levels, which may increase the risk of cardiovascular disease. Prevention is a critical component of the global fight against HIV. Pre-Exposure Prophylaxis (PrEP) is a promising tool in HIV prevention, particularly for high-risk populations. PrEP involves taking a daily oral dose of antiretroviral medications to reduce the risk of acquiring HIV. When taken consistently, PrEP has been shown to reduce the risk of HIV infection by more than 90%.

Condom use remains one of the most effective methods for preventing HIV transmission, particularly in heterosexual populations. Education about safe sex practices, harm reduction strategies for people who inject drugs, and regular HIV testing are essential elements of a comprehensive prevention strategy. Despite significant progress in treatment and prevention, there is no cure for HIV. However, research into potential cures and vaccines is ongoing. Several promising approaches are being explored, including:

Technologies like CRISPR-Cas9 may eventually be able to “edit” the HIV genome out of infected cells, offering hope for a cure. • Unlike preventive vaccines, which aim to prevent infection, therapeutic vaccines aim to stimulate the immune system of those already infected with HIV to control the virus without ART. Clinical trials are underway, but a functional cure has yet to be realized. • These antibodies are capable of neutralizing a wide range of HIV strains and may offer an additional tool in the fight against HIV.

Conclusion

HIV/AIDS remains a major public health issue, but the landscape of HIV treatment, prevention, and care has changed dramatically over the past few decades. ART has allowed individuals living with HIV to live longer, healthier lives, and advancements in prevention, such as PrEP, have the potential to reduce new infections. However, challenges remain, particularly related to drug resistance, adherence to treatment, healthcare access, and the stigma associated with the virus.

A continued commitment to research, healthcare infrastructure, and global collaboration is essential in moving towards the ultimate goal: ending the HIV/AIDS epidemic. Until a cure is found, ensuring equitable access to treatment, prevention strategies.