World AIDS day 2014
World AIDS Day is held on 1 December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day, with the first one held in 1988.
NDM spoke to Associate Professor Lucy Dorrell, Honorary Consultant in GUM/HIV and Jenner Investigator about the outlook for patients diagnosed with HIV, a possible HIV vaccine and the problem of co-infection.
Q: What is the situation in the UK today compared to 10 years ago?
Lucy Dorrell: The number of people living with HIV in the UK has doubled over the past 10 years and has now risen to over 100,000. This is due to a number of factors including increased testing for HIV and improved survival thanks to effective antiretroviral therapy (ART). The good news is that people who are diagnosed early, and started on ART promptly, can expect to have a near-normal lifespan. However, there are still major challenges to overcome: a quarter of those infected are unaware of this and so are at risk of passing on the infection; and a high proportion of people are still diagnosed late and this carries a higher risk of mortality.
Q: What are the limitations of the current antiretroviral therapies?
LD: Current antiretroviral therapies are very effective in blocking virus replication and preventing AIDS. But they do not eliminate the infection from the body and so they only work if taken every day for the patient’s lifetime. If treatment is stopped, the virus comes back and T cell counts start to fall, a sign of damage to the immune system, all over again. This is because the virus is able to hide in some of the T cells in the body for many years and therefore the drugs are unable to touch it. Having to take pills every day is a huge commitment for many people. We need better therapies that not only block virus replication, but also flush it out from the cells where it is hiding.
Q: Can you tell us about the prevalence of
co-infections and what we can do about it?
LD: As HIV-positive people are living longer, prevention of comorbidities has become a priority. About a quarter of men who have sex with men (MSM) who have recently been diagnosed with HIV are found to have other sexually transmitted infections (STIs). This is a concern as concurrent STIs increase the risk of HIV transmission. Also, we have seen a big rise in some serious infections such as hepatitis C, which is not usually spread through sex, among MSM in Europe. Hepatitis C is more serious and can be more difficult to treat in people with HIV. We need to strengthen efforts that focus on making people aware of how they can minimise the risks, promoting regular screening for STIs and condom use and we also need vaccines to prevent HIV and hepatitis C. That’s something we’re working on.
Q: How could your research help develop a vaccine against HIV in the future?
LD: HIV is a difficult target for a vaccine because it can evade the host immune response in many different ways. Our research aims to work out which parts of the virus are the most vulnerable to immune attack and to build a vaccine based on these. We can only fully understand this by studying people with HIV and working out what enables some people to control the virus better than others. We also need speed up testing of different vaccine approaches in people so that we can learn quickly what works and what doesn’t and focus our efforts on improving the design.
NDM additionally spoke to one of Associate Professor Dorrell's patients about their experiences of living with HIV.