A Look Back at HIV

2 Docs Talk


Before we jump in. Let's clarify what exactly HIV and AIDS are good call. Hiv stands for human immunodeficiency virus which is a virus that causes Acquired Immune Deficiency Syndrome or AIDS. Yes so HIV is a retrovirus which means it is an rn. A virus that is a cellular machinery from the infected cell to do a reverse transcription of itself a DNA version which is inserted into the cells on DNA when the cell becomes active. It will make new copies of the virus that go out and continue the cycle and this is important because the drugs that we use today to combat HIV a variety of antiretroviral agents target different points in the cycle. The right combination of drugs can keep the viral load solo that it isn't detectable exactly so HIV infects a specific immune cell the CD four cell and over time the virus kills a CD foresaw which being part of the immune system plays a critical role in the body's ability to fight infection as de decline. The body becomes susceptible to opportunistic infections. Right these are often infections caused by pathogens that are normally present in on or around the body but a healthy immune system recognizes them and keep them in check someone with the depleted immune system however is susceptible to unusual infections. That healthy folks don't need to worry about. Plus they're they're susceptible. To all the irregular infections even healthy people get okay so an untreated course of goes something like this. A person is infected with HIV. The virus being transmitted during sexual activity directly into the bloodstream during childbirth or breastfeeding or a blood transfusion at this point the virus makes its way to the lymph nodes where has access to lots of CD. Four cells and replicates like crazy? This goes on for about three weeks three or four weeks. The patient may experience a viral type of illness during this time period. Fever swollen glands rash but not everyone experiences this yes and it feels like a regular just viral infections. So you don't really think about that. That might be what it is but after about two weeks the viral load in the blood is at a peak and CD four levels fall. This is a period of time where it is really easy to transmit the disease to another sexual partner because the viral load is so high after about six months the viral load and CD. Four count stabilized to set point and the chronic phase issue begins. This can last a up to ten years without treatment during which HIV gradually destroys CD. Four cells at some point the CD four count gets low enough. That opportunistic infections are possible. Yes and that's how we define AIDS either the CD. Four count is below two hundred cells per mil or the patient has an AIDS defining conditions such as retinitis from cmv cytomegalovirus or invasive cervical cancer or many many others so this was the typical course of disease for people early in the epidemic. Did you amy? That AIDS was around before the Nineteen Seventy S. That's when the epidemic began but it is believed that the virus jump from chimpanzees to humans in the Democratic Republic of the Congo in one thousand. Nine hundred and sporadic cases were reported from then until the mid seventies when the epidemic got its legs. Very interesting now. It wasn't until Nineteen eighty-one that we really understood what was happening in. La There were five young gay men who develop Mrs to screen pneumonia PCP which is now new. Mississippi'S VICI pneumonia. I know I can never get used to that. I still call it. Pcp Yeah. I'm sure a lot of school. It was pretty much standard at the time right. I mean that was like defy so defining but anyways another group in New York in California who developed Kassy's sarcoma which is an aggressive cancer caused by the human herpes virus eight that wouldn't normally happen without a suppressed. Immune system right both of those diseases. And by the end of that year there were two hundred seventy cases of severe immune deficiency among gay men and nearly half had died. Yeah that we knew so fast forward. A few years by the end of nineteen eighty five. There were over. Twenty thousand reported cases coming from every region of the world. The virus was officially named in Nineteen eighty-six and in nineteen eighty seven A. Z. T. was introduced. The this was the first antiretroviral drug this drug worked by inhibiting the initial reverse transcription of the virus into DNA. This was a very exciting development because the epidemic was growing quickly. Now there were three hundred seven thousand reported AIDS cases worldwide compared to the twenty thousand. You mentioned just fine. Harsh prior and two hundred and seventy just nine years prior to that. It's impressive how. The pharmaceutical industry kind of ramped up so quickly research development. Yeah and those remember. Those were the reported numbers so they estimated that there were actually a million AIDS cases in another eight to ten million living with HIV worldwide. At that point. So if you're younger just in med school residency right now. It's hard to explain. How unsettling this was that how fast it was spreading right. Yeah and these patients were so sick and dying in such large numbers and there didn't seem to be in and site to the expansion of the epidemic. So there's a lot of fear and misinformation out there the had a policy to not allow those infected with HIV into the country and it was still viewed as a gay disease. So that created a lot of stigma for the LGBTQ community so by nineteen ninety three. There were two point five million AIDS cases globally the US Congress dug in and voted to continue the travel ban. Things are not looking good even with easy. T- which wasn't really panning out as everyone had hoped. And the fact that it was approved at all was questioned by many. Yeah so but in one thousand nine hundred things really started changing. This was kind of a turning point. The first price inhibitor was approved these inhibit the protease enzyme. Which is important in the translation of HIV v? Virus back into Aurigny. Yeah and this was the beginning of Heart H. A. RT highly active antiretroviral therapy and it immediately dropped deaths from AIDS related diseases by at least sixty percent but still there were thirty three million people living with HIV by nineteen ninety nine and fourteen million people had died since epidemic began. Those are huge as is to be expected the UN had to step in and negotiate prices to make antiretroviral therapy available to the people who need it The World Trade Organization that announce the Doha Declaration allowing developing countries to manufacture generic versions of drugs. Go See Fire Dallas buyers club. Yes also yeah so in the two thousands people who needed it weren't getting treatment aids. Was the number one cause of death in sub Saharan Africa. That blows my mind by the two thousand ten. A lot of goals had been set to get treatment where it was needed and have the spread of HIV an organization such as the UN and the World Health Organization and individual government agencies are getting involved at this point yeah the US finally lifted the travel ban for people with HIV treatments that decrease the chance of spread were discovered pre exposure prophylaxis or prep was shown to reduce transmission between male and male sexual partners by about forty four percent. Yeah in two thousand. Eleven research demonstrated that early initiation of antiretroviral treatment reduce transmission to partners by ninety six percent. So this is a real game changer. Because until this time the antiretrovirals weren't started until HIV was had started advancing and causing aids. So this is when they started the treatment early after the infection was discovered and it really changed things as far as transmission. Yeah as related. Deaths fell thirty percent from the peak. Year two thousand five and thirty five million people were living with HIV dramatic slowdown in the spread of the epidemic compared to previous decades. Yeah Okay but now we may find yourselves at a standstill here. We are twenty twenty because the immediate crisis of the wildfire spread and almost certain death is well behind us. Attention has waned key populations that account for over half of new infections are not receiving access to combination therapy and the gap between resource need and provisions as widening. The funding is is shrinking. It's pretty typical right. Yeah as a species. Humans aren't very good at thinking long term. If it's not an immediate threat it's not threat right well. It is a threat to those populations. So there's clearly still stigma that has marginalizing

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