Researchers are actively working on producing preventative and therapeutic vaccines for HIV. Preventative vaccines immunize an individual against a disease, so that he or she does not become infected. A therapeutic vaccine, also called a treatment vaccine, does not keep someone from getting a disease the way a preventative vaccine does. Instead, therapeutic vaccines are used to boost the body’s immune system in order to help control infection. The potential exists to prolong life indefinitely using these and other drug therapies to boost the immune system, keep the virus from replicating, and ward off opportunistic infections and malignancies.
^ Jump up to: a b Anglemyer, A; Rutherford, GW; Horvath, T; Baggaley, RC; Egger, M; Siegfried, N (April 30, 2013). “Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples”. The Cochrane Database of Systematic Reviews. 4: CD009153. doi:10.1002/14651858.CD009153.pub3. PMC 4026368 . PMID 23633367.
[Guideline] DiNenno EA, Prejean J, Irwin K, Delaney KP, Bowles K, Martin T, et al. Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men – United States, 2017. MMWR Morb Mortal Wkly Rep. 2017 Aug 11. 66 (31):830-832. [Medline].
A small group of individuals continue to dispute the connection between HIV and AIDS, the existence of HIV itself, or the validity of HIV testing and treatment methods. These claims, known as AIDS denialism, have been examined and rejected by the scientific community. However, they have had a significant political impact, particularly in South Africa, where the government’s official embrace of AIDS denialism (1999–2005) was responsible for its ineffective response to that country’s AIDS epidemic, and has been blamed for hundreds of thousands of avoidable deaths and HIV infections.
Since the discovery of HIV and its link to AIDS, great strides have been made in understanding its biology and in developing effective treatments. The difficulty in dealing with HIV on a global scale is largely due to the fact that HIV infection is far more common in resource-poor countries.
Sexual contact with an infected person, when the mucous membrane lining the mouth, vagina, penis, or rectum is exposed to body fluids such as semen or vaginal fluids that contain HIV, as occurs during unprotected sexual intercourse
Despite generally high levels of awareness of the risks for HIV acquisition, in 2012 an estimated 34% of adults were diagnosed with a CD4 cell count ≤200 per mm3 within three months of diagnosis. The percentage diagnosed with CD4 cell counts ≤350 per mm3 (the threshold at which treatment should be considered according 2008 British HIV Association guidelines) was 34%.
HIV invariably develops resistance to any of these drugs if they are used alone. Resistance develops after a few days to several months of use, depending on the drug and the virus. HIV becomes resistant to drugs because of mutations that occur when it replicates.
Popper SJ, Sarr AD, Travers KU, et al. Lower human immunodeficiency virus (HIV) type 2 viral load reflects the difference in pathogenicity of HIV-1 and HIV-2. J Infect Dis. 1999 Oct. 180(4):1116-21. [Medline].
There are now six approved combination pills that allow for a full regimen to be taken as a single pill once per day, so called single tablet regiments. This includes the following NRTI plus third drug combinations:
Achenbach CJ, Buchanan AL, Cole SR, Hou L, Mugavero MJ, Crane HM, et al. HIV viremia and incidence of non-Hodgkin lymphoma in patients successfully treated with antiretroviral therapy. Clin Infect Dis. 2014 Feb 12. [Medline].
The success of ART is assessed by measuring plasma HIV RNA levels every 8 to 12 wk for the first 4 to 6 mo or until HIV levels are undetectable and every 3 to 6 mo thereafter. Increasing HIV levels are the earliest evidence of treatment failure and may precede a decreasing CD4 count by months. Maintaining patients on failing drug regimens selects for HIV mutants that are more drug-resistant. However, compared with wild-type HIV, these mutants appear less able to reduce the CD4 count, and failing drug regimens are often continued when no fully suppressive regimen can be found.
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