HIV treatment has evolved a lot in 40 years, but there is still room for more – 08/09/2021

By the end of 2020, around 37.6 million people were living with HIV worldwide. Due to the evolution of treatment, currently the life expectancy of a person infected with the human immunodeficiency virus is very similar to that of the rest of the population.

But it was not always so. In the early 1980s, just as HIV began to be reported, the world’s scientific community faced its greatest challenge: how to treat a deadly disease caused by an unknown virus? It was something completely new for scientists and researchers, so being diagnosed with HIV was almost a death sentence.

According to Valdez Madruga, infectologist and researcher at the Research House of the Reference and Training Center – STD/AIDS (SP), at the beginning, the disease was known as “the plague or gay cancer”, as it was still believed that only the homosexuals were infected.

“Then, it was discovered that the disease also affected people with hemophilia and intravenous drug users and, later, women. Only then did they begin to think that HIV was transmitted by an infectious agent through sexual intercourse or blood transfusion” , remember.

The situation generated a worldwide panic and AIDS, which is a clinical syndrome, that is, when symptoms appear, it was widely disseminated. Very briefly, HIV (the acronym for the Human Immunodeficiency Virus) attacks the immune system, which defends the body from disease.

The virus has CD4 T lymphocytes as its target cells, which are responsible for identifying and destroying foreign microorganisms that enter the human body. Thus, those infected developed AIDS and died after contracting opportunistic infections, that is, diseases that would be easily fought off by a competent immune system. This was the case with pneumonia or tuberculosis, for example.

At this time, infected people still died shortly after diagnosis. “We didn’t have drugs available to treat the disease. They were palliative treatments. It was only in the late 1980s that the first drugs began to appear and even so the response was not good”, adds Valdez.

The first antiretrovirals

AIDS treatment, medicine, syringe, needle, AIDS, HIV - Thinkstock - Thinkstock
Image: Thinkstock

One of the first drugs to be used for treatment was AZT (zidovudine). The drug was initially used to treat leukemia and later became an antiretroviral option for HIV. However, scientists realized that the virus was gaining resistance to the drug.

“Other medications appeared, but their efficacy was low and people continued to die”, explains Gisele Gosuen, an infectious disease specialist and responsible for the HIV and Aging Clinic, at EPM-Unifesp (São Paulo School of Medicine, Federal University of São Paulo).

It was not until the mid-1990s that highly active antiretroviral therapy, known as “cocktail” or HAART, emerged. Thereafter, people improved considerably and deaths declined. This type of treatment prevents the virus from reproducing and multiplying.

“The treatment gained the popular name of ‘cocktail’ because it was a combination of medications. After the initial euphoria, we began to notice that it had many side effects and low tolerability”, highlights Madruga.

Imagine having to take a large number of pills with rigid intervals or on an empty stomach? Most were sick—nausea, diarrhea, fatigue and dizziness arose, which impacted adherence and contributed to mutations, making the virus resistant to the drug.

“People used to ingest 20 to 30 pills a day. Many gave up or did not ingest properly, which increased the risk of treatment failures and development of viral resistance”, says Jaime Emanuel Brito, infectious disease specialist at the Alcides Carneiro University Hospital, in Campina Grande (PB), from the Ebserh Network.

However, the “cocktail” united drugs that inhibited the enzymes that reproduced the virus. With this, for the first time, the disease began to become chronic, that is, medications considerably increased the life expectancy of people infected with HIV.

constant evolution

science, research, laboratory - iStock - iStock
Image: iStock

Science continued to evolve and new medications emerged. The scientists’ goal has always been to reduce the number of pills, the frequency of doses, and reduce side effects. Currently, there are dozens of drugs with different possible combinations to treat HIV infection.

Although there is no cure yet, most people with the virus take antiretroviral drugs co-formulated with two or three drugs in combinations.

When a person with HIV starts therapy with antiretroviral drugs, their viral load in the body decreases (undetectable), that is, they have a small amount of virus in their blood, which cannot be detected. The situation usually occurs about six months after treatment.

As a result, the virus becomes less transmissible. Currently, experts understand that treatment also works as a way to prevent the spread of HIV, in terms of public health. But it is necessary to continue the follow-up with doctors and follow the treatment without interruptions.

It is worth remembering the importance of using condoms during sexual intercourse to prevent HIV and other STIs (sexually transmitted infections), such as syphilis and HPV (Human Papilloma Virus).

Advances and perspectives for the future

Brazil is one of the few countries in the world that has offered antiretroviral free of charge since 1996. And since 2013, the SUS (Unified Health System) guarantees treatment for all people with HIV, regardless of viral load and CD4 T lymphocyte count .

In addition to the cure and the vaccine, scientists and researchers want to ensure that the treatment becomes just a single daily pill, with co-formulations of different classes of antiretrovirals. And there are already well-advanced studies with long-lasting injectable antiretrovirals, which may soon be available to everyone.

For experts consulted by Live well, the evolution of treatment in the last four decades was very positive. “It is a very new disease and even the use of AZT was fundamental. Today we consider HIV a chronic infection that requires lifelong treatment. Currently, there are patients who have aged with HIV. It was a great achievement”, says Gosuen.

Living with HIV

Vanessa Campos - Personal archive - Personal archive

Vanessa Campos

Image: Personal archive

The story of Vanessa Campos, 49, is very similar to that of thousands of people around the world. Not being part of the “risk group”, it took her two years to be diagnosed with HIV.

Living in Manaus, the test result took about two months to be ready. “I was infected in 1990, when I was 17. I only found out when my ex-boyfriend died of complications from AIDS in 1992. The diagnosis was a shock. .

More than 30 years later, Campos made it his mission to fight discrimination and prejudice, and he committed to helping people with HIV to know their rights and have a better quality of life. Today she is the Information and Communication Secretary at RNP+Brasil (National Network of People Living with HIV and AIDS).

For Vanessa, it was essential to never stop making plans because of HIV. Thus, he married twice and had three daughters. She fights daily for the sexual and reproductive rights of people with HIV.

Currently, he has had an undetectable viral load for 15 years, but he believes that there is still a lot of lack of information and little “active listening” from doctors, which leads to low adherence to treatment.

“It is common that, after diagnosis, the individual still thinks he will die or imagine that he will never be able to relate again. We are people and not a virus. Our rights and our dignity must be respected”, he concludes.

References: Unaids Brazil, Ministry of Health and CDC (Centers for Disease Control and Prevention).