Understanding the course and therapy of HIV infectionDining with someone infected with HIV? Kissing someone who is HIV-positive? These questions reflect uncertainties. Our society's prejudices against people infected with HIV are reflected in the following. For a well-founded opinion, a basic understanding of transmission pathways is essential. Disease progression and knowledge of current treatment methods essential.
"We can live very well with HIV. With exclusion no human being can. " (Respect! on World Aids Day 2016) The annual campaigns for World Aids Day on 1. December draw attention to the situation of HIV-infected people. Past campaigns are considered to have been very successful overall.
The general knowledge about sexual ways of transmission of HIV in the population is very high. For example, according to a representative survey by the BZgA (2014), 99% of respondents classify unprotected sexual intercourse as a possible route of transmission. The population is equally well informed about the fact that there is no risk of infection in contacts with HIV-infected persons in everyday situations ( Fig. 1 ). Some uncertainty exists in the assessment of kissing. Here, 11% of respondents are not sure and 26% answer in the affirmative whether there is a risk of transmission. The picture changes when the population is asked about potential behavior rather than knowledge. For example, 85 % of the respondents are "quite sure" to have dinner with a colleague who is infected with HIV, but only 22 % would definitely "move in with someone who told them that he/she is HIV-positive" . When it comes to kissing, this figure drops to 13 %. The closer and more immediate the contact, the more uncertainties exist ( Fig. 2 ).
This discrepancy between knowledge and action, familiar from many contexts, may be understandable, especially since HIV infection is not curable and is associated with disease and z. T. Infirmity is associated. Uncertainty does not necessarily lead to stigmatization and discrimination, yet HIV-positive people often experience rejection and exclusion. In a study conducted by Deutsche AIDS-Hilfe (DAH), about 77% of respondents reported having experienced discrimination (ranging from gossip and insults, to physical assaults) in the year prior to being interviewed. 20 % of respondents were even referred to a health service because of their infection (z. B. in a doctor's office) denied (DAH 2011).
Scientific developments in HIV therapy have led to a significant improvement in the living situation of HIV-infected people over the past 30 years (DAH 2017). Whereas therapy in the 1990s was still very stressful for patients, today's drugs allow them to live almost free of side effects. More than 20 antiretroviral drugs are available. Almost all processes of viral replication are used as drug targets ( Fig. 3 ). CCR5 anatgonists prevent docking, fusion inhibitors prevent the virus from entering the host cell. In addition, inhibitors of reverse transcriptase, integrase and proteases are available (Golz 2009).
Since the virus can quickly develop resistance, at least three active substances are always used simultaneously (combination therapy in one tablet). With optimal therapy, the viral load is at its maximum after three months (max. six months) below the detection limit (DAH 2016). The drugs must be taken for life; a cure in the true sense is currently not possible. The HI-virus is not removed from the body, but only its reproduction is prevented. Thus, the number of CD4 cells remains high, the immune system can work "normally" and AIDS is prevented.