Human Immunodeficiency Virus (HIV) a Real Treat to the Developing World – An Overview
Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) are one of the significant causes of death in developing countries. HIV is indeed a challenge for the developing world with more than 60 million people infected with HIV. Knowing of current pattern of HIV and its prevalence is essential for fund allocators. The mode of transmission of HIV includes drug injection, transfusion, semen, mother to child via breast milk, or through vagina. The rate of transmission of HIV is 3 to 5 per hundred persons per year in Africa.
HIV infection has three stages. First stage has dramatic drop in CD4+ cell count with viremia observed on this stage. Second stage is asymptomatic stage with the T4-cell count is moderately decreased during this stage. Asymptomatic stage is variable. Third stage is opportunistic infection stage which is also known as the Autoimmune Deficiency Syndrome (AIDS) stage. HIV-1 and HIV-2 are the two sub-types of the HIV virus and both have same mode of transmission. HIV-2 manifests as less severe form with a lower mortality rate. Asymptomatic stage is also lengthier for HIV-2 and CD4+ is also decreases much slowly as compare to HIV-1.
Vaccine against HIV-1 shows its efficacy in macaques model (a primitive monkey) in both cell mediated and humoral arms of immune system. One recent research shows that gene therapy in mice and monkeys provides vaccine like protection against HIV-1. The mechanism behind is production of vector-encoded antibody. This technique is also called as Vectored Immune Prophylaxis or more simply as VIP. This technique overcomes the difficult phase of antigen design and phases of regular vaccine protocol.
Rate of survival is significantly improved in people infected with HIV due to development of the new HIV treatments. Person who have been infected with HIV as well as TB they should start both therapies immediately. The risk of Immune Reconstitution Inflammatory Syndrome (IRIS) is present at this stage, hence anti HIV therapy should be started after intensive phase of TB has been treated.
In pediatric group nevirapine is found to be effective. A recent study found Ritonavir and lopinavir (both protease inhibitors) to be superior in both mother and children in comparison with nevirapine. In adults combination of lopinavir-ritonavir is better tolerated and superior to nelfinavir. Role of IL-2 plus antiretroviral therapy has not established in studies in spite of increase in CD4+ count.
The common side effects of Highly Active Antiretroviral Therapy (HAART) include cardiovascular, renal, metabolic and neuro-cognitive dysfunctions as well as development of malignancies and lipodystrophy. HAART therapy has not yet solved the problem related to other infection besides HIV or chronic illness. This is also established that increase exposure to protease inhibitor is associated with Myocardial Infarction (MI) as presence of dyslipidemia is seen in patients of protease profile. Besides other psychiatric disorder like Attention deficit hyperactivity disorder (ADHD), the most common psychiatric side effect is the development of depression. Moreover, phobias, bipolar disorder, rapid deterioration of mental and cognitive abilities are also common.
In a recent research, Heffron prove that inject-able hormonal contraception is associated with increase HIV- 1 transmission. Recently, Truvada (a fixed combination of Tenofovir/emtricitabine) has been approved by the Food and Drug Administration (FDA), US for the prevention of HIV transmission. The preventive strategies include male circumcision, awareness of use of condoms and prompt treatment of HIV infected person.
About the author:
Subhan Iqbal is a final year student from the Dow Medical College, Karachi, Pakistan. He can be reached at: [email protected]
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