HIV/AIDS: The Organism That Causes the Disease

            The human immunodeficiency virus (HIV) is the microbe responsible for HIV/AIDS infections (CDC, 2021). HIV is a microbe in the genus Lentivirus and HIV-1 and HIV-2 species (Esbjörnsson et al., 2019). HIV-1 is the most common, aggressive, and infectious species and it originated from chimpanzees (Pan troglodytes) (Esbjörnsson et al., 2019). HIV-1 currently replicates in human beings only.

Life Cycle

The HIV life cycle has seven stages that are binding, fusion, reverse transcription, integration, replication, assembly, and budding (NIH’s Office of AIDS Research, 2021). According to the NIH’s Office of AIDS Research (2021), the life cycle begins with HIV binding to the surface receptors of the CD4 cell. The HIV moves inside the CD4 cell after it joins together with the membrane of the CD4 cell. In the third stage, which is reverse transcription, HIV changes the CD4 cell DNA to ensure it moves to the cell nucleus (NIH’s Office of AIDS Research, 2021). Specifically, HIV RNA is converted into HIV DNA using reverse transcriptase enzyme that HIV generates (NIH’s Office of AIDS Research, 2021).

HIV releases another enzyme, integrase, in the integration stage. Then, the viral DNA is integrated into the CD4 cell DNA using the integrase enzyme. Applying the CD4 cell machinery, HIV replicates by forming HIV protein chains in the replication cycle. In the assembly stage, non-infectious HIV are assembled when HIV RNA and HIV proteins transfer to the CD4 cell surface (NIH’s Office of AIDS Research, 2021). The HIV life cycle ends when HIV produces protease that converts non-infectious HIV into mature infectious HIV (NIH’s Office of AIDS Research, 2021). Before releasing the enzyme, the immature HIV moves out of the original CD4 cell.

How it Spreads and the Infection Process Inside the Human Body

Blood, pre-ejaculate, rectal fluid, vaginal fluid, semen, and breast milk are the bodily fluids with high concentration of HIV (CDC, 2021). Therefore, HIV is spread through sexual intercourse including vaginal, anal, and oral sex, blood transfusion, injection drug use, and pregnant women to babies (CDC, 2021). Notably, HIV from the mother can infect the baby during pregnancy, birth, and breastfeeding.  Once it enters the human body, the infection process starts by HIV replicating in CD4 T cells. Haider et al. (2019) mentioned that after replicating in the CD4 T cells, HIV infects other immune system cells including dendritic and macrophages cells. Susceptible CD4+ CCR5+ T cells are the primary targets of HIV (Monaco et al., 2017). Then, HIV travels to the lymph nodes, blood, and other body parts (Monaco et al., 2017).

World Regions Where Microbe Is Found

            HIV/AIDS is found in all continents of the world. However, sub-Saharan Africa particularly Eastern and Southern African nations have the highest percentages of HIV/AIDS cases (Joshi et al., 2021). Joshi et al. (2021) mentioned that in 2019, 57 percent of global new HIV infections were in sub-Saharan Africa. Therefore, HIV transmission is currently higher in sub-Saharan Africa than it is in other regions. The number of individuals living with HIV is also highest in sub-Saharan Africa, standing at 67% of the infected people globally.

Social and Economic Issues

Internalized stigma as well as community level and healthcare provider discrimination are types of stigma and discrimination that influence spread of HIV (Stover et al., 2019). Notably, internalized stigma decreases HIV testing, linkage to treatment, treatment adherence, and viral suppression (Stover et al., 2019). Gender-based violence especially towards women is another social issue that hinders prevention, testing, and treatment of HIV (Stover et al., 2019). Low access to justice and law reform related to drug use and criminalization of sex work and same-sex sexual activity also increases HIV transmission in most countries (Stover et al., 2019).

According to Govender et al. (2021), although both genders have similar incidence rates, HIV global prevalence is higher in females but mortality is higher in males. Nonetheless, incidence, prevalence, and mortality rates are higher among males in Western Europe, Brazil, and the US (Govender et al., 2021). Infants and 20 to 39 year olds have the highest incidence HIV rate (Govender et al., 2021). In sub-Saharan Africa, young women aged 15 to 24 years old are the most vulnerable due to poverty and power inequality in sexual relationships (Govender et al., 2021).

Socioeconomic status such as social class, financial security, income, and education level affects HIV transmission. Low socioeconomic status and homelessness increases risky sexual behaviors including transaction sex for food, housing, drugs, safety, and money (Stover et al., 2019). It also drives people into entering sexual relationships that have power differences. Additionally, low socioeconomic status has a negative effect on HIV treatment and AIDS development.

Historic Perspective

According to the CDC (2022), HIV/AIDS was first identified in June 5, 1981 in Los Angeles, US, among gay men. The CDC began using AIDS to describe the condition in September 24, 1982. In the same year, reports of perinatal and blood transfusion transmission of AIDS were made (CDC, 2022). By the end of 1983, the CDC had recognized all the HIV transmission routes and declared that air, environmental surfaces, water, casual contact, and food cannot spread the virus. In 1991, CDC releases guidelines for healthcare workers with HIV after a HIV-positive dentist infects a patient through a dental procedure in 1990. The leading cause of mortality among 25 to 44-year-old US males is AIDS in 1992 (CDC, 2022). China, India, Cambodia, Vietnam, Soviet Union, and Eastern Europe experienced HIV outbreaks in 1996 (CDC, 2022). Moreover, the WHO noted in 1999 that the AIDS was the major cause of death in Africa and the fourth biggest globally (CDC, 2022). In 2002, AIDS in sub-Saharan Africa was by far the primary killer according to UNAIDS. HIV/AIDS is still an ongoing global pandemic.

Current Statistics About This Disease

Since 1981, HIV has infected approximately 79.3 million worldwide and killed around 36.3 million (UNAIDS, n.d.). In 2020, 37.7 million individuals were living with HIV globally, there were 1.5 million new infections, and 680, 000 AID-related deaths (UNAIDS, n.d.). Furthermore, 28.2 million were using antiretroviral therapy by June 2021. In 2020, 6.1 million HIV-positive people were not aware of their status. In 1997, new global HIV infections were 3 million, which have reduced by 52 percent to 1.5 million in 2020 (UNAIDS, n.d.). The 1.5 new HIV infections 2020 were a 31 percent decrease from 2.1 million new cases recorded in 2010. There was also a 64 and 47 percent reduction in AIDS-related deaths since 2004 and 2010, respectively (UNAIDS, n.d.). Therefore, HIV infection rates and deaths are getting better. However, Govender et al. (2021) found out that HIV incidence has been rising in South America, the US, and Europe in the last decade.

The Disease Process

            The disease stages of HIV infection include acute infection, chronic infection, and AIDS (CDC, 2022). During the acute HIV infection stage, individuals have a high viral load; hence, they are highly infectious. Viral load is the amount of HIV in bodily fluids (CDC, 2022). Some people do not experience any symptoms during acute HIV infection phase but others have flu-like signs such as fever, night sweats, rashes, swelling in the lymph nodes, fatigue, sore throat, chills, mouth ulcers, and muscle aches (CDC, 2022).

HIV then enters the chronic stage also called the clinical latency or the asymptomatic HIV infection phase because the virus reproduces very slowly (CDC, 2022). HIV transmission still happens in this stage. Some people have symptoms in this stage but others are asymptomatic even for a decade without medications. By the end of the chronic phase, the CD4 cell count has reduced while the viral load has increased. Rising viral load causes symptoms and AIDS, which is the final stage, begins when the CD4 count is less than 200 cells/mm (CDC, 2022). However, taking medications early prevents AIDS.

Human Immune System Response

In the acquired immunodeficiency syndrome (AIDS) stage, people are extremely infectious due to a high viral load. The immune system is highly compromised and people get opportunistic infections including pneumonia, TB, HSV, wasting syndrome, candidiasis, Kaposi’s sarcoma, toxoplasmosis, encephalopathy, progressive multifocal leukoencephalopathy, mycobacterium avium complex, and salmonella septicemia (CDC, 2022). HIV/AIDS weakens the immune system by destroying CD4 T lymphocyte cells that fights infections in the body (Haider et al., 2019). Thus, without medications, AIDS causes opportunistic infections that kills people within three years (CDC, 2022).

Is the patient a carrier, or infected with recurrent episodes or is the surviving patient immune from further infections?

HIV patients are carriers; they can be symptomatic or asymptomatic for more than ten years (CDC, 2022). However, the asymptotic patients will still transmit the virus. HIV-1 mutates very fast; hence, two different strains can infect a single individual.

What Is Being Done to Combat This Disease and by Who?

Current Medications

Scientists have not yet succeeded in developing a HIV vaccine due to the high mutation rate. However, antiretroviral therapy (ART) that is a combination of different medications for HIV is being used to manage the disease. The Combivir is the first ART that the FDA approved in 1997 and it is a single daily tablet that combines two medications (CDC, 2022). Cheaper generic HIV medicines including nevirapine began to be manufactured in 2001 for developing countries. Another ART, Complera, was approved by the FDA in 2011 (CDC, 2022). ARTs aims at viral load suppression and CD4 count increase (CDC, 2022). Undetectable viral load reduces the HIV transmission risk to zero, that is, Undetectable = Untransmittable” (U=U) (CDC, 2022). Moreover, PrEP (pre-exposure prophylaxis) was recommended in 2011 to prevent infection among at-risk people who were HIV negative (CDC, 2022). PEP (post-exposure prophylaxis) can be used within 72 hours for emergency situations to prevent HIV infection (CDC, 2022). For instance, people who have sex with a HIV positive individual without a condom, the condom broke, or in the case of rape.

Latest Technologies 

The latest technology in HIV treatment that scientists are trying to develop is immunologic intervention to neutralize latent HIV-infected cells during ART. The technology would ensure viral load does not increase when HIV patients stop taking ART (Mitchell & Deaconess, 2021).

National and International Efforts

National and international efforts to eradicate HIV/AIDS include diagnosing HIV early, starting effective HIV treatment immediately, use PrEP to protect at-risk people, and quick response to new clusters of new HIV infections (CDC, 2022). Prevention of mother-child transmission also plays a vital role in eliminating HIV locally and globally.  It is also vital to increase HIV/AIDS awareness through public education. UNAIDS and the WHO recommended male circumcision in 2006 in highly infected areas, as it lowers female-to-male HIV transmission by 60 percent (CDC, 2022). Additionally, the Prevention Access Campaign launches the Undetectable = Untransmittable” (U=U) slogan globally to end HIV/AIDS stigma and discrimination (CDC, 2022).

Future Prognosis for This Disease

Finally, according to Assefa and Gilks (2020), the UNAIDS introduced the third Sustainable Development Goal (SDG-3) in 2015. The SDG-3 includes the 90-90-90 targets to ensure that by 2030, 90 percent of infected people are aware of being HIV positive (Assefa & Gilks, 2020). ART should be available to 90 percent of the HIV diagnosed people and viral suppression to be achieved among 90 percent of those receiving ART. If SDG-3 target is attained, HIV/AIDS will stop being a public health epidemic in 2030, since new transmissions and deaths will reduce significantly. Political commitment and sustainable domestic and global funding in all nations is necessary to achieve SDG-3.

What Can Your Audience Do to Protect Themselves?

            The audience can protect themselves from HIV/AIDS by abstaining from sex, getting diagnosed before sex, having only one sex partner, and using condoms correctly and consistently during all sexual encounters (CDC, 2022). Avoiding drug injection is also important. Nonetheless, individuals who inject drugs should never share needles and drug equipment. STD diagnosis and treatment also reduces the risk for HIV infection.  Moreover, if you are at-risk, visit a healthcare provider to get PrEP. People can also use PEP in case of emergency circumstances but it is only effective within three days.

What Can They Do to Help the Fight Against This Disease?

            People can contribute to the efforts of fighting HIV/AIDS by protecting themselves and others. Protecting others starts by individuals getting tested and starting ART immediately. Achieving undetectable viral load means that the person cannot transmit HIV to other people (CDC, 2022). Pregnant women should also get a HIV diagnosis as early as possible to prevent mother-child transmission during pregnancy, birth, and breastfeeding. Individuals can also help governments in increasing public awareness of HIV/AIDS.

 

HIV/AIDS Annotated Bibliography

Assefa, Y., & Gilks, C.F. (2020). Ending the epidemic of HIV/AIDS by 2030: Will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries? International Journal of Infectious Diseases, 100, 273-277. https://doi.org/10.1016/j.ijid.2020.09.011

The article notes that the goal of the third Sustainable Development Goal (SDG-3) is to reduce HIV/AIDS by 90 percent by 2030. If the goal is attained, HIV/AIDs will be managed through an integrated health system instead of a fully vertical approach. According to the authors, sustainable national and global funding and political commitment are crucial in accomplishing SDG-3 target. This information is necessary for my project in indicating the approaches the world is using to eradicate HIV/AIDs by 2030.  Both authors work in the School of Public Health in the University of Queensland. The article meets the authority, currency, objectivity, and verifiability criteria. Nonetheless, this is a non-research article.

Haider, J., Lutfullah, G., Rehman, I. U., & Khattak, I. (2019). Identification of risk factors for human immunodeficiency virus-1 infection in Khyber Pakhtunkhwa population: A case control study. Pakistan Journal of Medical Sciences, 35(5), 1258–1263. https://doi.org/10.12669/pjms.35.5.258

According to the article, at-risk populations for HIV include individuals who have unprotected sex, injecting drug users (IDUs), blood transfusion, and those aged 35 years and younger. Additionally, HIV virus is present in specific bodily fluids including semen, pre-ejaculate, blood, and breast milk. The authors recommend increasing HIV awareness, frequent screening of IDUs, and avoiding re-using and sharing syringes. This source is applicable to my topic in explaining how HIV virus is spread and the people who are most susceptible to the microbe. The authors have also analyzed how HIV virus reproduces by replicating in the CD4+ T cells in the body, then infecting other cells. The reduction of CD4+ T cells weakens the immune system and results in AIDS. The source is a current and a peer-reviewed journal article. The authors are Biotechnology and Microbiology professors who conducted a quantitative observational study with no conflicting interests.

Joshi, K., Lessler, J., Olawore, O., Loevinsohn, G., Bushey, S., Tobian, A.A.R., & Grabowski, M.K. (2021). Declining HIV incidence in sub-Saharan Africa: A systematic review and meta-analysis of empiric data. Journal of the International AIDS Society, 24(10), e25818. https://doi.org/10.1002/jia2.25818

The authors of this article concluded that the incidence of HIV in Sub-Saharan countries has been reducing. They also note that investing heavily in HIV programs using domestic and international donations has played an important role in curbing new HIV infections in the region. The article is relevant to my project topic, as it shows where HIV/AIDS is prevalent and the interventions being used to control infections. I will use the article to explain that Sub-Saharan Africa particularly Eastern and Southern African countries bear the highest burden of HIV globally. Besides, it will help in describing in the final project how the COVID-19 pandemic could affect the progress made in HIV management. This article is current because it was published in 2021. Moreover, it is highly authoritative and credible since the authors are professors in major US universities, and it is published in a peer-reviewed AIDS journal. The article also presents objective data from verifiable studies and evidence.

Stover, J., Glaubius, R., Teng, Y., Kelly, S., Brown, T., Hallett, T.B., Revill, P., Bärnighausen, T., Phillips, A.N., Fontaine, C., Frescura, L., Izazola-Licea, J.A., Semini, I., Godfrey-Faussett, P., De Lay, P.R., Benzaken, A.S., Ghys, P.D. (2021). Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030. PLoS Medicine, 18(10), e1003831. https://doi.org/10.1371/journal.pmed.1003831

After using mathematical simulation models, this source concludes that new HIV infections and AIDS-related mortality would decrease by 83 and 78 percent respectively, if 2025 targets were achieved. However, COVID-19 and social enables including stigma, discrimination, and gender-based violence might hinder the goal. This article is relevant to my project in demonstrating the social issues that contributed to HIV/AIDs becoming a global pandemic. Stigma and discrimination prevents people from testing for HIV, seeking, and adhering to treatment; thus, increasing the transmission rate of the virus. This is a peer-reviewed article containing quantitative research published in a credible journal. The authors are also qualified researchers in their field.

 

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