LEARNING FROM AIDS PANDEMIC

Over the past several decades, researchers have learned a lot about the human immunodeficiency virus (HIV) and the disease it causes, acquired immunodeficiency syndrome (AIDS). But still more research is needed to help the millions of people whose health continues to be threatened by the global HIV/AIDS pandemic. The HIV pandemic identified as Global health crisis, by 2006, an estimated 38.6 (33.4 to 46.0) are living with HIV infection, While about 25 million already dead. But AIDS pandemic brought in Global unity of sharing knowledge on science, technology and remedies to the existing crisis. 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 programmes and initiation to screening all Blood donors for Life threatening viral diseases, were made mandatory. Progress in last three decades. In the last three 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 multiple 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. Some of the researchers have found a simple, cost-effective way to cut HIV transmission from infected mothers to their breastfed infants. Others have developed an index to help measure the role of alcohol consumption in illness and death of people with HIV/AIDS. 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 fulfill 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. Roche has also developed an HIV test called Amplicor HIV-1 Monitor Ultrasensitive Method. This test, approved by the U.S. Food and Drug Administration for clinical diagnostic use in 1999, can detect viral levels down to 50 copies per millilitre of plasma, a proportion previously undetectable. Other companies such as Chiron Corporation and Organon Technika have developed kits for measuring HIV in blood or plasma. 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 Retroviral 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 Microbicides 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. The long term goal is to find ways to get rid of the latent virus. If you could get rid of that, you could potentially safely stop anti-HIV drugs. At the moment you need to be on the anti-HIV drugs for life, because if you stop them the virus just re-emerges. The impact could be finding a way to reduce the time someone has to take anti-HIV drugs for: from 50-60 years down to 4-5 years. At the present moment there are 33 million people infected with HIV. In poor countries, about 8 million of these people are on treatment and about 15 million need treatment. So we have a gap of 7 million people not receiving treatment who need it. If we could treat a lot more, at least 15 million if not more, we may have a very significant impact. There are 4.2 million people living with HIV in Asia. In many countries in Asia the epidemics are in high risk groups, such as people who inject drugs; people who engage in sex work; MSM and so forth. Consequently, the challenges in Asia are different from Africa, for example, where there is a generalised epidemic. 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 To date approximately 30 vaccines against HIV have been tested, most in phase 1 or phase 2 trials to determine their safety and immunogenicity. Only one vaccine candidate, made by VaxGen, Inc., has gone on to phase 3 efficacy trials, which will probably not be completed for some time. Development of an HIV vaccine has become a very high priority in AIDS research. Dr.T.V.Rao MD Professor of Microbiology freelance writer (Original Article published in Articleset.com Available in 6 International Languages)