Recent television shows such It’s a Sin and Pose portray Acquired Immunodeficiency Syndrome (AIDS) as a death sentence. Both feature young characters coping with the discrimination associated with being LGBT+ and watching their friends die from a mysterious illness. Fewer patients infected with Human Immunodeficiency Virus (HIV) are dying prematurely due to the efforts of the scientific community to study, understand and treat HIV.
Of the estimated 101,000 people in the UK infected with HIV, the virus that causes AIDS, gay men, bisexual men, and men who have sex with other men are one of the most affected groups. Due to a lack of trust in medical professionals, some delay seeking treatment, fearing that a HIV diagnosis would bring further stigma from peers, employers, and family members. Efforts of activists, medical groups and public health campaigns have been successful in making treatment accessible. 87% of HIV positive people are virally suppressed, meaning that the virus exists in trace amounts in the blood and cannot be transmitted to other people. This contributes to a decrease in new HIV diagnoses.
HIV is a retrovirus that attacks the CD4 cells of the immune system and weakens the natural defences, resulting in fatal infections that would normally be fought off. It does so by entering and hijacking the machinery in the CD4 cell to replicate. The new virus particles may break out of the cell to infect and kill other CD4 cells. CD4 count is used to measure the health of the immune system; a CD4 count over 500 is typical in unaffected people but decreases as HIV causes more damage to the body.
The initial infection causes acute HIV syndrome, characterised by a sharp decrease in CD4 count and symptoms such as headaches, fever and sore throat. AIDS occurs during the late stages of infection when CD4 count reduces and weight loss, night sweats may be experienced. People with AIDS cannot fight off infections and may develop bacterial pneumonia, tuberculosis, yeast infections and cryptococcal meningitis. Some cancers, such as Kaposi’s sarcoma and non-Hodgkin’s lymphomas, cause tumours and lesions that require chemotherapy.
Transmission between people occurs through unprotected sex (anal, vaginal, and oral) and from mother to child during pregnancy, labour and breast-feeding. Less common routes include contaminated blood products and sharing needles for intravenous drug use.
Regular testing and starting treatment early are imperative to reducing transmission and preventing the onset of AIDS. The most common and most accurate test is the HIV immunoassay that detects antibodies in blood samples. Faster and cheaper self-testing kits are widely available at chemists and charities such as the Terrence Higgins Trust but are less likely to detect a positive result. Increased testing at general practitioners, antenatal clinics and gay clubs have made testing more accessible to those most at risk of contracting HIV.
A study in 2011 showed that anti
–retroviral treatment (ART) reduces transmission of HIV by suppressing HIV load and can suppress viral load within three months of starting treatment. In 2017, 98% of HIV positive people received ART and 97% were virally suppressed. As a result, more people with HIV are growing older; in 2016, 39% of people with HIV were aged over 50.
Pre-exposure prophylaxis (PrEP) combines two antiretroviral drugs which prevent HIV negative people from contracting HIV. A study in 2015 showed that PrEP reduces HIV infection rates by 86% by stopping the virus from replicating. Although HIV education and awareness, condom availability and harm reduction strategies have reduced transmission, unequal access to the drug means that at-risk, especially vulnerable Black African women, are hardly offered PrEP. Similarly, post-exposure prophylaxis (PEP) is a short course of antiretroviral drugs taken within a 72-hour window of infectious contact with a HIV positive person.
Although ART, PrEP and PEP are paramount in reducing infection rates and transmission, there is no cure for HIV. Advancements that are affordable by all countries and reduce the number of drugs needing to be taken regularly are key factors when looking for a cure. In 2019, a London HIV patient underwent a bone marrow transplant from a donor with a mutation that made them resistant to HIV infection. Although this is effectively a cure, the procedure is risky and invasive, and therefore not scalable. The first-in-human clinical trial of a HIV vaccine published in January 2021 showed that antibody production occurred in 97% of participants but requires further testing. A treatment option combining a vaginal ring and oral PrEP is being studied in young women in southern Africa. These recent and ongoing studies show the commitment of scientists to HIV research.
There are several limitations to current HIV treatment which need to be addressed. 43% of diagnoses happened at a late stage of infection, particularly in heterosexual men and women and Black African communities. Testing and treatment need to be done earlier to reduce transmission and improve the outcome for the patient. Outreach to marginalised communities such as the Black and Minority Ethnicity (BAME) community is critical since they make up 14% of men who have sex with men who receive HIV treatment, despite only being 2% of the UK population. There is an alarming lack of data on HIV prevalence in transgender people although scarce data suggests that prevalence is similar to other groups.
With increased access to screening facilities, treatment such as PrEP, and a drastic improvement in public attitudes, HIV and AIDS diagnosis is no longer fatal to the LGBT+ community and others affected. More people with HIV are living longer and increased understanding of the virus brings us closer to a cure.
Zainab Patel is a second-year Medical Physiology Student from Leicester. She has a passion for all things science and technology, crime novels and plants. Find her on Twitter: @zainabbpatell or Instagram: @zainabb_patell