According to the UNAIDS report, 37.7 million people globally were living with HIV (Human Immunodeficiency Virus) in 2020, and 1.5 million people became newly infected with the virus the same year. Ever since the HIV epidemic erupted, more than 70 million people have acquired the infection, out of which 30 million people have lost their lives to the virus. When the pandemic first erupted in the 1980s, there was little hope for those diagnosed with HIV with no treatment on the horizon or awareness-raising efforts. However, with gradual medical advancements and breakthrough drug developments, the diagnosis, prevention, and treatment of HIV-AIDS have successfully helped reduce the death rates resulting from the virus. New HIV infections have been reduced by around 52% since the peak in 1997.

While a variety of drugs have been developed since the discovery of HIV, many proved to be ineffective in slowing down the virus' progression. Antiretroviral Therapy (ART) is one of the major scientific breakthroughs of modern medicine, which has dramatically improved the health of people diagnosed with HIV, making their life expectancy much closer to typical life expectancy.

An effective ART improves immune functioning and enhances the overall quality of life while lowering the risk of both AIDS-defining and non-AIDS-defining complications. ART involves taking a combination of HIV medicines every day and is recommended for anyone who has HIV to reduce a person's viral load to an undetectable level. The therapy also reduces the risk of HIV transmission to sexual partners and infants born to people infected with HIV. As per certain ecological studies, it has been found that high ART uptake and its expanded usage may lower the incidence of HIV in a community.

How Does ART Work for HIV Patients?

When the human immunodeficiency virus enters the bloodstream, it binds to a kind of receptor (CD4) on the surface of the T-cells, a kind of white blood cell that helps fight infections. Then, the virus starts replicating itself and destroys the host cell, which slows down the body’s ability to combat infections. Antiretroviral therapy works by preventing viral replications, allowing the body’s immune system to recover. When the viral load reaches a point that it becomes undetectable and cannot damage the immune system, then there is no risk of virus transmission to other individuals. This is known as ‘undetectable = untransmittable (U=U)’. Most people are able to successfully control the viral load within a period of six months with ART.

ART consists of various drugs wherein one drug works to suppress a certain mutation while the other drugs block the different stages of HIV’s growth cycle. The risk of severe HIV-associated and non-HIV-associated illnesses can be reduced by 72% if one starts ART at an early stage. As per Centres for Disease Control and Prevention, people with HIV should take ART, regardless of how long they have acquired the virus or their current health status. Consistent use of HIV keeps the immune system strong enough to combat infections as well as HIV-related cancers.

Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

PrEP is an FDA-approved treatment designed to prevent or control the spread of infection or disease for people who are at great risk of acquiring HIV. If an individual is exposed to HIV through sexual intercourse or injection use, taking daily PrEP medicine can reduce the risk, stopping HIV from taking hold and spreading throughout the body. However, PrEP does not protect individuals from other kinds of transmissions or sexually transmitted diseases.

The PrEP medicine is recommended only for HIV-negative adults and adolescents who have had anal or vaginal intercourse with

·         A partner who is HIV positive

·         A partner who has not consistently used a condom

·         A partner who has been diagnosed with a sexually transmitted disease in the past six months

PrEP is right for people who inject drugs or have an HIV partner that injects drugs, or shares needles, syringes, or other injection equipment. Women who have an HIV partner and are considering getting pregnant should opt for PrEP to protect the baby from acquiring HIV while being pregnant or during breastfeeding.

Although PrEP is a safe procedure, some people might have side effects like nausea, but not anything serious. Combining PrEP with preventive measures like using condoms further reduces the risk of getting HIV. People who take PrEP medications must visit their healthcare provider every three months for HIV tests, prescription fills, and follow-ups. 

Long-acting Injectables for HIV Management

People living with HIV can now opt for monthly, long-lasting injectables instead of taking a pill every day of the year to keep the viral load at low levels in the body and maintain healthy immune functioning. FDA has approved the first long-acting injectable for HIV treatment, known as Cabenuva (comprising Cabotegravir and Rilpivirine), which allows individuals to lead a healthy life without taking mental stress of administering medications. Daily adherence to treatment over the lifetime can be a challenge for many people who forget to take medications, travel constantly, or are simply embarrassed about taking medications in a public place.

Uncovering Myths about HIV

Despite the growing number of treatment options for HIV-AIDS, there is still stigma attached to the disease due to the plethora of misinformation surrounding it.

Myth 1: HIV can transmit from touching

According to the US Centres for Disease Control and Prevention, HIV cannot transmit from touching, hugging, kissing, or shaking hands with an HIV-positive person. HIV can only transmit through the transfer of bodily fluids like blood, semen, vaginal fluid, rectal fluid, or breast milk. However, if an HIV-positive mother does not take antiretroviral medication, she can pass the virus to her baby through breastfeeding. With PrEP and long-lasting injectables, HIV-negative adults can have sexual intercourse with HIV-positive individuals as the transmission risks become low.

Myth 2: Getting HIV is like a death sentence

There is no permanent cure for HIV, but a range of treatment options are available for those who are HIV-positive or at risk of acquiring HIV. HIV-positive people do not die due to the virus itself rather from the “opportunistic infections” that take advantage of a compromised immune system. Thanks to revolutionary treatment methods like ART medicines and long-lasting injections that allow HIV-positive individuals to lead a normal life and roughly have the same life expectancy just like an average HIV-negative individual.

Myth 3: If you are taking medications, then you cannot transmit the virus

If you are HIV-positive, taking consistent ART medicine to reduce the viral load of HIV in the body then it does not guarantee that you cannot transmit the virus to other individuals. Engaging in unprotected sex, exposing others to your bodily fluids, or sharing equipment such as needles or injections can spread the virus and infect others.

Myth 4: Babies born to HIV positive mothers also have HIV

Perinatal transmission of HIV from mother to her child during pregnancy is a possibility, but early treatment can help to reduce the risks. Healthcare providers perform a cesarean delivery in women who have a high viral load near the time of delivery to lower the risk of transmission. Rather than breastfeeding, mothers can opt for formulas that are readily available in the market to feed the babies to eliminate further transmission risks.

Myth 5: HIV leads to AIDS

HIV is a virus that causes acquired immunodeficiency syndrome (AIDS), but that does not mean that all HIV-positive individuals will develop AIDS. AIDS is a syndrome resulting from deficiencies in the immune system, and it can be prevented by early diagnosis and treatments. The current HIV therapies like ART and PrEP can help to regulate the viral load and maintain a healthy immune system.

Government Benefits for HIV-positive Patients in the US

HIV management requires an ongoing prescription, frequent lab work, and other diagnostic tests, which can result in hefty medical costs. According to the CDC, the average lifetime cost of treating HIV is approximately USD380,0000, making it difficult for low-income groups to avail the treatment. US Government offers benefit programs to support HIV patients and cover their bills. Here are some of the programs that benefit HIV patients and provide them with some form of assistance to avail the treatment.

·         AIDS Drug Assistance Program (ADAP)

ADAP is a state and territory administered program that provides FDA-approved HIV-related prescription medicines to insured and uninsured individuals. ADAP funds may also be used to purchase health insurance for low-income group people to enhance their adherence and access to drug treatments.

 ·         Medicaid

Medicaid is an entitlement program that covers various categories of low-income adults and children, enabling them to get a broad range of optional medical benefits offered by the state. People with an annual income up to 138% of the federal poverty level are eligible for the Medicaid program.

 ·         HOPWA (The Housing Opportunities for Persons With AIDS)

HOPWA program provides permanent housing assistance for low-income group people (at or below 80% of the area median income) living with HIV/AIDS. Some programs also allow HIV-positive individuals to stay at the offered accommodation as long as they want by paying the rent. Some HIV residential programs provide people with their own bedroom with a shared bathroom and kitchen.

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