World aids day how medical research made a disease manageable

In the 1980s and early 1990s, the diagnosis of HIV/AIDS was tantamount to a death sentence, as there was no effective therapy available. Today, human immunodeficiency virus (HIV) infection is considered a chronic, effectively treatable condition, and HIV-positive individuals have an almost normal life expectancy if diagnosed and treated in a timely manner. So HIV therapy with highly active drugs is one of the great successes of modern medicine. We observe World AIDS Day on 1. December to look back on the history of HIV infection and the development of effective drugs against HIV, and to outline current challenges.

The AIDS as a disease (Acquired Immune Deficiency Syndrome resp. acquired immunodeficiency syndrome) was described in 1981 as an emerging condition of unknown cause. Two years later, scientists succeeded in detecting the HI virus type 1 in a patient for the first time, and in 1986 the related HI virus type 2 was discovered.

The spreading HIV epidemic caused fear and terror in the early years and demanded Numerous deaths. At the same time, vibrant research efforts began to find drugs to fight the virus. In 1987, the U.S. Food and Drug Administration (FDA) granted approval to the first antiretroviral drug, zidovudine (AZT). Studies have shown that the drug prolongs the life of patients but does not completely suppress viral replication.

In the following years, new Active substances developed against HIV, and it became apparent that much better treatment success could be achieved when two or more substances with different mechanisms of action were combined: the highly active antiretroviral therapy (HAART) was born and caused a sharp decline in AIDS cases in Europe in the years 1994 to 1998. Today, a large number of drugs are available to treat HIV, very often in a triple or quadruple combination – often in a single tablet – are administered.

HIV and AIDS – what exactly does that mean?

HIV is a virus that belongs to the group of retroviruses and particularly attacks cells of the human defense system. An untreated HIV infection increasingly damages the immune system so that it is no longer able to fight off other pathogens (bacteria, viruses, fungi). These germs can then lead to serious illnesses. The process often takes years – but the progression of HIV disease can be successfully halted with medication. A person is said to be infected with HIV if he or she carries the virus – regardless of whether the immune system is still functioning to a large extent or whether the progression of the disease is slowed down with HIV medication. People who are infected with HIV and do not receive treatment can infect other people with the virus.

AIDS Stands for the acronym Acquired Immune Deficiency Syndrome. One speaks of AIDS only if after an HIV infection for AIDS typical illnesses appear. These include, for example, a certain form of pneumonia and other serious infectious diseases, so-called opportunistic infections.

HIV is transmitted through blood and other infectious body fluids (semen, vaginal secretions, fluid film on the intestinal mucosa). Most common Transmission route are unprotected sexual contacts.

HIV in Germany: Some facts, figures and challenges

About 88.000 people are living with HIV in Germany. Thanks to modern drugs, most of them have an almost normal life expectancy. You can work in any profession. spend their free time as others do.

Around 71.400 people took HIV medications in 2018. About 2.400 people were infected with HIV in 2018 – this number is very low compared to other European countries and has been almost constant for several years. In general, the care of people with HIV infection in Germany works very well, according to Dr. Viviane Bremer, head of the HIV/AIDS department at the Robert Koch Institute (RKI) Berlin, Germany.

Nevertheless, there are some Challenges. So experience about 1.000 people each year only learn of their HIV infection when they already have AIDS or a severe immunodeficiency. HIV infection is often diagnosed late, especially in people who have been infected through heterosexual contact. It is also problematic when people do not have health insurance. They have very limited access to health care, which can also lead to late diagnosis and inadequate care for HIV infection, explains Dr. Bremen.

Round 10.600 people in Germany do not know that they are infected with HIV – many have been living unknowingly with HIV for years. "These are the people we need to reach earlier and counsel for HIV testing. At this point the supply must become better", demands Dr. Volker Mertens of the German AIDS Foundation.

HIV/AIDS and Corona: what's special in 2020?

The COVID 19 pandemic has significantly changed our everyday lives since the spring of 2020. How has the pandemic affected people living with HIV/AIDS?? "Anecdotal reports indicate that there have been intermittent restrictions in supply at the local level. In particular, the test offers were cut back in the spring, so it is to be expected that fewer people were tested for HIV," reports Dr. Bremer from the RKI.

"Older HIV-positive people who experienced the beginning of the HIV epidemic in the 1980s felt strongly reminded of that time in the spring of 2020. "This led to anxiety and mental stress," says Dr. Mertens. HIV/AIDS counseling centers were sometimes difficult to reach during the Corona Lockdown, making personal conversations and social contacts difficult for those affected. "We must continue to provide sufficient information about protection against HIV and other sexually transmitted infections and offer low-threshold tests, even under corona conditions," the expert emphasizes.

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