Anti Retrovirals (ARVs) suppresses HIV, so if we have a way to manage HIV, why do we need a cure?
Less than half of people living with HIV are on treatment. This means that over half of HIV positive people are not on any treatment. With over 2.1 million new HIV infections globally in the year 2015, this growth must be addressed. (1)
At the moment, the most effective way to treat HIV is by suppressing the virus using antiretroviral therapy (ART). This is a daily pill, taken for the rest of the person’s life, that suppresses the virus. As soon as as someone is diagnosed with HIV they should start ARVs.
Someone using ARVs consistently has a life expectancy as long as someone who doesn’t have HIV. ARVs are very effective at giving HIV-positive people their health, peace of mind, bring sensuality back to the bedroom. Even conceive, give birth and breastfeed without risk of transmitting HIV! (2) (3)
If HIV is undetectable in the blood, then the virus cannot be transmitted to other people, which is great! (4)
The South African government is trying to make ARVs accessibility straightforward and easy, and places like the Desmond Tutu HIV Foundation are doing their best giving people living with HIV a helping hand by making healthcare services more accessible and friendly. Until there is a cure, the goal is to get everyone on ARVs.
ARVs must be taken for the rest of the patient’s life. This can be an economic burden if ARVs cannot be procured for free or through insurance. In South Africa, ARVs can be accessed for free. (7) This is a bold and crucial step taken by the South African government in tackling the virus and is to be commended. The barrier for many South Africans, whilst not financial, is accessibility: medication refills must be done at a clinic and transport can be time-consuming and expensive. Patients are also dependent on the pill, which is not ideal if they are unable to access the drug for any reason.
As with any chronic disease such as cancer or even daily birth control, taking a pill everyday can be stressful and tiring. Pill fatigue is a symptom seen in some patients who have a high demand of pills to take everyday. A patient may stop taking their pills because they are fatigued from the monotony of pill-swallowing.
For people who struggle with taking a daily pill, a choice to take a less-frequent treatment would be better than once-a-day medication. Generally, patients with chronic conditions have better adherence to medication when the doses are less frequent, but this is also dependent on the individual. (8) Even better would be a one-time cure that eliminates any virus from the body, or traps HIV so it can never reactivate. Neither of these are options for HIV-positive people at the moment, but researchers are still searching.
Additionally, effective treatment means that there is a growing ageing population of people taking chronic HIV medication. The research into the long term effects of ART is ongoing. (9) There is evidence that HIV positive people are more susceptible to non-communicable diseases which introduces a new layer of complexity in treating HIV in the long term (10).
The advantages of a cure are that HIV-infected people can be free of the virus, free from a daily pill regimen and free from the mental burden that comes with the infection. For many rural or isolated communities, especially the ones that the Desmond Tutu HIV Foundation (DTHF) works with in South Africa, clinics are difficult to access. A clinic visit, to get prescriptions or healthcare, might require time off work or school. DTHF wants to ensure that people with HIV are not discriminated against at work or burdened with extra schoolwork for needing time off to get medication. These sorts of sacrifices put patients in a position where they may need to choose between education, employment or health.
A once-off cure would be a load of many people’s minds.
However, the HIV cure is difficult to create. Researchers are trying to find a cure, but in the meantime ARVs are the best option for anyone with HIV. There are many charities, NGOs and free government services that are specialised to help streamline your ARV experience.
For information on where to find your nearest ARVs, or any other HIV related queries, phone the free South African AIDS helpline at 0800-012-322
(1) By mid-2016, 18.2 million people were receiving HIV antiretroviral therapy (ART) globally. While this number illustrates a formidable success in HIV treatment scale up over the past decade, it accounts for only 46%. http://www.who.int/features/qa/71/en/
(2) Life expectancy now near-normal in people with CD4 counts over 350 a year after starting therapy. http://www.aidsmap.com/Life-expectancy-now-near-normal-in-people-with-CD4-counts-over-350-a-year-after-starting-therapy/page/3138633/
(3) But research has since emerged, particularly from South Africa, that shows that a combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of transmitting HIV to babies through breastfeeding. http://www.who.int/bulletin/volumes/88/1/10-030110/en/
(4) 1. Can a person with HIV who has an undetectable viral load transmit HIV?
No. A person living with HIV on antiretroviral therapy (ART) with an undetectable HIV viral load in their blood for at least six months has a negligible risk of transmitting HIV to a sexual partner. https://www.preventionaccess.org/faq
(6) Know your Viral load graphic http://www.knowyourviralload.org/language/en/about-viral-load-testing/
(7) On 10 May 2016, the South African Minister of Health, Aaron Motsoaledi, announced in his Health Budget Vote Speech to the Parliament of South Africa that the country will implement a new evidence-based policy of offering HIV treatment to all people living with HIV by September 2016. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/may/20160513_UTT
(8) In some literatures, including that on diabetes, hypertension, and HIV/AIDS, there is strong, consistent evidence that increases in dose frequency and regimen complexity (multiple medications, multiple doses, specific dietary or time requirements) are related to poorer adherence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868342/
(10) While antiretroviral drugs have significantly improved the life expectancy of people living with HIV, the virus – and often the ARVs themselves – can make people more susceptible to non-communicable diseases than the rest of the population.