Medical

Undetectable=Untransmittable: Modern Medicine Has Changed Life After HIV

HIV was once regarded with fear and stigma, but ground-breaking advancements in antiretroviral therapy (ART) have changed that..

By URLife Team

18 May 2023

The World Health Organisation has states that around 84.2 million people have been infected with HIV and about 40.1 million people have died of HIV worldwide as of 2021. Africa remains most severely affected, with nearly 1 in every 25 adults (3.4 per cent) living with HIV and accounting for more than two-thirds of the people living with HIV worldwide.

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As of today, there is still no cure for the human immunodeficiency virus (HIV). According to a 2015 study published in the British Journal of Clinical Pharmacology, in the last 30 years, there have been over twenty-five drugs developed to counter HIV. The first antiretroviral agent, zidovudine (AZT), a nucleoside reverse transcriptase inhibitor (NRTI), was shown to have a positive impact on clinical progression and HIV-caused death. The challenges of early NRTI regimens included high pill intake, inconvenient doses, treatment-limiting toxicities and incomplete virological suppression. Sequential monotherapy and incomplete virological suppression resulted in the emergence of multiple resistance mutations, with long-term treatment consequences.

In the battle against HIV, modern medicine has armed us with groundbreaking antiretroviral therapies which have a profound impact on the lives of those touched by HIV/AIDs.

Antiretroviral Therapy (ART)

As per a 2022 systematic review by Frontiers in Pharmacology, 73 per cent of HIV-infected people in the world received antiretroviral therapy which was found to be effective in decreasing the mortality and transmission of HIV.

Antiretroviral medications work within the body, suppressing the virus and significantly slowing down the progression of HIV. While they may not completely eradicate HIV, they have the remarkable ability to suppress it to undetectable levels in many cases. This achievement is nothing short of extraordinary, as it allows individuals to regain control over their lives and envision a future beyond the limitations once imposed by the virus. The effectiveness of antiretroviral medications lies in their ability to target different stages of the HIV life cycle.

How does the Antiretroviral drug work?

By inhibiting viral replication and preventing the virus from multiplying, antiretroviral medications effectively keep HIV in check. They not only protect the immune system from further damage but also reduce the risk of transmission to others, a crucial aspect in curbing the spread of the virus.

Moreover, antiretroviral therapy (ART) has proven to be highly personalised, with healthcare providers tailoring treatment regimens to suit individual needs. This personalised approach takes into account factors such as a patient's viral load, CD4 cell count, potential drug interactions, and any existing comorbidities. By fine-tuning the treatment plan, healthcare providers can optimise the benefits while minimising side effects, ensuring the best possible outcomes for patients.

Types of Antiretroviral Drugs

HIV treatment typically involves a combination of these drugs, known as combination antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART). This approach, often referred to as an HIV drug "cocktail," helps to maximise effectiveness, minimise side effects, and reduce the risk of developing drug-resistant strains of the virus.

The main types of antiretroviral drugs used in the treatment of HIV include:

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs): These drugs interfere with the reverse transcription process, inhibiting the conversion of viral RNA into DNA. Examples include zidovudine (AZT), lamivudine (3TC), tenofovir disoproxil fumarate (TDF), and abacavir (ABC).
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): NNRTIs directly bind to the reverse transcriptase enzyme, preventing it from converting viral RNA into DNA. Examples include efavirenz (EFV), nevirapine (NVP), and rilpivirine (RPV).
Protease Inhibitors (PIs): PIs target the protease enzyme, which is essential for the final maturation of HIV particles. By inhibiting protease (an enzyme that breaks down protein into single amino acids), these drugs prevent the production of infectious viral particles. Examples include ritonavir (RTV), atazanavir (ATV), and darunavir (DRV).
Integrase Inhibitors (INSTIs): INSTIs block the action of the integrase enzyme, preventing the integration of viral DNA into the host cell's genome. This inhibits the virus from establishing a persistent infection. Examples include raltegravir (RAL), dolutegravir (DTG), and elvitegravir (EVG).
Entry Inhibitors: These drugs interfere with the entry of HIV into the host cell. There are two types of entry inhibitors: fusion inhibitors and CCR5 antagonists. Fusion inhibitors, such as enfuvirtide (T-20), block the fusion of viral and cellular membranes. CCR5 antagonists, like maraviroc (MVC), block the CCR5 co-receptor on host cells, preventing HIV entry.
Pharmaco Enhancers: Medications such as ritonavir (RTV) and cobicistat (COBI) are often used as pharmacy enhancers. They boost the effectiveness of other antiretroviral drugs by inhibiting enzymes responsible for their metabolism, thereby increasing their concentration in the body.

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Beyond the suppression of the virus, modern medicine has empowered individuals at high risk of contracting the virus to protect themselves and take charge of their sexual health. According to a 2022 study issued by StatPearls, A typical initial HIV regimen includes 3 HIV medications from a minimum of 2 drug classes which has led to a 60 to 80 per cent decline in the rates of AIDs, hospitalisation, and death.

Improved understanding of the virus's complexities has led to more accurate diagnosis, enhanced prevention strategies, and comprehensive healthcare approaches that address the physical, emotional, and social aspects of living with HIV.

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How to practise safe sex?

Practising safe sex not only protects your health but also promotes the well-being of your sexual partners. People exposed to HIV-positive infectious bodily fluids either by skin puncture, damaged skin, or direct mucous membrane contact are at risk for transmission. They should start antiretroviral therapy within 72 hours post-exposure. Those exposed to HIV should have follow-up HIV testing at 6, 12, and 24 weeks. If the test results are negative at 24 weeks, they are considered uninfectious. It is crucial to prioritise and maintain open communication, consent, and responsible sexual behaviours for a healthier and safer sexual experience.

Always use condoms correctly and consistently
Regular testing for STIs
Reduce the number of sexual partners
Get vaccine HPV (human papillomavirus) for HIV

Learn here how to practise safe sex

UR.Life OHC doctors create HIV awareness

Speaking to a UR.Life OHC doctor will help you gain a better understanding of HIV by leveraging their expertise, knowledge, and compassionate care.. Here are some ways UR.Life OHC doctors can contribute to HIV awareness:

1. Education and Counseling: OHC doctors can provide counselling sessions to address misconceptions, fears, and concerns surrounding HIV, promoting accurate information on sexual health.

2. HIV Testing and Screening: OHC doctors can facilitate and encourage regular HIV testing and screening for individuals, particularly those who may be at higher risk due to specific symptoms.

3. Prevention Strategies: OHC doctors can educate about effective HIV prevention strategies, such as the proper and consistent use of condoms, the availability and benefits of pre-exposure prophylaxis (PrEP), and the importance of regular screenings for sexually transmitted infections (STIs).

4. Treatment and Care: UR.Life OHC doctors can offer specialized HIV care, ensuring access to antiretroviral therapy (ART) for diagnosed individuals. They can monitor treatment progress, manage side effects, and provide ongoing support to enhance adherence and overall well-being.

Schedule your test here.

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