Category: HIV

There are high rates of chronic infections among many cultures around the world. The Human Immunodeficiency Virus, otherwise known as HIV, is one of the leading infections that can be transmitted in numerous ways affecting children, heterosexual’s, and homosexual’s, via blood transfusions, semen, vaginal fluids, rectal fluids, breast milk, accidents in a healthcare setting, blood from used injection needles, etc., (AIDS, n.d.). Symptoms of HIV include: flu like symptoms, fever, chills, night sweats, rashes, and some acute infections (Cunningham et al., 1998). HIV infects cells in the body called TH cells, and if the body doesn’t have enough TH cells it can no longer fight off infections and illness (Weiss, 1993). HIV can be either asymptomatic or symptomatic. An individual who is HIV positive and asymptomatic contracts the virus, but doesn’t experience any symptoms for perhaps years, while an individual who is HIV positive and symptomatic contracts the virus will experience symptoms (Santrock, 2007). This virus can also lead to a disease called Acquired Immunodeficiency Syndrome, AIDS, which can result in death (Weiss, 1993). Places like Botswana, a country found in Africa, suffer from high population rates of HIV. The purpose of this essay is to identify and describe all the aspects of the HIV epidemic in homosexuals of Botswana, and to create a prevention plan to help with addressing the needs of the affected population.

Culture Characteristics

Background

Botswana is located in South Africa, with 603,200 square kilometers of land (. It is a landlocked nation, which means that is has no coastline or seaport because it is majority surrounded by land, so it is dependent of South Africa for access to ocean ports (. Botswana has a multiparty political system, as it is part of the British Commonwealth (. Over half of its population identifies as being part of the Tswana heritage (. Originally the people of Botswana we referred to as Basarwa, commonly known as Bushmen, and they were hunters and gatherers who adapted well to harsh environments (. They developed more ingenious techniques to extract what the land offered (. They had very little, no crops, or domesticated animals, and they only had a few possessions which were portable and necessary for everyday life (.

Healthcare

Botswana is predominantly composed of urban areas, which is one reason why the population has high HIV and AIDS affliction (McDonald, 1996). The World Health Organization (2016), WHO, found the life expectancy for the entire population to be around 69.9 years of age, which is a dramatic increase from 2000 where it was 39.9 years. Homosexuality is illegal in Botswana, which makes it very difficult for men who have sexual relations with other men to receive HIV services (McDonald, 1996).

Importance

It is important to facilitate health care prevention plans for the Tswana culture because current rates of HIV in Botswana are extremely high. The number of individuals living with HIV is 380,000, and adult prevalence of HIV in individuals ranging from age 15-49 is 22.8% (UNAIDS, 2018). Adult males have lower statistics of knowing that they are infected, receiving treatment, and being virally suppressed (UNAIDS, 2018). The policy in Botswana does cover some key concerns and questions in regard to HIV testing. It is not mandatory to get HIV testing done before marriage, is solely based on voluntary and informed consent, but for certain age groups it is mandatory, and there is routine viral load testing done for antiretroviral therapy for adults, adolescents, and children who suffer from the virus (UNAIDS, 2018).

Facets of a Prevention Plan

HIV-related Stigmas

Three components lead to HIV-related stigmas in health facilities: Fear of casual contact due to being uneducated on how HIV is transmitted, association of HIV with improper or immoral behavior, and lack of awareness of health workers knowing what a stigma is and why it is harmful (Nyblade, Stangl, Weiss, & Ashburn, 2009). Because of these stigmas, individuals who suffer from HIV tend to seek testing and treatment services late in the progression of their disease, which is often beyond their ability to receive drug intervention (Nyblade et al., 2009). Individuals who do receive antiretroviral medications in Botswana have been found to grind their drugs into powder so that they aren’t seen taking medication in the presence of others, which can produce inconsistencies in their doses (Nyblade et al., 2009). Since healthcare professionals in Botswana struggle with self-stigma regarding potential HIV diagnosis, and fears of stigmatizing attitudes and behaviors from colleagues, this can lead to lack of HIV testing and early treatment if it is needed (Nyblade et al, 2009).

Sex Workers

Cultural attitudes and behaviors towards sex workers exist in Botswana, and because of the country’s experience with poverty and inequalities in wealth and income, sex work is a controversial topic that has caused for sex workers to be blamed as the main cause for transmission of HIV and AIDS (McDonald, 1996). Individuals who participate in this act do not define the individuals that they interact with as being ‘clients,’ instead they refer to them as partners or boyfriends (McDonald, 1996). There are a number of homosexual men working as male sex workers because they need money to eat, who have unprotected anal sex (McDonald, 1996). The number of youths who have admitted to having sex without use of condoms in exchange for money, gifts, or favors ranges between 8-15% (McDonald, 1996).

Presence of STDS

Transmission of HIV in Botswana is also associated with presence of other sexually transmitted diseases which are considered to have high influence in facilitating HIV (McDonald, 1996). This is also seen as the main factor of the spread of HIV in Botswana given the number of high incidence rates of contracting sexually transmitted diseases (McDonald, 1996).

Psychological Principles

Implementing and educating the population of the use of condoms would be implemented to help with protecting themselves and others from potentially contracting an STD, since prevalence of HIV in Botswana is linked to having other forms of STDs. Condoms should be distributed in a classroom setting to help with limiting the number of youths having unprotected sex. Educating this population would be ideal with preventing future generations from having exceedingly high rates of STDs because they would understand the importance of not having unprotected sex which could lead to numerous health concerns. This would differ from existing HIV prevention programs in Botswana because currently knowledge on HIV and other STDs is low due to how they are culturally and socially viewed. This would also help with challenging the cultural beliefs and stigmas of preventing HIV and transmitting it, also with being open to the idea of talking about it and receiving treatment. Overcoming these obstacles will take time because of the negative connotation already associated with even the idea of HIV in Botswana, but the more that the population because open with being educated on it, the more that they can prevent it from occurring in high percentages. This doesn’t mean that no one will get the virus because there are outlying factors like addiction that may lead to transmitting the disease, but it will lower the rates and help with healthcare providers also being more intuitive when it comes to the illness and its risk factors.

References

1. Acquired immune deficiency syndrome learning center. (n.d.). Retrieved from http://www.healthline.com/channel/hiv-aids.html
2. Cunningham, W. E., Shapiro, M. F., Hays, R. D., Dixon, W. J., Visscher, B. R., George, W., Ettl, M. K., & Beck, C. (1998). Constitutional symptoms and health-related quality of life in patients with symptomatic HIV disease. The American Journal of Medicine, 104(2), 129-136. doi:10.1016/s0002-9343(97)00349-5
3. McDonald, D. S. (1996). Notes on the socio-economic and cultural factors influencing the transmission of HIV in Botswana. Social Science & Medicine, 42(9), 1325-1333. doi:10.1016/0277-9536(95)00223-5
4. Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: What works? Journal of the International AIDS Society, 12(1), 15. doi:10.1186/1758-2652-12-15
5. Santrock, J. W. (2007). Adolescence (11th ed.). Boston, MA: McGraw-Hill.
6. UNAIDS (2018). ‘Country progrss report’, Botswana: UNAIDS
7. Weiss, R. A. (1993). How does HIV cause AIDS? American Association for the Advancement of Science, 260(5112), 1273-1279. Retrieved from https://doi.org/10.1126/science.8493571

HIV stands for Human Immunodeficiency virus, when this virus is at its most progressive stage it is known as Acquired Immune Deficiency Syndrome (AIDS). HIV belongs to the Retroviridae family. The genome of this virus is constituted of a single strand of RNA encapsulated in an HIV Capsid protein that forms the core shell of the virus. Moreover, the virus possesses a lipid bilayer composed of surface proteins and transmembrane proteins. Intracellularly beneath the lipid bilayer there is a matrix protein p17 followed by the conical capsid p24 that most commonly have the shape of a cone as seen in electron microscopes, also where the nucleic acid-binding protein and integrase are found bound to the RNA. (Seitz and für Impfstoffe und biomedizinische Arzneimittel, 2019).

HIV Anti-retroviral therapy (ART) refers to the multiple combinations or a single dose of HIV suppressant drugs that impede the progression of the viral infection. (Who.int, 2019). The anti-retroviral drugs have evolved from being a monotherapy with the administration of a single drug to a therapy that nowadays combines diverse types of drugs for a more effective response, nevertheless, complete eradication is not possible. Currently, 17 different drugs being utilised for treatment. (Volberding, P.A. and Deeks, S.G, 2010).

HIV travels through the bloodstream and with other body fluids and infects particularly T helper lymphocytes. (Nucleus Medical Media, 2013). The life cycle of HIV life cycle involves the following steps of binding, fusion, reverse transcription, integration, replication, assembly, and budding. During the first stage, a mature HIV’s surface antigen binds to a CD4+ T cell surface receptor and the receptor CCR5 or CXCR4. Then, the enveloped virus fuses into the helper T cell. After, HIV reverse transcriptase enzymes serve as catalysts during HIV RNA’s transcription into another RNA. During the integration step, the virus then takes over the T cell’s reproductive system and produces infectious particles named virions that carry the nucleic acid genome. The virus’s structure progresses as a result of the proteolytic cleavage step of assembling in which the binding polypeptide chains. Once it is matured, it leaves the body and travels to infect and kill other cells.

During the binding step, the inhibitory drug utilised is Maraviroc, it impedes the binding of CCR5 to a HIV’s antigen. In the fusion stage, it is the enfuvirtide that is used as it blocks the fusion of the virus into the healthy T cell. Next, the reverse transcription step has the most possibilities for inhibitory drugs by using nucleoside analogues and non-nucleoside reverse transcriptase inhibitors such as Tenofovir, Integrase Inhibitors, Abacavir, Lamivudine, Emtricitabine, Efavirenz and Nevirapine, all of these drugs will affect the nucleic acids to inhibit transcription thus inhibiting the creation of more viruses. In the integration step, Raltegravir and other integrase inhibitors are utilised to impedes the integration of the HIV RNA into the T cell’s genome. Finally, during the last step, the proteolytic cleavage can be inhibited by the following drugs, Atazanavir, Darunavir and Lopinavir which inhibit the proteins from cleaving to create a new mature virus.

HIV does not have a cure due to there is a small probability that a T cell with a genome that possesses instructions to produce HIV viruses can remain only dormant and it can be triggered to begin replicating HIV viruses at any moment leading to the continuation of the infection. (TedEd, 2019)

The HIV life cycle stage of budding where the virion (immature virus leaves the host cell) crosses the plasma membrane while it forms its lipid layer to mature. Budding is induced by the Endosomal Sorting Complexes Required for Transport (ESCRT). These molecules have their cycle in which they assemble and disassemble to function, to carry out this action they utilise a vacuolar protein sorting AAA-ATPase. ESCRT cannot be targeted as it is taken from the host T cells being utilised during cellular activities that are crucial such as the multivesicular body sorting pathway that regulates the cell’s surface receptors signalling. (Ahmed et al., 2019). The genome for that codes for these receptors could be cut from HIV, preventing it from maturing and being released to infect other healthy lymphocytes, virions are not infectious only when they mature. However, useful target proteins would be the HIV receptor Gag, this protein antigen is responsible for recruiting ESCRT proteins. (Sundquist and Krausslich, 2012).

Nonetheless, a side effect would be the possibilities that the drug could affect healthy cells’ receptors and the limitation is that both possible drugs would need to be combined with other types of drugs so that if the drug is inaccurate there is still another manner of inhibiting the life cycle of HIV.

Alternatively, Vpu accessory protein is utilised to promote the release of mature virions. (Janvier et al., 2011). Although, this would not be as effective since the T cell can burst and the virions can be realised and can infect other lymphocytes.

References

1. Who.int. (2019). WHO | Antiretroviral therapy. [online] Available at: https://www.who.int/hiv/topics/treatment/art/en/ [Accessed 13 Oct. 2019].
2. Seitz, R. and für Impfstoffe und biomedizinische Arzneimittel, B. (2019). Human Immunodeficiency Virus (HIV). Transfusion Medicine and Hemotherapy, [online] 43(3), pp.203-222. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924471/ [Accessed 14 Oct. 2019].
3. Nucleus Medical Media (2013). Medical Animation: HIV and AIDS. [image] Available at: https://www.youtube.com/watch?v=ng22Ucr33aw [Accessed 15 Oct. 2019].
4. Volberding, P.A. and Deeks, S.G. (2010). Antiretroviral therapy and management of HIV infection. [online] Science Direct. Available at: https://www-sciencedirect-com.wwwproxy1.library.unsw.edu.au/science/article/pii/S0140673610606769 [Accessed 2019 Oct. 14AD].
5. TedEd (2019). Why it’s so hard to cure HIV/AIDS – Janet Iwasa. [image] Available at: https://ed.ted.com/lessons/why-it-s-so-hard-to-cure-hiv-aids-janet-iwasa#review [Accessed 14 Oct. 2019].
6. Ahmed, I., Akram, Z., Iqbal, H. and Munn, A. (2019). The regulation of Endosomal Sorting Complex Required for Transport and accessory proteins in multivesicular body sorting and enveloped viral budding – An overview. International Journal of Biological Macromolecules, [online] 127, pp.1-11. Available at: https://www.sciencedirect.com/science/article/pii/S0141813018358380 [Accessed 14 Oct. 2019].
7. Sundquist, W. and Krausslich, H. (2012). HIV-1 Assembly, Budding, and Maturation. Cold Spring Harbor Perspectives in Medicine, [online] 2(7). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385941/ [Accessed 14 Oct. 2019].
8. Janvier, K., Pelchen-Matthews, A., Renaud, J., Caillet, M., Marsh, M. and Berlioz-Torrent, C. (2011). The ESCRT-0 Component HRS is Required for HIV-1 Vpu-Mediated BST-2/Tetherin Down-Regulation. PLOS. [online] Available at: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001265 [Accessed 14 Oct. 2019].

Human immunodeficiency virus (HIV) damages cells of the immune system in particular CD4 cells or T cells leading to reduced numbers. This, therefore, lowers the ability to fight off infections and diseases. Over time the immune system becomes weaker and weaker until the final stage of HIV is reached, Acquired immune deficiency syndrome (AIDS). The severity of AIDS makes suffers highly susceptible to life-threatening conditions for example cancers. There is currently no cure for HIV and AIDS, however, it can be managed effectively with the right treatment plans. Through time the way we view and treat HIV has drastically changed. This essay will discuss the symptoms and spread the virus as well as how HIV was dealt with and diagnosed in the past and present. It will also cover possible future advances in treatments for the disease.

Causes, Symptoms and Spread of HIV

The HIV virus is round and has a 100nm diameter with a lipid bilayer membrane envelope (Transfus Med Hemother 2016). It is a retrovirus with two forms HIV-1 and HIV-2, HIV-1 has the highest prevalence. The two forms genomes differ by 55% meaning that a test for HIV-1 will not necessarily detect HIV-2 (Aidsmap 2012). The retroviruses produce a number of regulatory proteins. One of these is called Nef, this protein prevents CD4 being displayed on the host cell surface membrane resulting in deficiency causing reduced immune response. Nef increases pathogenicity more in HIV-1 than HIV-2 due to it having a lower amino acid structure in HIV-1 (Transfus Med Hemother 2016). Infection occurs when the virus enters the host cells it can do this by crossing a mucous membrane, entering damaged skin, entering the skin when pierced with a contaminated object and passed from infected mother to her foetus. HIV is spread via sexual intercourse by the viral cell binding to dendritic cells of the immune system and then pass through the lipid bilayer, replicating inside the dendritic cell using the host’s components.

Early symptoms of human immunodeficiency virus occur 2-6 weeks infection from the pathogen, it is normally in the form of a short illness with similarities to the flu. Following this, there may not be any other signs of HIV for a long period of time even though the virus is still continually destroying CD4 cells weakening the immune response. Symptoms are not particularly specific therefore diagnosis is difficult because carriers do not know they have acquired the disease. Risk is highest in; black Africans, homosexual men and individuals who share needles (NHS 2018). It has a higher frequency in homosexual men due to an increased chance of transmission during unprotected anal sex rather than vaginal or oral intercourse. Prevalence of HIV-2 in black Africans is because high percentages of the population carrying the disease with lack of diagnosis, treatment and education, this also leads to large numbers of children being infected from their mothers during pregnancy.

Past spread and treatment of HIV

Between 1981 and 2003 Human immunodeficiency virus infected 60 million people worldwide causing fatality in more than 20 million of these individuals (Nature Medicine 2003). The HIV virus is thought to have first spread to the human population in the 1920s. The disease originated from Simian immunodeficiency virus (SIV) in African Mangabey monkeys, once this virus passed to humans from consuming infected monkey meat, it mutated leading to HIV-2. Evidence of positive responses to HIV antibodies from isolated SIV in chimpanzees suggests HIV-1 diverged from SIV in chimpanzees located in Gabon (Springer 2018). The epidemic came to worldwide attention in the early 1980s, at this time the first cases of AIDS were identified. The disease caused mass panic and false ideas about the spread of the disease due to the lack of research at the time. HIV was largely associated with the gay male population and drug users creating a stigma around the disease.

In 1983 HIV-1 was isolated for the first time in the Institut Pasteur, Paris, France (Nature Microbiology 2013). The pathogen being identified allowed epidemiological tests to be carried out revealing that HIV was the cause of AIDS. The isolation of the HIV-1 virus allowed antibody structure to be analysed so a diagnostic test for their presence on large scale could be used. This meant blood for transfusion could be successfully screened preventing infection. Testing meant doctors could identify sufferers in the early stages of the disease so the progress of the illness could be monitored, meaning symptoms could be established. In 1984 it was discovered that CD4 class of T lymphocytes were the main receptor for HIV (Nature medicine 2003). Further structural analysis distinguished the presence and structure of; 3 structural gene and 6 regulatory genes, together coding for 15 proteins essential for HIV viral replication. Knowing the method of replication process of the virus was key in identifying effective drug targets (Nature Medicine 2003). The research at this time was extremely important for later development of antiretroviral drugs for the treatment of HIV and AIDs that are available at the present, which are capable of greatly extending life expectancy and quality.

Present treatment and prevalence of HIV

In 2017 approximately 1.8 million people were newly infected by the virus and between 31.1-43.9 million were living with HIV (UNAIDS 2018). At the present day, there is still no definite cure for the disease. Despite this, there is high availability of emergency preventative treatments and antiretroviral drugs. These drugs reduce risk and increase the quality of life for people with the danger of contracting the disease or existing sufferers.

Post-exposure prophylaxis (PEP) is an emergency medication for patients who believe they may have come into contact with the virus. After taking PEP when HIV enters the cell activity of reverse transcriptase is reduced meaning it is less likely for the virus to be able to replicate. Replication is decreased because nucleoside reverse transcriptase is inhibited leading to termination of the replicating chains after they have been integrated into viral DNA. Research shows that the medication can reduce chances of contraction by over 80% (Canada’s source for HIV and hepatitis c information 2018).

For patients who are already HIV positive, antiretroviral drugs play a key part in treatment. Each particular group of these drugs for HIV carriers have different targets to cause action including; reverse transcriptase inhibitors, viral protease inhibitors, integrase inhibitors, maturation inhibition and viral entry inhibitors. Reverse transcriptase inhibitors can be used in HIV sufferers as well as in emergency medicine and work via the same method as explained in PEP to reduce replication. Protease inhibitors target viral proteases e.g. HIV aspartyl protease, these enzymes cleave new precursor proteins. When the proteases are inhibited viral polyproteins cannot get split into smaller proteins, therefore, do not gain their functional or structural roles. Integrase inhibitors; MK-0518 and GS-9137 being the most common have the ability to prevent the strand transfer reaction. This reduces the stability of the viral genome as well as hindering expression of genes. 3-O-(3′, 3′-dimethylsuccinyl)-betulinic acid (Bevirimat) can act as a maturation inhibitor. It interferes with the processing of HIV group-specific antigen (gag proteins) which make up 50% of viral particle mass (Trends in MIcrobiology 2013). This interference stops maturation of capsid protein p25 rendering the HIV particle non-infectious. Viral entry inhibitors block non-specific interaction with heparan sulphates on the membrane of CD4 cells preventing HIV from fusing and subsequently entering. The use of medication can be successful in reducing symptoms and occurrence of the disease, however, the prevalence of HIV is still significant at this time.

Future Treatment of HIV

For the first time, there is evidence pointing towards the possibility of cures for HIV. With the development of gene editing and transplanting techniques in recent years, studies are now being done to attempt to utilise them in HIV treatment. In 2007 the first man became HIV free after a bone marrow transplant to treat cancer (New scientist 2019). One other person has been cured of the disease in the same way, with another reported but not confirmed in March 2019. All three of these patients were suffering from leukaemia or Hodgkin’s lymphoma and received a bone marrow transplant. As part of the method of the transplants, large quantities of their immune cells were destroyed via radiotherapy or medications and have to be replaced with donor cells. In these cases, the cells of donor bone marrow have a mutation in the CCR5 gene (New scientist 2019). The mutation is a 32 nucleotide deletion in a gene coding for beta chemokine receptor. The deletion provides resistance To HIV-1, however, is rare with 0.0808 frequency in Caucasians (Nature medicine 1996). Although this has the possibility of being a cure, the risks associated are extremely high and therefore should only be used as a last resort. However, the discovery of this has shown the potential of using genetic engineering to treat HIV/AIDs.

CRISPR/CAS9 is a part of DNA which contains short tandem base repeats. It can be used as a genetic engineering tool that uses the CRISPR sequence and its associated proteins to edit DNA. CRISPR sequences can be modified allowing it to recognise sections of bases in HIV-1 promoters. This means that the promoter sequence can be excised from host DNA. Modified CRISPR has been used in the lab on T-lymphocyte cell lines containing integrated HIV-1 and green fluorescent marker proteins. HIV-1 gene expression was inhibited in these cells (Nature 2016). Gene editing also could have the ability to give immunity to HIV. This could be done by using CRISPR/CAS9 to edit B-cells. Edited B-cell could produce improved versions of antibodies in vitro, these antibodies potentially would be given to people with a high risk of contracting the virus in the form of injection (New Scientist 2019). After the occurrence of HIV being cured, action has been taken to find less harmful techniques for use on the general population.

In conclusion, the way we treat and view HIV/AIDS has changed. When first cases appeared little was known and there was fear around the virus due to the high chance of fatality. The disease is no longer the life sentence it once was. Biomedical research has played a key part in saving millions of lives. New treatments allow people who have contracted the disease to live longer and people at risk of the disease to live with less danger. Discoveries from the past of the action and targets of virus have been built on giving the medications we have today. With greater technology, research to develop a cure can occur. This differs from the present where we can only prevent transmission and reduce symptoms once infected. The future for people suffering from HIV/AIDS looks promising, however, it may be some time before a worldwide cure can be established.

Introduction

In 1981 the Acquired Immune Deficiency Syndrome (AIDS) was firstly identified as a new disease caused by a retrovirus, human immunodeficiency virus type 1 (HIV-1). It was the cause factor of the most devastating disease that emerged in the last 35 years. HIV-1 also spreads by percutaneous and perinatal routes, or exposure at mucosal surfaces, but primarily via sexual transmission.(Cohen et al., 2011) Since the identification of this virus it infected more than 60 million people and caused about 25 million deaths. Developing countries have the highest mortality rate with especially high numbers in sub-Saharan Africa.

The sudden emergence of this new virus has always been in the focus of study of researchers. In 1986 an antigenically different HIV type 2 has been discovered in western Africa.(Clavel et al., 1986) This is very closely related to a simian virus commonly found in macaques.(Chakrabarti et al., 1987) After that, more simian immunodeficiency viruses (SIVs) were found in different species of primates for example in chimpanzees(Huet et al., 1990) and sooty mangabeys(Hirsch et al., 1989) , which were close relatives to HIV-1 and HIV-2. These viruses are mostly non-pathogenic to their hosts. These evidences implied the idea that AIDS developed in both macaques and humans because of cross-species infections with lentiviruses from different primate species.(Sharp et al., 1994) Moreover, HIV-1 and 2 are most likely a result of virus transfer to humans from infected primates in Africa.(Hahn et al., 2000) In this essay, I am going to summarize the known facts about the precursors of HIV-1 and HIV-2, examine their most likely evolutionary history and go through the steps that leaded to the AIDS pandemic.

Primate lentiviruses

Primate lentiviruses are mostly transmitted horizontally, but recent studies came up with evidence of vertical transmission (when they also infect the germ cells of the host) that occurred many times e.g. in Malagasy lemurs about 4.2 million years ago.(Gilbert et al., 2009) These living species provide direct evolutionary evidence of lentivirus changes. Molecular data analysis suggested that the ancestral SIVs existed a few hundred years ago. Only apes and monkeys from Africa were infected with SIV. This might suggest that the primate lentivirus emerged in Africa before the division of the Asian and African Old Word Monkeys, about 6-10 million years ago. However, neither Asian nor African New Word Monkeys were tested for the endogenous SIVs, therefore we cannot have a clear understanding of primate lentiviruses’ evolutionary history. It became clear though that SIVs are spread among 40 species of primates, most infections happened within species but also numerous cross-species transfer took place, generating newly emerged mosaic virus lineages. (Jin et al., 1994)

SIVcpz, a lineage within simian viruses, has quite similar genetic properties as HIV-1 and they show a close genetic relationship. Interestingly, only two of the common chimpanzees have this lineage of the virus, which indicates that these 2 species had acquired the SIVcpz more recently, after the split of their lineages.(Sharp & Hahn, 2011) According to the phylogenetic analysis, SIVcpz shows a complex mosaic. This is a result of a recombination of two ancestral SIV lineages, which might have occurred during predation (chimpanzees hunt for mammals and other monkeys) and lead to cross-species transmission event. (Bailes et al., 2003)

SIVcpz compared to other SIVs are pathogenic to its host and spread through sexual routes. They also increase the risk of mortality in infected individuals. Similarly to HIV-1, they cause CD4+ T-cell loss and can lead to the end stages of AIDS. Overall, they have a negative impact on reproduction and health of infected individuals.

A recently found new lineage (SIVgor) within the radiation of SIVcpz, appeared in several gorillas. It happened possibly due to a single cross-species infection from chimpanzee. Phylogenetic analysis supported this idea.(Takehisa et al., 2008) Due to the fact that only a few gorillas are infected it is hard to study SIVgor, but it has similar effects as HIV-1 on infected individuals (e.g. CD4+ T-cell loss).

HIV-1 origin

HIV-1 is further subdivided to M, N, O, and P groups that represent independent cross-species transmission events. Group M were recognised firstly, and had the most devastating effect on human populations among the 4 group. It causes the death of millions of people and has an impact in all countries on the Earth. Group O had been identified in 1990, and responsible for only about 1% of HIV-1 infections. Patients came from the area of Cameroon and Gabon. 8 years later a new N type was found, and so far, appeared only in 13 cases. The recently discovered (2009) P type only effects 2 individuals, a Cameroonian woman who lives in France and another person from Cameroon.(Plantier et al., 2009) In all types of this virus there is CD4+ T-cell depletion and the AIDS disease appears.

N and M type are more closely related to SIVcpzPtt, which indicates that the origin of these 2 types might be from chimpanzees. Furthermore, it was possible to even identify their ape precursors. M type most likely emerged in the area of Sangha and Boumba rivers, while N type possibly originates from the Dja Forest, both found in Cameroon.(Heuverswyn et al., 2007) The gorilla origin of P type is supported by existing phylogenetic data, however, some characteristic of the SIVgor trait also can be observed in this group. Since there is no particularly closely related ape virus to the O group, the origin of it is still unknown. The fact that O and P is more closely related to SIVcpzPtt than to SIVcpzPts implies that these 2 groups originate from west-central Africa.

The way how humans acquired all the types of HIV-1 is still not known. However, some suggestions can be made based on the biology and spreading mechanism of these viruses. The transmission must have occurred through mucous or cutaneous membrane exposure to infected ape body fluids and/or blood. Whatever the way it happened, the ape-human interactions resulted in 4 independent cross-species transmission event in west-central Africa.

HIV-2 origin

HIV-2 has remained mostly in West Africa since it has been discovered in 1986. Interestingly, the HIV-2 infection does not result in AIDS disease mostly, but when it does, it causes identical symptoms as HIV-1. Firstly, a sooty mangabey origin of HIV-2 was suggested in 1989(Hirsch et al., 1989). HIV-2 was very similar to a locally spread SIVsmm infection among sooty mangabeys supporting the idea mentioned previously. Moreover, these kinds of mangabeys were hunted for agricultural pets in this area of West Africa providing a possible way of cross-species infection. 8 different subgroups of HIV-2 viruses (A-H) had emerged so far, which are an analogue to HIV-1 viruses. A and B have an influence on a large group of people while the other 6 only have an impact on few individuals. All the 8 groups originated from the area of Cote d’Ivore, Liberia and Sierra Leone. (Sharp & Hahn, 2011)

Adaptation to new host

To gain access and to became able to infect new species, all virus trait must get over barriers of the host immune system. To become successful in such challenges, they need to overcome some adaptive hurdles before a lentivirus can effectively infect other species like humans. Evidence of host-specific adaptation had been found in change of sites in viral proteome. The viral matrix protein (Gag-30) encoded a Met in both SIVgor and SIVcpzPtt traits, while this had been switched to express Arg in HIV-1 ancestor, and it had been conserved as a basic amino acid (Arg, Lys).(Wain et al., 2007) This type is more efficient in humans while the ancestral trait is more successful in apes.

Origin of AIDS

Phylogenetical and statistical analysis dated the last common ancestor of HIV-1 M to 1910-1930, so it has been spread for 50-70 years before it had been discovered. Molecular epidemiological studies even identified the town where it probably originated, Leopoldville in west-central Africa. There were lineages only found in this area and also all subtypes of M had been found there. Leopoldville was the largest city in the area at that time, a likely destination of a newly emerged virus to spread. (Worobey et al., 2008)

Conclusion

Recent studies helped in understanding the evolution and the most likely origins of SIV and HIV. The method of transmission from primates to human is still unknown, but possible explanations can be made according to the biology of these viruses. Different types of HIV viruses are most likely a result of numerous cross-species transmissions from gorillas and chimpanzees to humans that lead to one of the most devastating diseases in the last 35 years.

Third World HIV Prevention Trials. In February 1994, the Data Safety and Monitoring Board of the U.S. National Institute of Allergies and Infectious Diseases interrupted AIDS Clinical Trial Group (ACTG) Study 076 (22). The preliminary data revealed a statistically significant and dramatic difference in vertical HIV transmission rates from mothers to their newborns, between women who received the active regimen and the placebo group.

The regimen quickly became the standard of care in industrialized nations, where no trial that would deny access to the ACTG 076 regimen or to a potentially equivalent intervention would satisfy the requirements of ethical review. In developing countries, however, the costs of the 076 regimen ($800 for the drug alone) put it out of reach. It was, therefore, a matter of some urgency that trials begin to determine whether radically cheaper alternatives could reduce maternal-fetal HIV transmission. The CDC and NIH launched nine placebo-controlled trials, all subject to careful ethical review, in developing countries.

Nevertheless, on 18 September 1997, Marcia Angell, executive editor of the New England Journal of Medicine, denounced the placebo-control trials in Africa, Asia, and the Caribbean. Citing the Declaration of Helsinki for authority, she noted that control groups had to be provided with the best current therapy, not simply that which was available locally. Taking her lead from Lurie and Wolfe, who first drew the comparison to Tuskegee in regard to the Third World studies as they had in Alaska, she argued, ‘The justifications are reminiscent of those for the Tuskegee study: Women in the Third World would not receive antiretroviral treatment anyway, so the investigators are simply observing what would happen to the subject’s infants if there were no study.’

However problematic the efforts to obtain informed consent in the Third World, investigators clearly made efforts to inform the enrolled women that they would be part of a study to reduce maternal transmission of HIV and that some would receive a placebo. No attempt was made to exploit the social vulnerability of the women involved. Indeed, it was the very poverty of the nations within which these women lived that served as the predicate for the challenged studies. Only to the extent that these women could be said to have a realizable claim on the care available in industrialized nations would the conduct of a placebo control trial have mirrored the deprivation of Tuskegee. But then any trial to find a cheaper and potentially less effective regimen–whether placebo controlled or not–would have been unethical as well. To the extent that the search for a less costly and potentially less effective intervention could be justified by the desperate need to find affordable interventions, the analogy to Tuskegee entailed a gross distortion.

Yet to the extent that women in poor countries have a moral–as contrasted with a realizable–claim on the care available to women in industrialized nations, critics helped to underscore the profound injustice that characterizes the world distribution of medical resources. Unfortunately, the invocation of Tuskegee launched a furious methodological debate that diverted attention from an analysis of the very poverty and inequality that necessitated the challenged studies.

Introduction

Human Immunodeficiency Virus / Acquired immunodeficiency syndrome (HIV/AIDS) is a life-threatening, secondary immunodeficiency disease and remains an immune threat to all over the world. HIV/AIDS has emerged as a serious public health emergency in Manipur, Northeast, India. The first HIV positive case in Manipur was reported in 1989 from the blood sample of an intravenous drug user (IDU). Since then Manipur with a population of 3 million has an area of 22.327 km square is reported as the second highest (1.43%) adult HIV prevalent state in the country, according to HIV estimation 2017 by the National AIDs Control Society (NACO). Manipur with hardly 0.2% of India’s population contributes 8% of India’s total positive case. The Strategic Information and Management SYSTEM is created at the State level to integrate from the grass-root level to the topmost level decision-maker for periodical tracking of the epidemic situation in Manipur. According to SIMS report 2016-17 by Manipur AIDS Control Society (MACS) the proportion of the male clients with HIV positive cases was found to be 56% followed by 43% of female clients with HIV positive case whereas Transgender / Transsexual with HIV positive case was found to be only 1% . The majority of the HIV positive clients were between the age group 35-49 years (41%) followed by age group 25 to 34 years (26%). One of the main causes of the high HIV prevalence in the state is the easy availability of heroin through illegal drug trafficking from the Golden Triangle area. To Limit the expansion of HIV, the various program has been initiated. NACO initiated Anti-Retroviral Therapy (ART) program countrywide on 1st April 2004 and to intensify the program, the second line ART program was started in January 2008. There are presently 11 ART centres providing free ART in Manipur. In addition, there is two private ART centres.

In this review, the authors focus on the current statistics of HIV of Manipur and its improvement data, major causes, and steps taken up by the Government of Manipur(SIMS), NGO, researchers and policymakers against the prevalence of HIV in Manipur.

Methods

The data for this study was collected from the SIMS Annual report by Manipur AIDs control society (MACS) https://manipursacs.nic.in/, HIV Sentinel Surveillance Report of Manipur, Annual Report NACO http://naco.gov.in/. In 10 April 2020, based on keywords search ‘Manipur’ and ‘HIV’ an advanced bioinformatics’ search for published literature in English in last decade (since 2010) was performed using PubMed https://www.ncbi.nlm.nih.gov/pubmed/, PubMed delivers a publicly available search interface for MEDLINE as well as other NLM resources, making it the premier source for biomedical literature and one of the most widely accessible resources in the world. The selected articles are further accessed in ISI web of science database to maintain the standard of this review article. Finally, the steps involved in our article involves plotting data and information from published literature and extraction of related data and analysis of the findings.

Results

From the database PubMed, many articles were found to be published, 17 articles were considered for this study. The collection of accurate data, facts and figures from different sections of the community as well as from various units of sub-divisions will present near-accurate data of emerging HIV/AIDS epidemic situation in the state Manipur, which can then be observed. SIMS may assist MACS & DAPCU in monitoring, evaluation and surveillance for taking appropriate preventive measures, analysis, identifying, alerting program management and providing way for corrective measures.

Targeted Intervention(TI) program TI-IDU:

The main High-Risk Groups (HRGs) are IDU, Female Sex Workers (FSW), Men who have sex with men(MSM), Transgender(TG) and besides HRGs, other population groups, Migrant workers and Long-distance Truckers, known as bridge populations. The prevention programmes focused among (HRGs) and Bridge population supported by NACP are termed as Targeted Interventions(TI). Manipur State AIDS Control Society is implementing 63 Targeted Intervention Projects covering IDUs, FSWs, FIDUs, MSM and Migrant workers. They are highly vulnerable to HIV infection. Prevention efforts have been targeted towards HRGs and Bridge populations to reduce new HIV infections and prevent transmission to low-risk populations.

Services provide under Targeted Intervention:

Behaviour change communication, condom promotion and distribution( except for bridge population) free as well as through social marketing, STI detection & treatment and Partner Management, Linkage with Integrated Counselling and Testing Centres(ICTC), Linkage with Care/Support/Treatment services for HIV positive Clients, Community mobilization and ownership building, Creating an enabling environment with community involvement and participation, Specific intervention for IDU: Distribution of clean needle and syringes, Abscess prevention and management, Opioid Substitution Therapy(OST), Linkage with Detoxification and Rehabilitation services, Specific Intervention for MSM/TG: Provision of Condom/Lubes.

Achievement of TI-IDU:

Table 1: The above shows the coverage of IDus during the year 2016-17.The total target of the IDU during the year 2016-17 is 16,500 and observed that average monthly coverage is more than 100%. The majority of the new IDUs covered during the year 2016-17 were Non-daily injectors.

Fig 1: As per the above graph, the majority of the TI-IDUs covered more than 100% out of the target given by SACS except for three IDU-TIs namely: WESDEV, IFORD and RVS Khongjom.

A major component of HIV intervention among the HRGs is Condom promotion. They are encouraged to use condoms and provided free as there is a chance of transmission of HIV through unprotected sex. As per data, it is observed that the estimated number of sexual acts was 1624860 among the male clients and 353764 among the female clients, an average Condom distribution was more than 100% out of the estimated sexual acts.

Fig 2: Condom services provided by MSM Tis, 2016-17

Migrant TIs:

Manipur State AIDS Control Society is providing a comprehensive package of services like Outreach services, Counselling services, Condom distribution, Health camps, IEC activities etc. for migrant workers through two TI-NGOs. A total number of new individuals registered during 2016-17 was 8,705 however the actual coverage of Migrants including Old could not be extracted due to inadequate data. Counselling services provided were 6,139. The total number of Migrants covered through outreach sessions during the 4807 IPC programs conducted and the number health camps organized was 126

Needle Syringe exchange program:

It is one of the most important components of TIs covering IDUs. Under this, TIs are distributed with new needles and Syringes to the IDUs and taken back from them after use it. As per the above table, more than half (71%) of the total number of estimated injecting acts are daily injectors and only 29% are non-daily injectors. The number of syringes distributed is about 95% of the estimated injecting acts. TIs need to distribute syringes as per the requirement to reduce the chances of sharing syringes. Further, the return rate of syringes was 77% only, TIs may focus to increase the return rate of syringes.

Integrated Counselling and Testing Centre (ICTC)

An Integrated Counselling and testing centre (ICTC) is a place where a person is counselled and tested for HIV, on his own free will or as commanded by a medical provider. The main functions of an ICTC are – Early detection of HIV, Provision of Basic information on modes of transmission and prevention of HIV/AIDS for promoting behavioural change and reducing vulnerability, Link people with other HIV prevention, care and treatment services, Provision of Early Infant Diagnosis.

Overall 1,013 clients were found HIV positive out of 78187 clients were tested at the ICTCs. About 4% of children were found HIV positive out of 1516 were tested. It is also observed that the HIV positive among the spouses is 43%, out of 407 were tested, so high. As such, the program needs to focus on HIV testing of spouses of HIV positive clients.

Fig 3: it is found that the majority of the clients detected HIV positive is male clients i.e,60% followed by 40% female clients and 1% among the TS/TG. Presently 42 FICTCs are functional in Manipur and SIMS.

Blood Safety:

Manipur-SACS is trying to make available enough safe blood in all the Hospitals of Manipur. Various activities like sensitization cum VBD camps are taken up by the blood safety division of MACS for ensuring access to safe Blood and Blood Products . Blood Transfusion services play a vital role in a health care delivery system. Under SBTC/MACS Manipur always try to address issues of Blood collection, access and quality management practices. As a part of the mobilization of blood donors, National Voluntary Blood Donation Day 2016 was observed on 1st October 2016.

Anti-Retroviral Therapy (ART):

There are presently 11 ART centres providing free ART. One Regional Paediatric Centre at JN Hospital has been implemented to treat complicated paediatric AIDS cases referred from different ART Centres of Manipur and the other the North East States. In addition, there is two private ART Centres, one at Churachandpur and another one at Moreh run by a bilateral donor Medicines Sans Frontiers. The state has at present a total of 9 LACS under MACS and orders MSF-Churachandpur to supplement the ART centres.

To render effective counselling to PLHA who are on ARV drugs about drug adherence and track down the lost to follow up patients of both Pre and on –ART patients, there are 9 Care Support centres under Vihan Project linked to all the ART centres. All the data of patients and children on ART are now computerised for proper monitoring in terms of drug adherence, loss to follow-up. Fixed-Dose Combination (FDC) paediatric formulations of ARV drugs are available at all ART Centres for better treatment and CLHAs. To render maximum treatment of PLHAs with ARV drugs, the maximum number of PLHAs have to be referred from different HIV service centres to ART Centres.

The number of PLHAs accessing ART have almost reached 15,336 as on 31st March 2016. The discovery of ARV and its accessibility have entirely changed the scenario of HIV/AIDS. It has improved the quality of life for many PLHAs which had literally made thousands of other PLHAs more open to coming out in the public and this has led to a substantial reduction in the level of stigma and discrimination.

Antiretroviral resistance and genotypic characterization of HIV in Manipur:

A publication related to resistance to HIV drugs suggests that the drug resistance mutation (DRMs) , genetic variance and origin of transmitted drug resistance of HIV-1 among the HIV-1 infected wives of IDUs in Manipur. HIV pol gene sequences were considered from blood samples by viral gene amplification method and sequencing. Sequences were then observed for origin and drug resistance genetic variants. The result indicates that among the treatment-naive cases, around 35% had transmitted drug resistance mutations(TDRMs) while among treatment cases, 50% had Acquired drug resistance mutation (ADRMs). TDRMs and ADRMs both shows resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors( NNRTIS),and protease inhibitors (PIs). Most of the isolated HIV 1 sequences (77%) were subtype C which is the highest prevalence among all HIV-1 subtypes and is predominant in our country India. While 9.1% was discordant subtype, 6% was subtype B ,and around 4% was CRF_01AE and about 2% was URF_BC. TDRM strains were found to be arise from Vietnam, Myanmar and mainland India. It also reveals the appearance of CRF_01AE for the first time in Manipur. The result of this case indicates high prevalence of drug-resistant mutation and complex molecular epidemiology in state Manipur.

Discussion:

This review article provided an opportunity to study and update the HIV/AIDS epidemic and prevalence. State Manipur lies adjacent to the Golden Triangle where the borders of Myanmar, Laos and Thailand meet, most of its eastern boundary is formed by the Myanmar which is the second largest opium producer in the world. Manipur is on a major drug-trafficking route from the Golden Triangle, thus drugs are variably available. Heroin, locally known as “number four” among IDUs, it is a major injecting drug in Manipur, and a powder form of dextropropoxyphene is also used by IDUs for drug Injection.

Fig 4: Map of the focus site and possible route of origin of transmitted drug-resistant strain of Manipur. Red star suggest the focus site. Arrows suggest the possible way of HIV origin according to viral subtype and pink triangle shows the golden triangle area.

IDUs who share needles are more likely to engage in unprotected sex with their regular partners. These results provide evidence regarding the debate around the increase in HIV transmission to spouses from high risk partners. A large proportion of HIV positive IDUs in Manipur have adopted safer injecting drug use behaviour and don’t share needles with others which is a major success of the MACS. This study adds literature suggesting a significant association between IDUs risky sexual practices with a casual partner and non-condom users. The data of this study indicate that the majority of the IDUs who have sex with female casual partners were not using condoms in their relationship, this finding is similar to those reported in studies elsewhere in India. Female sex workers are also in high risk for sexual transmission of HIV and Hepatitis virus. According to report, female drug users engage in sex work to support their drug use. As HIV/ AIDS is mainly associated with the behavioural nature of a person many people hesitate to disclose their HIV positivity. Various reports of HIV/ AIDS infected persons being bullied by their society. The ART drug distribution had been started since 1st April 2004 in Manipur, it remains inaccessible among the HIV/AIDS infected patients due to hesitation on being registered themselves in ART canters which results in serious public health issue for diagnosis and ART treatment. The easy availability of drugs(heroin) in Manipur, an important drug trafficking route, and ongoing political insurgency, have led many NGOs possibly focused on development to adopt drug use and prevention as their major goals, and to form alliances as anti-drug pressure groups. Moreover, drug trafficking is allegedly a source of funding for some of the insurgency groups; thus, combating the drug trade also serves political and military goals. From the perspectives of participants and key informants, the actions of many NGOs and anti-drug groups often serve to produce risk by fomenting criminalization and rigid abstinence-only approaches thereby targeting drug users themselves.

Most IDUs have low-wage jobs and are unemployed. Without the support from family members, some IDUs undergo crime activities in order to get or buy drugs for their eager needs, including stealing, which may lead them in prison sometimes from the direct report of family members. Moreover, injecting drugs may also be available in prisons, at higher prices, it is very difficult to get sterile needles in prisons. And many IDUs in prison, including those who are known to be HIV positive, may be forced to share needles with others. Drug use in Indian prisons has been caught by the Indian Government. But India does not have government-sponsored NSPs or opioid substitution treatment programmes in prisons, which increases the spread of HIV and negatively affects the health of HIV-positive IDUs inside the prisons.

Fig 5 : Flowchart of factors which influence high HIV/AIDS

The person-to-person spread of HIV is called HIV transmission. HIV is spread only in certain body fluids from a person who has HIV: Blood, Semen, Pre-seminal fluids, Rectal fluids, Vaginal fluid, Breast milk. HIV transmission is only possible if these fluids come in contact with a mucous membrane or damaged tissue or are directly injected into the bloodstream (from a needle or syringe). Mucous membranes are found inside the rectum, the vagina, the opening of the penis, and the mouth.

Manipur State AIDS Control Society has accorded the title of Brand Ambassador of HIV/AIDS to Mr. Khundrakpam Pradipkumar, recently crowned Mr. Manipur (60 kg wt), who has been living with HIV for over a decade now. He has also been selected among the six finalists in the Mr. India contest held in Meerut (UP) in last week of March. His mission as an Ambassador is to take a leading role in spreading HIV/AIDS messages to people, particularly the PLHAs to motivate them to ‘live and achieve’ even with HIV in them.

Conclusion :

Our study and finding shows that the IDUs who engage risk like unprotected sex with casual partners, unsafe needle-sharing drug injection habits are more likely to engage in unsafe sex with regular female partners so they must acquire specific knowledge by providing awareness programs. So the ongoing risk can be reduced for IDUs need to expand their main focus to add communication and idea about condom use in different relationships in addition to addressing IDUs unsafe injection practices in an effort to achieve the main goal of minimum or zero new infection. The study identified powerful social, economic legal, policy-level factors that lead to a context in which HIV positive IDUs in Manipur who might otherwise adopt safer injecting practices instead of sharing needles. Such high-level interventions hold the promise of effecting sustainable reduction of HIV infection among IDUs and improving the health of IDUs living with HIV in Manipur. Moreover, Manipur has the highest rate of HIV prevalence rate in the country so, any study related to HIV/AIDs in this region need to encourage, solve the health issue and encourage the development issue of the country as whole. The major cause of HIV pandemic in this International border area is the uses of the drug heroin which are transported and smuggled from the ‘South Asia Golden triangle’. The HIV pandemic in such border region is more complex than another region of this country due to the emergence of recombinant HIV forms and DR HIV-1. Further studies like emerging genetic variants in response to ART, the effect of coinfection with different viruses need to be inspired in all international borders to limit the expansions of more complex form of the virus and increase the rate of HIV testing coverage in Manipur.

Introduction

The human immunodeficiency virus (HIV) is estimated to affect 37.9 million people worldwide, of which 1.7 million are children (World Health Organization, 2018). The virus attacks T lymphocytes, cells used by the immune system to protect the body of foreign invaders. HIV uses these cells as a replication machine, leading to a depletion in T cells, therefore weakening the immune system, allowing for opportunistic infections to take over, thus causing autoimmune deficiency syndrome (AIDS) (Bhatti et al., 2016).

Although there are drugs that help with the management of the disease, patients that undergo this treatment develop dependency and several adverse effects. Hence, there is a need to develop new and better therapies for the treatment of HIV (Bhatti et al., 2016).

Gene therapies have been developed and are being used to treat thousands of diseases, however, due to ethical issues and because these therapies are still new, there is not enough evidence of their efficacy in humans. Nevertheless, they show great promise and their efficacy as gene-editing tools is undeniable (Manjunath et al., 2013). Thus, this brings the question, are gene therapies a realistic approach for the treatment of HIV?

Background

HIV is a pathogen that targets the immune system’s cells. According to the World Health Organisation (WHO), in 2018, 37.9 million people were estimated to be affected globally, of which 1.7 million are children. Also, 1.7 million new people were affected in the same year (World Health Organization, 2018).

Figure 1. Adapted from World Health Organization, 2018. The number of HIV related deaths.

As shown in figure 1, there were 770.000 HIV related deaths in 2018, among which 100.000 were children (World Health Organization, 2018). Although there has been a significant decline since 2000, the rate of HIV related deaths regression is expected to increase, with the aim of fewer than 400.000 losses by 2030. With the rapid development of new drugs and therapies and a better understanding of the virus, these numbers are realistic.

The Virus

To understand current treatments is important to understand the virus and how is causes pathogenicity. There are two types of HIV viruses, HIV-1 and HIV-2, although both can cause AIDS, HIV-2 is mainly restricted to West Africa and only affects up to 2% of HIV cases, thus, most research and this paper focus on HIV-1, also referred to as HIV (Visseaux et al., 2016).

Figure 2. HIV life cycle: 1. Binding, 2. Fusion, 3. Reverse Transcriptase, 4. Integration, 5. Replication, 6. Assembly, 7. Budding (AIDS info, 2019).

HIV is a lentivirus that binds to T cell receptors. C-C chemokine receptor type 5 (CCR5) is a protein that is present on the surface of white blood cells, acting as a chemokine receptor involved in the immune response. HIV has spike-like proteins on its envelope that mimic these chemokines, therefore aiding attachment of the virus to the immune cells (Sok et al., 2016).

Although CCR5 is the main receptor used by the virus, with the progression of the disease HIV is also able to use C-X-C chemokine receptor type 4 (CXCR4), another chemotactic receptor present on T cells’ surface (Alkhatib, 2009). After binding (step 1 on figure 2), the HIV fuses with the lymphocyte and releases its genetic material RNA, and proteins into the host cell (step 2 on figure 2). One of these proteins is reverse transcriptase, an enzyme that converts single-stranded RNA into double-stranded DNA, a process known as reverse transcription (step 3 on figure 2). HIV’s DNA then translocates to the nucleus where integrase, another viral enzyme, combines the virus’ genetic material to the cells’ DNA (step 4 on figure 2). When this occurs, the incorporated HIV DNA is called provirus and may remain inactive for indefinite time manufacturing little or no new copies. This stage is called latency, and the cell is said to be latently infected. When the host cell is stimulated to respond to infection and is activated, HIV takes advantage of its machinery and the provirus is transcribed by RNA polymerase, creating the proteins needed to make new viruses (step 5 on figure 2). Protease, another enzyme inserted into the T cell by HIV, cuts large precursor proteins into smaller proteins that conglomerate with the virus’ genetic material and form a new virus (step 6 on figure 2). The new virus pushes out of the host cell (“buds”) (step 7 on figure 2) and takes some of the cell’s envelope to form a protective barrier for the virus. In addition, the virus is also embossed with glycoproteins that will allow it to bind to other cells, starting a new cycle (Barré-Sinoussi et al., 2013). This cycle quickly destroys T lymphocytes, a key participant in the immune system response, thus allowing for opportunistic infections to appear. These infections cause autoimmune deficiency syndrome (AIDS) (Bhatti et al., 2016).

Current Treatment

The first treatment to be developed for HIV was antiretroviral (ART) drugs. According to WHO, 2018, 62% of HIV positive patients take these drugs for the management of the disease. ART drugs are not able to eradicate the infection, however, by acting on different stages of the virus life cycle, they prevent further destruction of the immune system, thus preventing AIDS (Maartens et al., 2014). Nevertheless, ARTs lead to drug resistance, drug abuse and metabolic, central nervous system, gastrointestinal, haematological, psychological, dermatological, musculoskeletal and miscellaneous adverse effects (Bhatti et al., 2016). Therefore, there is a need for new and better treatments.

The famous story of the Berlin patient has taken the world in 2008 when it was announced that the first person in the world had been potentially cured of HIV by stem cell therapy. This patient was diagnosed with cancer and HIV, and after undergoing chemotherapy he received stem cell therapy from an HLA-matched donor that carried a homozygous mutation for the CCR5 gene. This meant that the CCR5 protein present on T lymphocytes was not functional and, consequently, HIV was not able to infect the cells, leading to the eradication of the virus (Yukl et al., 2013). Due to the outcome of the Berlin patient, two other people have undergone the same procedure in Boston, however, unlike the Berlin patient, the donors for these two individuals were not homozygous for the CCR5 mutation. Therefore, although there was remission of the virus, the patients had to go back to ART treatment

Finding an HLA-matching donor is challenging, however, to find homozygous CCR5 mutated individual with HLA-matching to every HIV patient is nearly impossible. In addition, this therapy is expensive and difficult to treat in large numbers, and it would be difficult to take to Africa, where most HIV positive patients are (World Health Organization, 2018). Hence, although this therapy has proven to be successful, there is a need for new treatments that are easier and cheaper.

Gene Therapy

In contrast to ARTs and cell therapy, some gene therapies can be replicated, personalised, cheap and stored easily (Manjunath et al., 2013).

Following recent advances in the understanding of genetic mechanisms and development of genetic tools, precise gene engineering becomes a realistic and exciting prospect. Zinc Finger Nucleases (ZFNs), Transcription activator-like effector nuclease (TALENS) and clustered regularly interspaced short palindromic repeats (CRISPR) are novel genetic technologies that enable target specific gene editing.

ZFN

Figure 3. Adapted from BioScope, 2019. Zinc Finger Nuclease structure.

Zinc finger nucleases are artificial restriction enzymes that can cleave DNA. These proteins are composed of a DNA binding domain, and a DNA cleavage domain, as shown in figure 3. The first comprises of zinc finger domains that recognise specific base pairs, and the latter is a non-specific cleavage FokI restriction enzyme. As FokI is not able to target individual regions of the DNA, it needs zinc fingers to target specific sequences (Carroll, 2016).

Most studies focus on disruption of CCR5 and CXCR4 proteins due to their importance in the virus pathogenicity and to the understanding of the pathways involved. According to Manjunath et al., 2013, disruption of CCR5 proteins have been successful in various cell lines, hematopoietic stem cells and primary T cells. Mutated CCR5 proteins by ZFNs are inheritable, therefore, HIV positive patients would only need one set of treatment and potentially be cured (Manjunath et al., 2013).

As previously mentioned, HIV developed strains that can use CXCR4 as a primary target to attach to T cells instead of CCR5. Therefore, although mutated CCR5 proteins have proven to successfully reduce HIV infection, this method is not sufficient and will not work with certain HIV strains that can use CXCR4 as a point of entry in T cells (Yuan et al., 2012). Thus, CXCR4 is also an important target to achieve HIV resistance. Wilen et al., 2011, shows that is possible to use ZFNs to edit both CCR5 and CXCR4 proteins and produce a source of HIV resistant lymphocytes. Furthermore, Yuan et al., 2012, compared the efficacy of ZFN and shRNA for disruption of CXCR4 proteins. It was found that protein mutagenesis was superior with ZFN and that when reintroducing CXCR4 mutated CD4+ T cells into a humanised mouse model, these cells were resistant to HIV. In addition, Sangamo Therapeutics has completed phase II trials that aimed to study the safety of ZFN edited T cells in humans. The trial was a success and ZFN-mediated disruption of the CCR5 gene was safe and well-tolerated (Sangamo Therapeutics, 2015). Thus, ZFN proves to be a viable and safe method for gene editing to prevent and treat HIV infection.

TALENS

Figure 4. Adapted from Yu et al., 2016. TALENS structure.

TALENS are restriction enzymes that can be engineered to cut specific DNA sequences. As shown in figure 4, it composes of transcription activator-like effectors (TALE), the DNA binding domain, and a DNA cleavage domain. TALE are proteins secreted by type III secretion systems in bacteria and are used to infect a host, bind to promoter sequences and activate the respective gene (Boch et al., 2009). The DNA cleavage domain is a non-specific protein that is also used in ZFNs, FokI.

Although TALENS is a popular approach to gene editing, it is challenging to assemble TALE repeats as they present high sequence similarities (Gupta and Musunuru, 2014). Briggs et al., 2012, discusses a technique called a golden-gate assembly, that attempts to overcome this issue, by quickly assembling the repeats in a hierarchical form. This method has also accelerated the cloning process and provided the possibility for large-scale, cost-effective production of TALENS (Briggs et al., 2012).

Strong et al., 2015, discuss the use of TALENS as a potential treatment for HIV. In this study, it was shown that this technique could be used to mutate both CCR5 and CXCR4 genes (Strong et al., 2015). However, in contrast to ZNF, TALENS are large proteins, this causes challenges regarding delivery. Bergmann, 2014, discusses TALEN’s delivery methods and shows that most of the commonly used vector systems, for example, lentiviral and adenoviral vectors, fail in providing an appropriate capacity of two TALEN cassettes in one vector (Bergmann, 2014). TALENS are also easier to design and construct, nonetheless, unlike ZFN that each finger recognises 3 amino acids, each TALE repeat recognises only one amino acid. TALE repeats also present high sequence similarity, this causes a challenge in assembling them in the same compound (Gupta and Musunuru, 2014). Thus, it is possible to conclude that although TALENS are effective at mutating vital genes for HIV, further preventing disease progression and prevention, there is still a need for further research.

CRISPR

Clustered regularly interspaced palindromic repeat, also known as CRISPR, is a genetic engineering tool that was firstly used by bacteria (Ran et al., 2013). Bacteria can keep small pieces of invading viruses’ DNA and use it as an identification tool in case there is an invasion by the same or a similar virus. If this situation occurs, bacteria can recognise the virus and create a guide RNA from the virus’ genetic material, to guide CRISPR associated protein 9 (Cas9) to the sequence of interest and cleave the virus’ DNA. Thus, creating a break in the double-stranded molecule. Scientists have taken advantage of this mechanism and created a genetic engineering tool (Ran et al., 2013).

Figure 5. Adapted from Vox, 2018. CRISPR

Scientists can create a guide RNA (gRNA) in the laboratory. As shown in figure 5, gRNA consists of a CRISPR RNA (crRNA), that recognises the sequence of interest, and a trans-activating crRNA (tracrRNA). This sequence is used by endonuclease Cas9, which cleaves DNA at the recognised site. This technique can be used to disrupt a gene and therefore create a knockout, or to insert a new gene of interest (Ran et al., 2013).

Wang et al., 2018 explain in great detail how CRISPR has been used to study and treat HIV. The meta-analysis discusses how, much like for ZFN and TALENS, most research focuses on targeting CCR5 and CXCR4 receptors, however, Wang and colleagues have focused in CRISPR application strategies that target HIV’s viral genome instead of cellular sequences (Wang et al., 2018). Their research studies two approaches. In the first method a gRNA and Cas9 are inserted into infected cells to attack the viral DNA, and in the second CRISPR is introduced into uninfected cells that should act as a defence in case of an HIV invasion. Both methods reduced viral presence in immune cells, proving CRISPR efficacy in fighting HIV (Wang et al., 2018). However, further studies need to be completed as different gRNAs showed dissimilar suppression levels, allowing the virus to escape from inhibition from most cultures. Guide RNAs targeting strongly conserved sequences prevented HIV replication for longer periods, thus, future studies should focus on these sequences (Wang et al., 2018).

CRISPR is a gene-editing tool that is easier and faster to make than ZFN and TALENS, however, there are serious ethical concerns regarding editing the human genome. In 2018, a Chinese scientist used CRISPR to mutate the CCR5 protein on unborn twin girls (Normile, 2019). These girls are the first gene-edited babies. This project was not published until the editing was complete and concerns regarding the twin’s cognitive function have arisen as the CCR5 gene is also involved in memory and the brain’s ability to form new connections (Normile, 2019) (Lee et al., 2009).

Conclusion

To conclude, HIV is a mortal disease that can be managed by ARTs and has been potentially cured in the Berlin patient by cell therapy (Maartens et al., 2014)(Yukl et al., 2013). However, gene therapies are a more realistic approach for the treatment of the infection as they can be replicated, personalised, cheap and stored easily (Manjunath et al., 2013).

ZFN, TALENS and CRISPR are tools with high genome editing efficiency. They work by causing double-strand breaks in the genome and present various degrees of specificity and efficiency. ZFNs are the most studied. They have been reviewed in clinical trials and humanised models, having proved efficacy and safety (Yuan et al., 2012). In contract, TALENS are larger proteins that have delivery issues, however, they present minimal toxicity and off-target editing. Further studies to assess safety and efficacy in HIV-positive animal models is needed (Strong et al., 2015). CRISPR, unlike TALENS and ZFN, is controlled by RNA-DNA interactions. This offers an easy design, easy prediction regarding off-target effects, high specificity and is a method well suited for high-throughput. In addition, CRISPR is also able to target multiple genes simultaneously. Nevertheless, as this is a newer technique, further studies need to assess the safety and off-target predictability (Wang et al., 2018).

Thus, although HIV is manageable nowadays, there is still a need for a cure, and, with further research, gene editing tools present a realistic approach to the eradication of the disease.

The public health issue of Human Immunodeficiency Virus also known as H.I.V. destroys your immune system by harming the white blood cells within your body. Many people with the deadly disease feel perfectly healthy after a long period of their infection, therefore it is difficult to track the symptoms of HIV. It is very important to regularly get tested for any sexually transmitted disease. Unfortunately, no cure has been found to cure H.I.V completely, yet treatment can help slow HIV from spreading and worsening within a person’s body. HIV can easily spread to other people through unprotected sexual activity. Within the immune system, HIV destroys your T-cells, and therefore the body has a harder time fighting off any disease. HIV later leads to AIDS and at this point, the disease gets to its final stages. (Planned Parenthood, 2018)

H.I.V. still exists around the world today due to certain factors such as economic, socio-culture, demographic, political, and environmental all play a role in which a person is able to find treatment and to what extent they can spread it down to others. Globally there is a trend in which more than 70 million people have been infected with HIV and about 35 million others have been reported dead due to the disease. Many underdeveloped countries many people are uneducated, and therefore thousands of people are infected without knowing.

A link has been found between H.I.V. and SIV which is an immune system deficiency of apes. This meaning that the infection was based down from chimpanzees to humans. Additionally, the deadly disease continued to be passed down through unprotected sex, contaminated needles, blood transfusion, infected bodily fluids, and from a mother to a child during childbirth. During the 1920s studies concluded that in Congo the first HIV transmission took place. Congo was known to be a sex trade country and from there the transmission of HIV spread from one person to the other due to the unprotected sex. As a matter of fact, it was not until the 1980’s that the HIV epidemic started to spread outside of Kinshasa a city on Cango. (Daszak, 2019)

In the future, there are risk factors such as the progression of HIV into AIDS and continue spreading the disease into society. Unfortunately, medication resistance could take place which later will make it difficult to treat sickness around the globe. Progression of the disease might lead to other diseases, and cause people to be more prone to getting infected. There are a couple of etiological factors such as infants of infected parents, and unprotected sexual intercourse may lead to many infected individuals within the environment. Also, people living in poor countries such as Southern Africa are at greater risk due to their economic and demographic factors. All of the above factors play a major role in today’s society and the development of the disease. (Washington State HIV Surveillance Semiannual Report, June 2014.).

How to solve the public health problem:

HIV is a deadly disease and while it is hard to find a cure for, we can however set guidelines that would help prevent the transmission of the disease. Consulting with your doctor, and taking medications help prevent the disease from spreading worldwide. Action must be taken before HIV progresses into AIDs. In our society, it is important to advocate for timely diagnosis and treatment for those living with the disease. Advocating for pre-exposure precautions will help people take cautions by receiving microbicides. In the future to prevent HIV from traveling from one person to the other then public health must encourage the examination of the people for the disease. The above strategies all have the goal of reducing HIV cases around the world. Educating the people within the environment beyond the high school level regarding sexual intercourse will help reduce the number of HIV cases around the world. (HIV.gov, 2019).

Actions such as circumcision in males help prevent the transmission of many sexually transmitted diseases. Therefore, it is necessary for us to advocate for male circumcision in order to reduce the number of sexually transmitted diseases. However, the practice of female circumcision increases the likelihood of sexually transmitted disease, due to the increased exposure of the blood in the vaginal canal. Therefore, we must inform people of the dangers of digital circumcision, especially in underdeveloped countries. (Hrdy, 2017)

Different countries, cultures, and societies all play a different role in curing HIV around the world. In Canada, the WHO organization works with Canada in order to ensure that poor countries in need of preventions and treatments can actually receive it. In order to help build services, Canada spends about 100 million Canadian dollars. This is a great example of an aid provided by a country in order to cure the detrimental virus. The United Nations in order to help prevent HIV from spreading seven programs have been created and about $60 million in order to prevent the disease. In order to bring the disease to an end then we must not only work within our states but we must work as a globe in order to prevent the disease from reaching more people. We can always learn more from the other countries who are working in order to bring the deadly disease into an end.

Public Health problem in the Future:

According to the justification from the research literature, more research needs to be done in order to create new medications that will help cure infections such as HIV and AIDS around the world. Developing a cure that will help cure the disease completely will help improve our society. Providing education and training to all types of care providers allows the focus on behavioral and biomedical interventions for HIV and cultural competence. In order to increase the awareness of HIV and increase knowledge about HIV prevention and care in biomedical interventions, advertisements must be done. Researchers have been trying to increase education to cultural communities. Also, take sex education beyond public schools. Increasing federal HIV funding is necessary in order to promote curing HIV.

In my opinion, preventing the public health problem in the future needs all the countries to work together in order to bring the epidemic to an end. Raising awareness is very important in order to educate people around the world of HIV because many people, especially in underdeveloped countries, are not aware of the dangers of HIV. Moreover, groups and organizations should work hand in hand to travel to many different places in order to be a voice out there to cure HIV. Additionally, I also believe that federal funding plays a major role in curing any disease, therefore I believe increasing federal funding would help prevent HIV within the United States. In my opinion, providing more education and funding on infections such as HIV which later leads to AIDS could help prevent the diseases in the future. The public health problem of HIV has been decreasing in numbers due to the developed education provided by my schools in many countries around the world. In my opinion, we must continue working without giving up on our public health issues, and if we do so the world would be healthy, and safe. Taking your precautions by practicing safe sex, regularly testing for HIV, and for taking medications in case of an infection. Your actions will help determine where you will end up, stay safe and infections will become rare in our society.

Introduction

Sexually transmitted illnesses (STDs) are infections that spread person to person through intimate contact, STDs have an effect on everyone even babies, teenagers, healthy people, prosperous or the poor. According to WebMD (2019), it produces bacteria, parasites and viruses that have an effect on everyone, it causes many health problems but it can be more extreme for women. Human immunodeficiency viruses (HIV), in particular that is a kind of STD, alters the immune system, increasing the risk of other infections and diseases. Without treatment, the infection might development to an advanced stage called AIDS (Felman, 2018).

In the early years of 2000, HIV had a low charge in the Philippines. HIV/AIDS was not yet known as a panic-inducing epidemic in the Philippines (Mateo, 2004). The rates in all the common at risk organizations such as sex workers, male on male sex, etc. have remained below 1%. The incidence of STDs is increasing at that time, suggesting that an explosive epidemic may to appear in the future if the virus is able to go to the common at risk groups.

The Philippine government has confronted the problem f HIV/AIDS with an action design that puts emphasis on the response of the local government agencies, involvement and guide of non-governmental agencies (NGOs), incorporation of HIV/AIDS schooling into the college curriculum, and legal guidelines forbidding discrimination towards persons with HIV/AIDS or belonging to groups who are at risk (Mateo 2004). In a country, where STDs has not yet grown to be a generalized epidemic (UNAIDS, 2013) the government want to aggressively to confront the problem. One need to solely look at Vietnam and Indonesia to have an example of delayed epidemics, a comparable trajectory may eventually manifest in the Philippines (Mateo, 2004). In these countries, inactiveness of the authorities led to larger rates of people who are infected.

In the Philippines, there are 1,047 new HIV that people are infected with that are reported HIV/AIDS & ART Registry of the Philippines (2018). The median age was 28 years old. Alarmingly, the age range of those at risk is 15-24 years old. The cause of this is due to youth now not having ample expertise of the virus. Most of the time college-educated Filipino youths had unprotected sex at some point of their first time. The reluctance of children to use condom is another possible explanation for the growing rate of STD. Young Adult Fertility and Sexuality (2013) showed that the percentage of contraception is the least amongst 15-19 years old, 21 at 44% and amongst single sexually single women, what they call “withdrawal” used to be most common. The Independent (2015) say that teenagers say that condoms are hard to use mainly for those who are sexually inexperienced, and additionally, it detracts from sensual pleasure. Furthermore, many youngsters do not find themselves at risk of contracting the virus.

Main Body

HIV is one of the pinnacle health priorities for the authorities of the Philippines. The wide variety of new infections in the Philippines has doubled in the previous six (6) years from an estimated 4,300 in 2010 to an estimated 10,500 in 2016 (UNAIDs, 2018). The Philippines has turn out to be the quickest developing HIV epidemic in Asia and the Pacific. It continues to see accelerated expansion of the HIV infection. National HIV and AIDS Registry (2018) reveals an exponential enlarge in newly reported HIV, it has expanded to one in every three hours in 2012.

The uptrend in the epidemic is not surprising considering the much less than most beneficial application coverage for most at-risk populations. Moreover, stigma and discrimination against people living with HIV remain a problem for the Philippines. Although protection of human rights for those with HIV is covered in the Philippine AIDS Law, the PLHIV Stigma Index Report (2010) still showed discrimination amongst the population further confounding the AIDS response.

In addition, discrimination associated to sexual orientation and gender identification nonetheless persists, driving individuals of the LGBT community to situations that place their physical, mental and social well-being at greater risk. Stigma and discrimination places many of the populace in the shadows, unable to get admission to life-saving prevention and treatment.

The AIDS epidemic is trouble that should get urgent action amongst the people, particularly in places that has a high chance of infections (National Chair of the League of Cities of the Philippines, 2018). The Philippine authorities agreed that there is a need to scale-up offerings tailored to key populations that go beyond female intercourse workers. More than 90% of new HIV infections are happening amongst men who have intercourse with men and transgender people. Condom use among guys who have sex with men and transgender people hovers at 50% and 37% respectively and HIV trying out is low. Only 16% of MSM knew their HIV fame in 2015 (UNAIDS, 2018).

The UNAIDS also leads the world advocacy to help with tackling the problem of AIDS via working with and offering technical assist to the government, civil society and the personal area (Mendoza, 2018). Local governments in the Philippines has the assets and could start with more creative HIV prevention services. For example, Quezon City has opened three Sundown clinics that supply speedy HIV checking out and counselling in a non-stigmatizing environment for homosexual men, guys who have sex with men and transgender people. The city has additionally increased its HIV funding nine instances seeing that 2012 and has been urging different provinces to follow go well with (UNAIDS, 2018).

Conclusion

Such a gargantuan public health trouble seems, at the outset, too large to combat. But despite the colossal task going through everyone, there are useful starting factors for identifying solutions. For one, at least from an economic point of view, preventing HIV is indeed higher than curing it. This is especially relevant to developing nations like the Philippines where sources to fight HIV-AIDS are severely constrained. According to (Powell, 2019) the most comparatively cheap measures are mass media campaigns, whether it is through television, radio, newspapers, or the internet, so that people can disseminate data and help educate the public.

Another solution is anti-retroviral therapy. It is listed among the least affordable measures to fight HIV-AIDS. It’s at least 80 times more costly than mass media campaigns, which are considered amongst the cheapest buys. Estimates advise that anti-retroviral therapy may limit the number of new infections with the aid of solely 40,000 yearly, while preventive measures can prevent as a lot as 3.53 million new infections yearly (HIV Treatment: The Basics, 2019).

And due to the fact that the HIV-AIDS epidemic is largely borne by unprotected sex, it is vital that secure sex be promoted as a much as possible. Condoms, when precisely and consistently used, are considered an essential section of the global marketing campaign of HIV prevention. The RH Law could assist in this regard. By mandating authorities to provide for contraceptives such as condoms, the RH Law can be a key player not only in the reproductive fitness front, but also in the HIV-AIDS prevention front.

Preventing the spread of HIV doesn’t have to be too complicated or too costly. Measures as simple as data campaigns and condom distribution can go a long way in keeping off the quantity of new HIV cases in a low rate. Battling HIV requires a buildup of effective mind-set and self-confidence amongst the people who are afflicted or potentially afflicted. Stigmas and discrimination involving sex, condom use, and HIV-AIDS only serve to compound and now but not reduce the burden felt by these people. Only when we ultimately destroy these misconceptions and biases will we be able the battle HIV-AIDS and without a doubt, take flight.

HIV

Human Immunodeficiency virus or better known as HIV has been around for many years. The origin of this disease was traced back all the way to West Africa. Scientist believed that a Chimpanzee carried a version of “HIV” and when humans hunted and came in contact with the infected animal and its blood it mutated to a human version of it and is now known as HIV (the aids institute, 2013). The first case of HIV was reported to be around the late 1950’s in the country of Congo. Over the years we have learn many new information and well as studying possible ways the human race came in contact with this particular virus. It wasn’t until the late 1970’s that it was known that untreated HIV would eventually lead a person to have “acquired immunodeficiency syndrome” or better known as AIDS.

Invasion of the Host

Transmission of this virus is through direct blood contact or certain bodily fluids. For example: blood, semen, pre-seminal fluid, rectal fluid, vaginal fluid and/or breast mild. The virus comes in contact with the host mucous membrane or any other damaged tissue and it inserts itself right into the blood stream. Once inside the host’s bloodstream it will more specifically attack CD4 cells which are also known as T Cells. T Cells are mainly known for fighting infections. If left untreated the virus will continue attacking the cells and making the host immune system weaker which makes it more susceptible to other infections as well as cancer related (Center for disease control and prevention, 2019).

Morphology/Stages

“The HIV Virus is a gram-negative bacillary bacteremia in Human immunodeficiency virus type 1” (CDC, 2019). When cultured, the HIV Virus contains large number of 130-200 nm particles containing a 130-nm-long by 30-70 nm-wide core and it is pear shaped. (the aids institute, 2013). There are three stages to this virus, Stage one usually between 2 to 4 weeks after the initial infection. Symptoms: flu-like symptoms which may last a couple of weeks. Stage two is the period that I usually called asymptomatic HIV infection. This is the time where the host has no symptoms at all but still can infect a person. Some bodies may stay at this stage for years. Lastly, Stage three is known as AIDS and it is the most severe phase of all three. The bodies at this stage has very compromised immune systems that they have increasing number of other illness due to illnesses called “opportunistic illnesses”. Any host without treatment at this point will survive abut 2-3 years. Symptoms for this stage are chills, fever, sweats, swollen lymph glands, weakness, and weight loss (CDC, 2019). No cure is yet to be available but there is medication used to treat a patient at any stage of the virus. Antiretroviral therapy or ART is taken depending on how much of a “viral load” they have in their blood. This medication inhibits HIV from continuing to reproduce inside the host and allows for the body’s defense system to recover. Although the medication does not kill the virus off completely it allows it to be strong enough to fight common infections as well as cancer related ones.

Conclusion

Human Immunodeficiency virus is a virus that has been around many years. Even though the origin of this disease is known there are still many questions that remain wide open. How did this virus exactly transfer to the human race? Why has it been so difficult to find a cure? HIV is a virus that feeds off the immune system and it is known for debilitating its host so much that It is left weak and ready to be invaded by other infections as well. No cure has yet to be found but with the help of ART medication most infected parties are able to live long lives.