‘HAART is very effective in combating HIV’

On a day when the people of the world come together in the fight against ‘HIV/AIDS’, in an exclusive interview with Salome Phelamei of Zeenews.com, Dr. Jai Babu discusses the chronic and critical condition stimulated by the deadly virus, its care and precautionary measures that need to be taken. December 1 is observed as World AIDS Day every year.

Dr. Jai Babu did his MBBS from Bangalore Medical College, and MD in General Medicine from PGIMER, Chandigarh. He also completed his Senior Residency from JIPMER, Pondicherry.

What is HIV/AIDS?

Human immunodeficiency virus (HIV) is the name of the virus that causes acquired immunodeficiency syndrome (AIDS). The virus interferes with the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers.

Can you please tell us about the history of HIV/AIDS?

The earliest known identification of the HIV-1 virus comes from Congo in 1959 and 1960, though genetic studies indicate that it passed onto the human population from chimpanzees around fifty years earlier. A strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969. HIV descends from the related simian immunodeficiency virus (SIV), which infects apes and monkeys in Africa. AIDS was first reported in the US on June 5, 1981.

Who are at risk?

- Unprotected sexual contact with an infected person
- Transmission from an infected woman to her fetus or baby
- Through needle sharing among intravenous drug users
- Rarely, through accidents involving needle-stick injuries and other blood exposures of healthcare providers

Which body fluids are responsible for HIV transmission?

HIV has been found in saliva, tears, nervous system tissue, spinal fluid, blood, semen, vaginal fluid and breast milk. Blood, semen, vaginal secretions, and breast milk generally transmit infection to others.

How is HIV linked to other sexually transmitted disease?

Individuals who are infected with sexually transmitted diseases are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another sexually transmitted disease, he or she is more likely to transmit HIV through sexual contact than other HIV-infected persons.

What is the prevalence rate of HIV/AIDS in India and abroad? And what is the mortality rate of the disease worldwide?

According to estimates from the UNAIDS Global Report 2010 around 30.8 million adults and 2.5 million children were living with HIV at the end of 2009. More than 60% of the HIV-infected population lives in African countries. South Africa is reported to have the largest population living with the disease, followed by Nigeria in 2nd place and India in the 3rd. India is estimated to have 23.9 lakh people infected with HIV, at an estimated adult HIV prevalence of 0.31%. Adult HIV prevalence among men is 0.36%, while among women it is 0.25%.

Right now, there is no cure for AIDS. It is always fatal without treatment. Many patients survive many years after diagnosis because of the availability of highly active anti retroviral therapy (HAART). HAART has dramatically increased the duration people with HIV remain alive.

What are the tests available to diagnose HIV/AIDS?

HIV infection can be diagnosed by serologic tests that detect antibodies against HIV-1 and HIV-2 and by virologic tests that can detect HIV antigens or ribonucleic acid (RNA). Antibody testing begins with a sensitive screening test (e.g., the conventional or rapid enzyme immunoassay [EIA]. Reactive screening tests must be confirmed by a supplemental antibody test (i.e., Western blot [WB] and indirect immunofluorescence assay [IFA]) or virologic test (i.e., the HIV-1 RNA assay).

What are the social aspects of HIV/AIDS?

AIDS epidemic is a relatively recent and a global phenomenon. The impact of AIDS and HIV infection on social and economic development is crucial. Public awareness for AIDS needs to be increased. Psychological attributes such as guilt, anxiety, depression and other stressful emotions have to be addressed. Effective therapy should aim at inducing a sense of well-being and a positive outlook towards life. Emphasis should be on mass media programmes in both urban and rural areas as part of public health measures. People should be aware of the origin of the disease, modes of transmission, prevention, testing and therapies available. Myths surrounding the illness should be dispelled.

Please elaborate about the treatment aspects…

There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life for those who have already developed symptoms.

Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. Preventing the virus from replicating can help the immune system recover from HIV infection. HAART is not a cure for HIV, but it has been very effective. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mm3), life can be significantly prolonged and improved. CD4 cells are a type of immune cell. They are also called "T cells" or "helper cells". However, HIV may become resistant to HAART, especially in patients who do not take their medications on schedule every day.

Medications are also used to prevent opportunistic infections if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

What are the recent advances made in the treatment protocol for HIV/AIDS?

Many antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen) and filgrastim (G-CSF or Neupogen), are sometimes used to treat anemia and low white blood cell counts associated with AIDS. There has been a case where bone marrow transplant has been successful. The patient received the marrow from a carefully selected donor with a mutated form of the CCR5 gene. HIV requires the CCR5 protein, which is on the surface of white blood cells, in order to attach to and infect the cell.

Another experimental approach to finding a cure for HIV is the development of therapeutic vaccines. Therapeutic HIV vaccines work by enhancing the body’s natural immune response, helping to control HIV in people already infected with the virus. This is in contrast to preventive vaccines, which are used in HIV-negative individuals to prevent infection.

Gene therapy is an experimental approach that is currently in early stages of clinical testing. Gene therapy involves modifying the genetic information in a cell so that it becomes, for example, resistant to HIV infection.

Side effects of anti-retroviral therapy…

HAART (highly active anti retroviral therapy) is a collection of different medications, each with its own side effects. Some common side effects are:
-Collection of fat on the back ("buffalo hump") and abdomen
-General sick feeling (malaise)

When used for a long time, these medications increase the risk of heart attack.

What are the long term treatment goals of the therapy?

The principal goal of therapy is to prevent or reverse the progression of clinical illness. The long term goal of therapy, however, should be to achieve viral suppression to undetectable levels or levels as close to undetectable as possible.

According to the United Nations 2011 AIDS report, there has been a 56% decline in the number of new HIV infections in the last 10 years in India. What do you think is the reason behind this huge drop?

India, which has one of the highest populations of HIV-infected people in Asia, has witnessed a decline in new infections by a significant 56% from the epidemic`s peak in 1996, with other Asian countries also showing a plunge. According to the UNAIDS World AIDS Day report 2011, the number of new HIV infections has been falling significantly in Asia, with India leading the pack.

This decline is only possible with a combination of commitment, heightened public awareness, greater access to treatment, effective national programmes and help from concerned NGOs.

At present, India spends about 5% of its health budget on HIV/AIDS. Is the government giving enough support to fight HIV/AIDS?

HIV spending increased steadily in India from 2003 to 2007 but has since fallen. In 2006-2007, $171 million was spent to contain and prevent the growth of HIV, which represented an increase of 28% from the previous year. Currently, India spends about 5% of its health budget on HIV and AIDS. However, the World Bank has warned that India will have to scale up prevention efforts in order to avoid spending more of its health budget in the future. According to the World Bank’s report, by 2020 India will have to spend 7% of its health budget on AIDS if the rising tide of the AIDS epidemic in New Delhi, Mumbai, the North and the Northeast is not halted. This would put further strain on a struggling health sector which, on top of HIV and AIDS, faces a growing multitude of health challenges including malaria, diabetes, heart disease and cancer. Yet, in 2008-2009 spending on HIV/AIDS fell by 15% to $146 million.

A recent report states that India has banned home testing for HIV. What is your take on it?

India will not allow home testing for HIV. The country`s National AIDS Control Organisation (NACO) is against allowing finger pricks or mouth swabs to be used by individuals to know their HIV status. A variety of tests are now available which can produce results in 1-20 minutes. The costs of these tests are also low. However, NACO says its policy is clear - testing will have to accompany pre-testing and post-result counselling.

Advantages of home testing - A person who`s scared about being seen in a clinic can do the test without anyone outside their home knowing about it. They may feel more comfortable doing the test alone.

Disadvantages of home testing - Getting a positive test result can be hard to deal with. A person may never hear all the counseling and information they need to hear. For this reason test counseling is best done face-to-face, and is most effective this way. The person may not follow the steps accurately and may get a false positive or negative result, both of which can have devastating consequences.

Can you please explain how HIV transmission can be prevented?

Do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones. These programs can also provide referrals for addiction treatment.

Avoid contact with another person`s blood. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured.

Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. Infected people should tell any sexual partner about their HIV-positive status. Preventive measures such as condoms will give their partner the most protection.

HIV-positive women who wish to become pregnant should seek counseling about the risk to their unborn children, and methods to help prevent their baby from getting infected. The use of certain medications dramatically reduces the chances that the baby will become infected during pregnancy. Pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to their baby less than 1% of the time, compared with about 20% of the time if medications are not used.

Safe-sex practices, such as latex condoms, are highly effective in preventing HIV transmission. However, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

Also, tell us about the importance of preventive measures, including health education, in tackling this global pandemic.

Planning and implementing effective and efficient public information programs are essential to successful HIV/AIDS prevention efforts. Public information programmes build general support for safe behaviour, support personal risk reduction, inform persons at risk about infection and how to obtain specific services, encourage volunteerism, and decrease prejudice against persons with HIV disease. These programmes raise awareness, increase knowledge, refute myths and misconceptions, influence attitudes and social norms, suggest and enable action, show the benefits of a behaviour, increase support and/or demand for services, and help coalesce organizational relationships.

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