Introduction

HIV remains a significant global public health issue, affecting millions worldwide. HIV is a virus that attacks the immune system and can lead to AIDS, a serious condition that weakens the body’s ability to fight off infections and diseases. Blood, semen, vaginal secretions, and breast milk are among the biological fluids through which it can spread. However, it cannot be spread through casual contact such as hugging or sharing food. Fortunately, antiretroviral therapy (ART) is available to treat and prevent HIV, but without proper treatment, HIV can progress to AIDS over time. In recent years, there has been significant progress in HIV research towards finding a cure.

While a cure for HIV is not yet available, the ongoing research and advancements in the field give hope for a future where HIV is no longer a threat to public health.^1,2

Let us will explore the latest developments in HIV symptoms and treatment options.

Symptoms of HIV

Depending on the stage of infection, the symptoms of HIV might vary. There are three stages of HIV infection: acute (initial) stage, clinical latency (chronic) stage, and acquired immunodeficiency syndrome (AIDS) stage. The following are the symptoms of each stage:

Acute HIV infection symptoms

• Fever
• Headache
• Muscle aches 
• Joint pain
• Rashes
• Sore throat, cough
• Painful mouth sores
• Swollen lymph glands, majorly near the neck
• Diarrhoea
• Losing weight
• Night sweats

Chronic HIV infection symptoms

• HIV may still be present in the body and white blood cells
• No symptoms in many people
• The stage can last for many years if receiving antiretroviral therapy (ART)

However, some people may show symptoms. These symptoms may be:

• Fever
• Fatigue
• Swollen lymph nodes
• Diarrhoea
• Losing weight
• Thrush (yeast infection) 
• Herpes zoster (shingles)
• Pneumonia

Late-stage HIV infection symptoms (AIDS)

• Increased likelihood of opportunistic infections or cancers. Opportunistic infections or cancers are infections or cancers that take advantage of a weakened immune system, such as in people with HIV e.g., pneumonia and tuberculosis.
• Sweats
• Chills
• Recurring fever
• Chronic diarrhoea
• Swollen lymph glands
• White patches or odd lesions on the tongue or in the mouth that persist
• Persistent, unexplained fatigue
• Weakness
• Weight loss
• Skin rashes or bumps.³

Treatment Options for HIV

Antiretroviral therapy (ART)

• Antiretroviral medicines are used to treat HIV by preventing the virus from replicating in the body.
• A combination of HIV drugs is used to prevent the virus from adapting and becoming resistant.
• Some HIV treatments are combined into a single pill, although these may be more expensive.
• Typically, people who have been newly diagnosed with HIV take between 1 and 4 pills per day.
• Different combinations of HIV medicines are prescribed based on individual needs.
• The viral load, or the amount of HIV virus in the blood, is regularly measured to assess treatment effectiveness. Once it becomes undetectable, treatment is considered successful.
• HIV medicines can interact with other medications, including some over-the-counter and herbal remedies. It’s important to consult with healthcare professionals before taking any other medications.⁴

Pre-exposure prophylaxis (PrEP)

• PrEP (pre-exposure prophylaxis) is a medication used to prevent HIV transmission in people who are at risk.
• When used consistently, PrEP is extremely effective at preventing HIV transmission.
• PrEP can reduce the risk of HIV transmission during sexual activity by 99% when taken as prescribed and at least 74% when used by people who inject drugs.
• People who test negative for HIV and have had recent sexual activity without consistent condom use, have a partner with HIV, or have been diagnosed with an STD may benefit from PrEP.
• People who inject drugs and share needles or equipment may also benefit from PrEP.
• PrEP may be recommended for individuals who have used post-exposure prophylaxis (PEP) multiple times or report continued high-risk behaviours.
• PrEP may also be recommended for individuals who have a partner with HIV and are considering pregnancy or breastfeeding.
• It’s important to talk to a healthcare provider to determine if PrEP is right for you and to learn more about its benefits and potential side effects.⁵

Post-exposure prophylaxis (PEP)

• PEP is an abbreviation for post-exposure prophylaxis, which is a short course of HIV medication administered following a probable encounter to prevent the virus from taking hold in the body.
• To be effective, PEP must be administered within 72 hours after exposure.
• PEP is solely meant for emergency use and should not be used regularly by those who are frequently exposed to HIV.
• PEP may be appropriate if you are HIV-negative or do not know your HIV status and have had a recent possible exposure, such as through unprotected sex, sharing needles or other drug injection equipment, or workplace exposure.
• You should contact a healthcare provider immediately or go to an emergency room or urgent care clinic if you think you have been recently exposed to HIV.
• PEP involves taking HIV medication daily for 28 days and following up with healthcare providers for testing and other lab tests.
• If taken appropriately, PEP is beneficial in preventing HIV infection, however, it is not 100% effective.
• It is crucial to employ other HIV prevention strategies, such as condoms and sterilised needles while taking PEP.⁶

HIV Cure Research

Here are some research studies that might bring us closer to finding a cure for HIV:

• Scientists have developed a tool called CRISPR/Cas9 that can change the genetic code of cells. This can be used to fight HIV by targeting either the virus or the infected cells. It has been successful in lab studies with human cells and animals. Researchers are still working to see if this tool can be used safely and effectively in people with HIV.²
• A new study funded by the National Institute of Health shows that a long-acting HIV treatment given every four to eight weeks can suppress the virus in people who were previously not responding to treatment. The study focused on people with HIV who face barriers to accessing treatment, such as housing insecurity, mental illnesses, and substance use disorders. The results show that this treatment can benefit people who are often underserved and face multiple challenges to their health.⁷
• A recent case study of a man known as “the Dusseldorf patient”. He was diagnosed with both HIV and leukaemia and received a stem cell transplant that ended up being a remedy for HIV. Stem cell transplant is a medical procedure where healthy cells are taken from a donor and given to a patient to replace their damaged or diseased cells. This procedure is very risky and cannot be used for all people with HIV, but it provides insights into possible paths to finding a HIV cure.⁸

Challenges and Limitations

The challenges and limitations of finding a cure for HIV are numerous and complex, and they involve biological, social, economic, and ethical considerations. Let us discuss them below:

Biological Challenges

• Viral reservoirs: HIV can hide in various cells and tissues of the body, forming viral reservoirs that are difficult to detect and eliminate. These reservoirs can persist even in people who are on antiretroviral therapy (ART), making it challenging to eliminate the virus from the body.
• Viral diversity: HIV is a highly variable virus, and different strains of the virus can evolve and mutate over time, making it difficult to develop a cure that can target all strains of the virus.
• Latent infection: HIV can become dormant in cells, making it difficult to detect and target the virus. This can lead to the virus reactivating later on, even after a long period of being undetectable.^9,10

Social and Economic Challenges

• Stigma and discrimination against people living with HIV can prevent them from accessing healthcare and support.
• Poverty and lack of education can limit access to HIV prevention and treatment options.
• Limited funding and resources for HIV prevention and treatment can hinder progress in controlling the epidemic.^11,12

Ethical considerations

• Informed consent: People living with HIV who participate in clinical trials for potential cures must be fully informed about the risks and benefits of the treatment and give their voluntary, informed consent.
• Access to the cure: If a cure is developed, there may be ethical concerns around ensuring that it is accessible to all who need it, regardless of their ability to pay.
• Stigmatization: There is a risk that individuals living with HIV who do not access or respond to a cure could be further stigmatized by society.
• Justice: There may be ethical concerns around who gets prioritized for access to the cure, particularly if it is a limited resource.
• Safety and efficacy: Ethical considerations must be taken to ensure that any potential cure is safe and effective before it is widely distributed.
• Potential harm: There is a risk that the pursuit of a cure could divert resources away from prevention and care efforts, potentially causing harm to individuals and communities affected by HIV. While the pursuit of a cure is important, it should not come at the expense of prevention and care efforts, which are necessary to address the ongoing impact of HIV on individuals and communities affected by the virus.
• Community engagement: The involvement of communities affected by HIV in the development of a cure and in decision-making processes related to access and distribution is crucial to ensure that ethical concerns are addressed and that the cure is acceptable to those who need it most.¹³

Conclusion

While there is currently no known cure for HIV, significant progress has been made in developing effective treatment options that can help manage the virus and prevent its spread. With early detection and proper medical care, people living with HIV can lead long, healthy lives. It’s important to educate ourselves and others about the symptoms of HIV, as well as prevention methods such as safe sex practices and regular testing. Continued research and innovation in the field of HIV treatment and prevention offer hope for a future where a cure may eventually be possible.

FAQs

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References

1. HIV and AIDS [Internet]. World Health Organization. World Health Organization; Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids 
2. Xiao Q, Guo D, Chen S. Application of CRISPR/Cas9-based gene editing in HIV-1/AIDS therapy. Frontiers in cellular and infection microbiology. 2019 Mar 22;9:69. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439341/ 
3. Symptoms of HIV and AIDS: What to look for? [Internet]. [cited 2023 May 9]. Available from: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv/ 
4. HIV and AIDS- Treatment [Internet]. NHS choices. NHS; Available from: https://www.nhs.uk/conditions/hiv-and-aids/treatment/ 
5. Pre-exposure prophylaxis: Prep medication [Internet]. HIV.gov. [cited 2023May3]. Available from: https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis/ 
6. Post-exposure prophylaxis: Pep medication [Internet]. HIV.gov. Available from: https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/post-exposure-prophylaxis/ 
7.  Long-acting antiretroviral therapy suppresses HIV among people with unstable housing, mental illnesses, substance use disorders [Internet]. U.S. Department of Health and Human Services; 2023. Available from: https://www.nih.gov/news-events/news-releases/long-acting-antiretroviral-therapy-suppresses-hiv-among-people-unstable-housing-mental-illnesses-substance-use-disorders 
8. Croi 2023: Dr. Dieffenbach shares research highlights on long-acting HIV prevention and treatment, COVID, and a cure update [Internet]. Available from: https://www.hiv.gov/blog/croi-2023-dr-dieffenbach-shares-research-highlights-on-long-acting-hiv-prevention-and-treatment-covid-and-a-cure-update/ 
9. Fact sheet: HIV drug resistance [Internet]. World Health Organization; Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-drug-resistance 
10. HIV hides in immune system cells resistant to killer T cells [Internet]. [cited 2023 May 3]. Available from: https://news.weill.cornell.edu/news/2020/04/hiv-hides-in-immune-system-cells-resistant-to-killer-t-cells 
11. Bertozzi S, Padian NS, Wegbreit J, DeMaria LM, Feldman B, Gayle H, Gold J, Grant R, Isbell MT. HIV/AIDS prevention and treatment. Disease control priorities in developing countries. 2006 Apr 2;2:331-69. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11782/ 
12. Geter A, Herron AR, Sutton MY. HIV-related stigma by healthcare providers in the United States: a systematic review. AIDS patient care and STDs. 2018 Oct 1;32(10):418-24.Avaialble from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410696/ 
13. Lo B, Grady C. Ethical considerations in HIV cure research: points to consider. Current Opinion in HIV and AIDS. 2013 May;8(3):243. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825800/