Ten things you probably don't know about HIV

Francois Venter, Polly Clayden, Anele Yawa and Marcus Low, GroundUp | 2016-02-24 10:51:50.0
The reasons for this are complex, but include strong research funding, focused and effective
activism, and often younger, more dynamic and ambitious health professionals who recognised the
inability of modern medical delivery systems to get treatment right, reports GroundUp.
Whatever it was, 2015 was a stellar year for HIV breakthroughs, even when measured against
previous years.
We now know:
1. We should treat everyone.
The HIV worlds longest-running debate, about at which CD4 number (a measure of immunity) to
start treatment, was finally settled. Even at high CD4 counts, there is benefit from antiretroviral
therapy (anti-HIV drugs, known as ART) against TB, pneumonia and cancer. The South African
private sector will move to starting ART whenever someone is ready; the public sector is expected to
follow suit soon after.
2. HIV cure research has a long way to go
Although there were several cases of supposed cures in babies and adults, the virus came back every
time. The exception was one man, who is the only known case of a cure. But huge research efforts
are underway to try to untangle how to get it right.
3. Life expectancy in HIV-positive people is pretty much normal on ART
Especially if you start before you get sick or your CD4 count falls low. Studies from South Africa and
other African countries, as well as from Europe and the US, have demonstrated life expectancies
extending into their 70s and 80s. So, plan for grandkids and get those retirement annuities in.
4. Modern treatment has never been safer
Less than 5% of people on ART now have to switch treatment, and they then have many other
options.
5. Modern treatment looks to be getting better still
New drugs mean smaller tablets which dont require the high adherence levels required with current
treatments. Some of these will be available in the private sector probably in the next few months,
and soon in the public sector.
There are even preliminary results (itll be a few years before they become available) on a new
injectable antiretroviral combination, which means, like contraception, you can choose between a
daily tablet or an injection every few months.

6. We might need only two drugs or even one

The new drugs are so powerful, we might no longer need the three weve been using for 15 years. Do
not try this at home, though, until the research is in.

7. Treatment comes with a huge prevention benefit

HIV-positive people who have their virus fully suppressed on ART do not sexually transmit the virus.
8. The drugs work in HIV-negative people too (called 'pre-exposure prophylaxis' or PrEP)
Another huge breakthrough has been that giving antiretrovirals daily to HIV-negative people at high
risk of getting HIV (a bit like how we give contraception to prevent pregnancy) has been shown to
work very well.
9. PrEP studies are happening in South Africa on gay men and sex workers
Government is examining this as a countrywide option. But, the group who most needs it is young
women, and different delivery models for PrEP are being looked at. We will have news this week on
a long-acting vaginal ring that may deliver PrEP a little like the IUD delivers contraception.
10. HIV is still at catastrophic levels

New HIV infection rates are still very high in South Africa, with seven million HIV-positive people.
While condoms and male circumcision work, it seems it is not enough, and a vaccine, while hopeful,
is some way away. The South African government has committed to the UNAIDS/WHO 90-90-90
targets (90% of people to know their status; 90% on treatment, and 90% of these are virally
suppressed).
Mathematical modelling suggests that this aggressive approach to treatment, with an expansion of
PrEP, male circumcision, and continued condom provision, will be enough to bring the epidemic
under control in the next few decades.
Venter is an HIV clinician and researcher with the Wits Reproductive Health and HIV Unit.Clayden
is with HIV i-Base.Yawa is the General Secretary of the Treatment Action Campaign.Low is the
policy director of the Treatment Action Campaign.
Source: GroundUp
http://www.timeslive.co.za/lifestyle/2016/02/24/Ten-things-you-probably-don%E2%80%99t-know-abo
ut-HIV