Treatment of HIV
The HIV virus cannot be eliminated by the body, therefore once infected, it results in lifelong infection.
There is currently no cure for HIV, but HIV regimen (usually with 3 HIV medicines from 2 different classes combined into one pill taken once a day) known as antiretroviral therapy (ART) is available to suppress HIV replication to undetectable level in order to prevent damage to the immune system, lowers the risk of disease progression to AIDS and transmission to others. HIV infection is no longer considered a death sentence, it is a chronic but manageable illness. With effective treatment, people with HIV can live a long and healthy life.
HIV Medication in HK
There are several classes of HIV medicine (REF5), each targeting a different pathway in the HIV replication cycle, which includes:
- Nucleoside reverse transcriptase inhibitors (NRTIs) – Block reverse transcriptase
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – Bind to reverse transcriptase
- Protease inhibitors (PIs) – Block protease
- Fusion inhibitors – Block HIV from entering CD4 cells
- CCR5 antagonists – Block CCR5 co-receptors
- Integrase strand transfer inhibitors (INSTIs) – Block integrase
- Attachment inhibitors – Bind to gp120 protein
- Post-attachment inhibitors – Block CD4 receptors
- Pharmacokinetic enhancers – Increase the effectiveness of HIV medicine
HIV replication cycle.
Undetectable = Untransmittable (U=U)
The PARTNER (Partners of People on ART – A New Evaluation of the risks) study and the Opposite Attract study were carried out to assess the risk of HIV transmission to the HIV-negative partner from their HIV-positive partner on ART with undetectable HIV viral load. The results show that none of the HIV-negative partners contracted HIV from their HIV-positive partners despite regular unprotected (condomless) sex. However, not everyone on ART can achieve and maintain an undetectable viral load. So, it is crucial for people living with HIV to take their medicine every day and monitor their viral load regularly.
HIV High risk populations:
According to UNAIDS, the following populations are at increased risk of acquiring HIV than the general population:
- 26 times higher among gay men and men who have sex with men (MSM)
- 13 times high among transgender
- 30 times higher among sex workers
- 29 times higher among intravenous drug users
(REF1: Branson, B. M. (2010). The future of HIV testing. JAIDS Journal of Acquired Immune Deficiency Syndromes, 55, S102-S105.)
(REF2: Morrison, C. S., Demers, K., Kwok, C., Bulime, S., Rinaldi, A., Munjoma, M., ... & Salata, R. A. (2010). Plasma and cervical viral loads among Ugandan and Zimbabwean women during acute and early HIV-1 infection. AIDS (London, England), 24(4), 573.)
(REF3: Prabhu, V. S., Hutchinson, A. B., Farnham, P. G., & Sansom, S. L. (2009). Sexually acquired HIV infections in the United States due to acute-phase HIV transmission: an update. Aids, 23(13), 1792-1794.)
(REF4: Goodsell, D. S. (2015). Illustrations of the HIV life cycle. The Future of HIV-1 Therapeutics, 243-252.)