LEARNING FROM AIDS PANDEMIC

Dr.T.V.Rao MD
WHERE ARE WE
The HIV pandemic identified as Global health crisis, But AIDS pandemic brought in Global unity of
sharing knowledge on science, technology and remedies to the existing crisis. In 2013, there were 35
million [33.2 million37.2 million] people living with HIV.
Since the start of the epidemic, around 78 million [71 million87 million] people have become
infected with HIV and 39 million [35 million43 million] people have died of AIDS-related illnesses.
Today there are no regions in the world, not touched by the pandemic of AIDS. A few Countries are
shy to share their problem with other Nations. In the beginning it was though it was a male
dominated disease, the recent epidemiological trends show women were more burdened, now it
makes up to 42 % were women. Prevention of Mother to Child transmission gained top priority as it
has already left many AIDS orphans in Africa, UNAIDS championed the cause with several
collaborators and partners joined and supported HIV/AIDS as global concern. The voice of concern
has not reached many rural poor, and sects with dogmatic ideas. And many continue to be victims of
the preventable Disease. Controversies continue on sex education. Even in Developed countries
many people are unaware of their HIV status, and spread the disease in ignorance. The real
achievements lie in Diagnostic advances reached every nation .With little training and few
instruments one can make an Optimal Diagnosis. The Positive side of HIV pandemic contributed to
elimination of unnecessary blood transfusions, voluntary donor programs and initiation to screening
all Blood donors for Life threatening viral diseases, were made mandatory.

Progress in last three decades.

In the last two decades Science and Medicine has seen unprecedented growth of Virology,
Molecular biology and Immunology, leading many newer discoveries on all health related problems.
The pathogenesis of HIV involves infection and replication within CD4 sect of T lymphocytes, and
Macrophages and dendritic cells too are involved. The complicity of the virus lies with Rapid
multiplication of the virus even though it has small genome (10 KB) with few genes which take the
advantage of the different pathways in Immune system. Recent contributions include that half-life of
a single virus is so short that half the entire population of the virus is replaced in less than 30
minutes. A chronic patient with AIDS is burdened with 1010 new generation of virus particles per
day Apart from the enormous burden of new viruses, rapidly multiplying viruses diversify to new
antigenic variants and is threatening to be main obstacle in developing a vaccine. Few are still lucky
to escape HIV infection, recent findings focus on CCL3LI gene copies vary individually and higher
numbers of Gene duplication result in reduced susceptibility to Infection, making not susceptible to
HIV infection.

What we have achieved in Diagnostics.

In the recent past more sensitive and specific Diagnostic tools are discovered. Detection of
antibodies was easier and affordable in many of the Developing nation. Introduction of rapid tests
for detection of antibodies to HIV 1 and 2 gained faster acceptance as results can be issued within 20
minutes. The various samples can be tested for surveillance screening and even for diagnostic
purpose. The minimal skills in laboratory are adequate for performing the tests but it is impossible to

make 100 % accurate detection with detection of antibodies. The limitation of the serological tests is
detection of infection during the primary infection and in Infants younger than 18 months who
might have maternal HIV antibodies persisting. And need quantization of viral RNA or detection p24
antigen remain the only options. The 3rd generations ELISA systems with methodology of sandwich
are gradually taken over older generations of testing kits. More recently need is felt for 4th
generation ELISA methods for detection of antibodies along with detection of p24 in same run.
Public interest litigation of missed diagnosis is making the necessity for 4th generation
methodologies. Need for confirmatory tests arose to make a specific diagnosis and fulfil the legal
obligations. Western Blot methodology stood the test of time and most accepted confirmatory
assay. many consider it as Gold standard, for validation of HIV test results in particular situations to
rule out false Positive from ELISA and Rapid methods .Polymerase chain reaction emerged as a
exquisite toll for defining sensitivity by artificially replicating Nucleic acid sequence .Recent century
has seen various advances in PCR modification, PCR based COBAS - AmpliScreen HIV 1 (By Roche)
test has gained the high popularity. Cost remains the real limitation in Developing Nations.
Other supporting tests are of gaining Importance which include CD4 estimations and RNA levels in
helping the prognosis, linked to effectiveness of antiretroviral drugs, and early decisions on
preventing opportunistic infections, many of the newer generation Diagnostic tools are unaffordable
in resource poor nations. The solution remains with technology transfer and public health
supporting systems.

Breakthrough with Antiretroviral Drugs

Recently there were boom of antiretroviral drugs and even generic formulation overcoming all
patent limitation. Indian pharmaceutical Industry championed the Drug revolution. Of the 21 FDA
approved drugs 20 will target the Transcriptase or Protease High genetic variation HIV in 1, limits the
utility of the drugs and necessitated with use Highly Active Retro viral Treatments (HAART) and
helped in suppression of replication and emergence of drug resistant HIV 1 variants. With the
lessons from Developed countries, the Developing countries are adopting HAART which in turn has
created a hope on prolonging life.
What are Priorities on HIV / AIDS?
1 Creating awareness on testing and motivating for testing
2 The importance of the Knowing the status of disease should carry top priority.
3 Social and Moral support, creating agencies for Holistic support.
4 Regular supply of the antiretroviral drugs of good quality.
5 Prevention of Mother to Child transmission, motivating mothers to take a test for detection of
antibodies at least in 2nd trimester of pregnancy.
6 Scientific up gradation of all Microbiology laboratories to Diagnose Opportunistic infections at all
stages of the disease as many live longer and still suffer with several opportunistic infections
7 Diagnosis/ cure of Tuberculosis should be part the AIDS care
8 Continuous support to resource poor Nations,
9 Development of HIV preventive vaccine and International collaboration on Vaccine development
should take all Clades/variants into consideration

10 The testing protocols should not miss the Detection of HIV2 infections.
11 Newer and safe Microbicide and Male circumcision needs more motivation and research.
12 Ongoing education and curing of other sexually transmitted diseases should be priority in war on
AIDS.
Every Living Human should put best efforts, and our efforts are certain to succeed as the Future of
Human race is linked with more understanding and preventing the Pandemic of AIDS
Revised article Published in Articleset.com (2007)
Dr.T.V.Rao MD Professor of Microbiology Freelance writer