HIV and AIDS a Lookback at 2018 Highs and Lows

The Centers For Disease Control on April 24, 1980, received a report that Ken Horne of San Francisco was diagnosed with Kaposi’s Sarcoma (KS). In 1981, retroactively the CDC named his as patient one in the AIDS epidemic. It was later discovered that Horne also had Cryptococcus.

Flash forward to 2018, there have been many highs and lows in finding a cure for the disease.

The Good

Break-through for Karposi Sarcoma Sufferers

Cancer Immunology Research published a small study that showed that two-thirds of people with HIV who suffered from Karposi Sarcoma and received immunotherapy went into partial remission or complete remission. While rare, KS can develop or persist in individuals presently receiving antiretroviral therapy (ART). Nine men were in the study. They were all taking ART and seven of the participants had viral loads that were undetectable. Usually, patients with KS are treated with Chemotherapy, which can suppress the immune system. It also has horrible side effects. One person in the study went into total remission of his KS and five other it was observed that they went into partial. The other three participants were classified as being stable.

Hope for Drug Resistance

A new HIV drug was approved in 2018. Trogarzo (Genetic Ibalizumab) made by Theratechnologies is a drug in a new category called monoclonal antibodies. The drug is made for those who have multidrug resistance. It is an injectable medication given every two weeks. Another medication is in phase three clinical trial also for drug resistance people. This medication is an attachment inhibitor called Fostemsavir made by ViiV Healthcare.

Switching Medications While Undetectable Gets Easier

New Studies show it is safe to switch medications even when one’s viral load is undetectable. Two HIV drugs that have been just approved may be a good choice for individuals who want to reduce side effects or the amount of medication they are presently taking.  Juluca made by ViiV Healthcare is the first two-drug regimen and the first that does not have a nucleoside reverse transcriptase inhibitor (NRTI.)  Juluca combines Dolutegravir which is an integrase strand transfer inhibitor and Rilpivirine which is a non-nucleoside reverse transcriptase inhibitor.

The second drug is made by Gilead and is called Biktarvy.  It is a single dose combining unboosted integrase strand transfer inhibitor (INSTI) Bictegravir and Descovy (FTC/TAF) which are two nucleoside reverse transcriptase inhibitors (NRTIs.)  Biktarvy is approved to give to individuals who have just started treatment or those whose viral loads are undetectable and are looking to change their present antiretroviral regimen.

Addiction Drugs Can Lower Viral loads

It was found that Methadone which is used by addicts with chemical dependency can also be used to lower one’s viral load. Also, the Journal of Acquired Immune Deficiency Syndromes found that HIV positive people who took the medication Naxeltrone which is a drug that treats alcoholism may help people maintain or lower their viral load.

The Bad

Fatty Liver Disease

At the 9th International Workshop on HIV and Aging, Researches stated that they found 39 percent of people who are positive who are 50-years-old or older and 49 percent of people who are under the age of 50 have Hepatic Steatosis (Fatty Liver Disease).

Those individuals who are over the age of 50 who suffered from the disease were more likely to be women, Have Hepatitis C and be long-term HIV survivors who have been taking antiretroviral medication for longer than a decade.
Researchers also stated that obesity was a major factor in Fatty Liver Disease.

Kidney Disease Rates Rising For HIV Positive People Over 60

At the International AIDS Conference in the United Kingdom researchers stated that the diagnosis of Kidney Disease, Osteoporosis and Osteopenia was on the rise for people who were age 60 and over and HIV positive.

Between 2010 and 2017, those who are HIV positive and aged 60 or older have more than doubled. Researchers found in 2017 99.7 percent of the clinic’s clients who are over 60 are taking ART and 95.3 had undetectable viral loads. However, these people are more likely to have multiple medical issues, be on multiple medications (non-HIV related) and have stage three Kidney Disease. Kidney Disease is particularly prevalent in those individuals who have taken the drug Tenofovir Disoproxil Fumarate for their HIV.

Kick-and-Kill Fails

HIV can lie and hidden within the body where it will avoid being detected and can quickly increase if an individual stops their antiretroviral medication. For years, people have been hearing about kick-and-kill which is a meant to prime the body’s immune system, kick the latent, hidden HIV to be awake and have the immune system eliminate it.

This process is necessary for an HIV vaccine or cure. It was disappointing when researchers announced at the International AIDS Conference that kick-and-kill failed to eliminate latent HIV better than regular antiretroviral therapy.

According to the National AIDS Treatment Advocacy Project, this shows the difficulty one will have to reactivate latent virus and killing it with ART or in the case of kick-and-kill with an immune system.

AIDS Survivor Syndrome Is Going Nowhere

At this year’s United States Conference ON AIDS, it was reported that almost 50 percent of HIV positive men have mental health issues. A survey showed that 35 percent of those who are male long-term survivors still grieve for those lost and 7 percent show that they still grieve deeply.

A U.K. study of 6,000 people living with HIV infection is three to seven more times likely have anxiety and depression than those who are not infected.

A study in AIDS Care found that caregivers who are not professional and take care of those who are HIV positive also struggle with mental health issues. 46 percent suffer from Depression and 27 percent suffer from anxiety.

International Efforts to End AIDS Weakens

It seemed as if the lowering rates of new HIV infection made it seem like AIDS could be stopped by 2020. However, the IAC revealed that the goal was not going to happen.

Last year the world saw 1.8 new HIV cases. UNAIDS hoped that by 2020 there would be 500,00 new diagnoses. Instead, UNAIDS reports there is actually an increase in those newly diagnosed. Among those groups with an increase are Eastern European drug users and sub-Saharan adolescent girls in Africa.

A recent study by the Bill and Melinda Gates Foundation states that they fear that Zimbabwe which now has a new HIV diagnosis down 49 percent since 2010 could see an increase of new cases because 61 percent of those in Zimbabwe are under the age of 25 and are at the age where they are at a high risk to become infected.

The Institue for Health Matrics and Evaluation stated that funding for the global fight to stop AIDS has dropped $3 billion between 2012 and 2017.

As 2018 comes to a close, we look back on the highs and the lows and hope there will be more progress in eliminating HIV and AIDS.

Written by Barbara Sobel

Sources:

WebMD: The Fight Against AIDS, Then and Now
WHO: Unprecedented opportunity to Fight HIV/AIDS and Change the course of History
US National Library of Medicine/National Institutes of Health: Fighting HIV/AIDS: is success possible?
The Economist: Some good news and some bad, in the fight against HIV
ABC News: New report from UN warns we have ‘miles to go’ in fight against HIV
The New York Times: Fighting H.I.V., a Community at a Time
Bill & Melinda Gates Foundation: HIV Strategy

Featured and Top Image Courtesy of jacinta lluch valero’s Flickr – Creative Commons License