The Journey Towards Understanding and Combating HIV: Progress and Hope
For the past 40 years, HIV has been one disease that have made scientist worry so much and has given them though times all through. This is because when there is a new disease in town like that new sheriff in town, scientist immediately begin to look for drugs that can combat it and when they find the drug, everyone is happy and everything look somewhat normal back but for HIV, whenever scientist brought out a drug, the virus would find a way to mutate and make that drug unable to work. Another thing about the disease is that thousands of people get infected with it daily around the world.
Before you think we have had a working solution to HIV, this post isn't given you that information because till date there are no vaccines to prevent or treat HIV but scientist have made tremendous efforts and successes and we are going to be reaching that sooner than we expect. From knowing nothing about HIV in the past decades, we have been able to manage and control the disease, and as at today, a person with HIV when properly treated can live the same year as a person who isn't infected and can live a normal live without transferring the disease if being treated.
When the HIV pandemic emerged in 1981, little was known about the virus, and no specific drugs were available to treat it. Doctors primarily addressed the secondary infections and symptoms that arose due to HIV weakening patients' immune systems. HIV has the ability to destroy T cells, a crucial component of the immune system, leaving patients highly vulnerable to opportunistic infections.
Suramin was one of the first drugs that gave us hope that we could conquer HIV. It was able to reduce the amount of cell grown in petri dishes and in the blood of patients in vitro but when there was a clinical trial, it didn't work at all rather it made the patients more sick and began to act like a toxin in patients. It was able to have in vitro inhibitory effects on HIV replication but not in vivo.
In other to solve HIV once and for all, drugs were being looked into, and we came to find Azidothymidine which was to be used as cancer drug but didn't really go far but it was going to do well as it was able to keep cells infected with HIV alive for a longer time in the lab. With trial in the 1980, patients that used AZT had more T cells and this means that they were less likely to die. This made it the first AIDs drug in the United States in 1987. It worked against HIV as it blocks its reverse transcriptase which is the enzyme that copies the RNA based genome in the DNA of the patient.
Azidothymidine wasn't cheap, and came with lots of side effects which includes muscle weakness, anemia, nausea, insomnia, heartburn, heart damage, liver damage, swollen lymph nodes, and so on, so you would guess that we weren't there yet because the drug only work for a limited time and you could guess why? The virus had mutated, and so the viral load in the patients increased and the drug couldn't block Reverse Transcriptase.
HIV develops resistance to drugs easily as it makes lots of mistakes when copying its genome thereby causing it to mutate without planning for it. Soon scientist began to look at other ways to attack the virus instead of just the Reverse transcriptase only. The scientist began to target its protease, and so did the first HIV protease inhibitor drug became a thing in 1995. HIV used protease to cut protein enzymes into smaller pieces there helping it to make the protein needed including the one needed to infect new cells.
Although the drug wasn't a long lasting one, but scientist were making progress as they now had two drugs that targeted different part of the virus. Scientists began to combine the both drugs to attack the virus, making it difficult for the virus to mutate but do not forget that thy had side effects. Soon scientist started working on getting more drugs to tackle the virus, and they referred to this combination of drugs as Highly active antiretroviral therapy.
Today it is referred to as Anti-retroviral therapy as it is the standard treatment and lots of drugs are being used with many with lesser side effects compared to in the past. With anti-retroviral therapy, the HIV load in a patient is undetectable and this means that spreading the virus is much harder.
While this is good for now, scientist have decided to introduce Pre-exposure Prophylaxis (PrEP) where people who are at a high risk of getting the virus begin to take antiretroviral drugs. Studies have shown that people who take a daily pill of Antiretroviral drugs have a 90% lower risk of contracting HIV from sex as long as it is taken consistently.
With Antiretroviral drugs or PrEPs, there is a chance of a come back or infection if the person stops taking their medications. Letting the virus to replicate can lead to mutation and since the virus would be exposed to a part of the drug in the body even when not taking it, it could lead to drug-resistant virus making it difficult to treat.
When we look at cure for HIV, we would be considering a Sterilizing Cure, or a Functional cure. With a sterilizing cure, there is total eradication of the virus from the body but with a functional cure, it means being in remission where they can stop taking antiretroviruses but would still have the virus in them.
One notable case in the quest for a cure is that of Timothy Ray Brown, the Berlin patient, who had both HIV and leukemia. His treatment involved a bone marrow transplant from an HIV-resistant donor, resulting in an HIV-negative status without antiretroviral medication. However, bone marrow transplants are not a viable solution for everyone, being both costly and risky. He died in 2020 after a recurrence of cancer.
While this was successful, it cannot be done for everyone because bone marrow transplants are very expensive and risky. A lot of people die from the procedure and although it was successful for one, scientists are still not sure as to why Browns case was different. Scientists are still looking at how to treat the virus and scientists are looking at CRISPR which is a gene editing tool to help help change the person's CCR5 gene thereby making the virus infection of other cells difficult even when it has infected the person.
As we continue to unravel the complexities of HIV, there is hope for a future where it can be effectively controlled, if not eradicated. Research remains dynamic and promising, offering optimism in the ongoing battle against this persistent virus.
The journey to understand and combat HIV has been one of persistence and resilience. While a complete cure remains elusive, the advancements in treatment and prevention over the years provide hope for individuals affected by the virus. The scientific community's unwavering dedication to research and innovation promises a future where HIV may be effectively controlled and, ultimately, eradicated.
Reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8402867/
https://www.ncbi.nlm.nih.gov/books/NBK219126/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038244/
https://clinicalinfo.hiv.gov/en/drugs/zidovudine/patient
https://www.drugs.com/sfx/zidovudine-side-effects.html
https://pubmed.ncbi.nlm.nih.gov/1980381/
https://pubmed.ncbi.nlm.nih.gov/2462584/
https://www.hiv.gov/hiv-basics/hiv-prevention
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394821/
https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734620/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287108/
https://www.fredhutch.org/en/news/center-news/2020/09/timothy-ray-brown-obit.html
I remember the story of Mr Brown who was treated of HIV. I remember then, my grandma would say it was a miracle and that bone marrow surgery wasn't something everyone would be opportune to get. She usually sang this as a song for everyone when talking about HIV, I didn't know the treated patient was dead, I will have to read that up. Thanks for sharing.
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