AIDS - How Close We are to its Cure

AIDS (Acquired Immuno Deficiency Syndrome) is a fatal disease caused by a virus called HIV (Human Immuno Deficiency Virus). The disease probably originated in Southern parts of Africa but was first detected in June 1981 from Los Angeles, USA. AIDS in recent years has aggressively grown into a world wide epidemic. From the year 1980 to 2017, the disease has caused an estimated 35M of deaths worldwide. In India, first report of AIDS came in January, 1986 from Chennai and eventually engulfed other areas as well. The disease alters the immune system, making a person much more vulnerable to infections and diseases and is transmitted through body fluids of an infected person (semen, vaginal fluid, breast milk and blood).

Early symptoms of AIDS may be vague or ill-defined. The initial symptoms include weight loss, fever, diarrhea, oral thrush, joint pain, night sweats, a red rash, weakness and enlargement of the lymph glands. In many cases, after the initial symptoms disappear, there will not be any further symptoms for many years. During this time the virus carries on developing and damaging the immune system and organs. If left unattended, the HIV weakens the ability to fight infection and the person enters the HIV 3rd stage which is fatal. In severe condition, the patient may develop pneumonia, Kaposi's sarcoma (a skin cancer) and lymphoma (cancer of the lymph system). Although AIDS has a long incubation period, which is possibly five years but once it develops, the chances of death within a year is very high.

AIDS is transmitted through three main routes: sexual contact, hypodermic needles shared by addicts, and from mother to child during pregnancy, delivery or breast feeding. However, the virus is not transmitted by touch, nasal secretions, saliva, tears, urine or vomit (unless these are contaminated with blood). Globally, the most common mode of HIV transmission is via sexual contact. This can happen while having sexual contact without a condom, including vaginal, oral or anal sex, or sharing sex toys with someone who is HIV positive. Consistent use of condom reduces the risk of HIV transmission by approximately 80% over the long term. The risk of transmitting HIV through blood transfusion is extremely low in developed countries. However people sharing syringes with a HIV positive is extremely hazardous. Moreover, those at risk from AIDS should not be blood donors.

A widely used diagnostic test for AIDS is enzyme linked immuno-sorbent assay (ELISA). Diagnosis is made through a blood test and the blood is re-tested several times before a HIV positive is given. A home testing kit can be used as well. However, there is currently NO cure for AIDS. Treatments can stop the progress of the condition and improve general living in as little as one pill per day. But currently, there is no vaccine or cure for AIDS. If an individual believes they have been exposed to the virus within 72 hours i.e three days, then an anti-HIV medications called PEP (Post-Exposure Prophylaxis) may stop infection. The treatment shall be taken as soon as possible after contact with the virus.

Although there is no cure for AIDS, scientists and researchers are talking more and more about the possibilities for the cure. Mainly there are two types of cure that are being talked about- a functional cure and a sterilizing cure.

A functional cure would suppress the amount of HIV virus in the body that it can't be detected or make you ill, but it would still be present. There are very few examples of people being cured functionally, but sadly it has been seen that the virus had re-emerged.

A sterilizing cure is one where all the virus is eradicated from the body, even from hidden reservoirs. There is only one case of successful sterilizing cure. This occurred in a man named Timothy Brown who had undergone chemotherapy and then bone marrow transplant to treat leukemia. This seemed to have cured his HIV but is not clearly understood by doctors as to how it happened. Since bone marrow transplants are also very dangerous transplants, this cure is not practical for others. However, it has given the researchers a starting point towards the path of the cure.

Apart from these two main types of cures, there are also four broad strategies of cure therapy that are currently under investigations.

1. 'Shock and Kill’ is basically the idea to force the infected cell to become active so that the body's immune system or ARVs (antiretroviral drugs) can destroy the virus. There have been a number of attempts to apply this technique. Recently, in June 2015, researches at The University of California, USA announced that a compound called PE0005 is effective at waking up dormant HIV. However, so far these drugs have been effective only on some tissues and blood samples in the laboratory and not on the actual person living with AIDS. Also studies have found that this technique activated only a small amount of HIV infected cells and activating more might be damaging to the immune system.

2. ‘Stem Cell Transplant’, as used in the case of Timothy Brown, aims to completely eliminate a person's infected immune system and replace with a donor's system. This is the most complex and risky approach. A slightly successful case was discovered at the Mayo Clinic in Minnesota, USA where a 55-year old man living with HIV AIDS received a bone marrow transplant as a part of his cancer treatment. But it was found that the virus reappeared 10 months after the patient discontinued the therapy and the treatment has been reinitiated. Thus, it was concluded that Stem Cell Transplant might not work alone but requires a series of treatment and cure strategies to be more effective.

3. ‘Gene Editing’ aims to change immune cells so that they can't be effected by HIV. A study in 2015 used a technique by introducing modified stem cells into HIV infected mice and reported a 80 to 95% decrease in HIV level. The cell functioned normally once the virus was gone. But till now this technique has been used only on animals or cells in the laboratory.

4. 'Immune modulation' is looking for ways to permanently change the immune system by using drugs or procedures to fight HIV. There has also been a lot of researches into HIV vaccines with a number of encouraging results. However, a vaccine can only ensure partial protection and needs a combination of other treatments as well.

While there have been a lot of promising researches, currently there is no cure for the disease. In our country, the National AIDS Control Organization (NACO) and other Non-Government Organizations (NGOs) are doing a lot to educate people about AIDS so that they could prevent the occurrence of this fatal disease. For now, the best thing to do is to test regularly for HIV and if you are HIV positive, start the treatment and keep taking it regularly.

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