World AIDS Day, 2024: Progress, Challenges, and Path Forward

Acquired immunodeficiency syndrome (AIDS) is due to Human Immunodeficiency Virus (HIV), which attacks and weakens the immune system by reducing white blood cells. It makes individuals more susceptible to tuberculosis, infections, and cancers. Blood, breast milk, semen, and vaginal fluids are body fluids that spread HIV from one individual to another. It can be prevented and treated with antiretroviral therapy (ART), which delays its progression to AIDS if left untreated. 

CD4 cells are White Blood Cell types. They convey information to immune cells about bacterial and viral infections in the body. HIV infection destroys CD4 cells in the blood. A reduced number of these cells makes it difficult to ward off infections from the body.

To understand the current global impact of HIV/AIDS, we need to look back at its origins and the milestones that are responsible for shaping our response to this disease.

Morbidity and Mortality Weekly Report in the 1980s reported Pneumocystis pneumonia- Los Angeles, the disease we now know as acquired immunodeficiency syndrome, or AIDS. The lead article then was a report of dengue infections in vacationers. No one could have anticipated then the scale of the epidemic decades later.

Pneumocystis pneumonia first occurred in five homosexual men, and later other unusual infections presented themselves. They developed abnormal ratios of lymphocytes and were actively shedding cytomegalovirus (a virus that causes damage to the organs in people with weak immune systems). Soon, a basic outline of the epidemic was established. 

The disease was first identified in homosexual men, later in injection-drug users, and transfusion recipients, including those with hemophilia, infants, female sexual contacts of infected men, prisoners, and Africans. Opportunistic complications that developed were mycobacterial infections, toxoplasmosis, invasive fungal infections, Kaposi's sarcoma, and non-Hodgkin's lymphoma.  

Numerous theories regarding the cause of AIDS were forwarded. But none stood the test of time. Finally, the viral cause was accepted. Heterosexual contact was disregarded instead, spread among Haitians was thought to be a voodoo practice.  

A retrovirus was identified, and the search began for agents that might act on reverse transcriptase, the enzyme necessary for converting HIV RNA to DNA and replication.

Zidovudine, azidothymidine, or AZT as it is known is the first drug to be approved for the treatment of AIDS. After initial exuberance, AIDS patients turned against the drug and said cheap and simple treatments were overlooked in favor of mediocre, costly, and toxic drugs. Patients began to acknowledge that everyone they knew who took zidovudine did not survive.

Progress was slow in the years after the zidovudine. But soon, advances were made to prevent infections by P. carinii pneumonia and Mycobacterium avium.

Highly active antiretroviral therapy (HAART) became available, and it fundamentally altered the epidemic. It reduced AIDS cases and mortality. Breakthroughs included understanding HIV dynamics, the significance of viral loads, and triple-drug regimens. 

These advances improved survival but presented challenges like side effects and dosage timing. Efforts continued to reduce side effects and regulate the dose once a day. Modern long-acting injectables have helped in eradicating latent HIV.

There is a sense of anticipation for the global epidemic despite advances. Millions have been infected with HIV and have died, and several children have become AIDS orphans. Transmission from the mother to child has also taken many lives. 

WHO statistics

In the year 2023 estimated

• 39.9 million people suffer from HIV worldwide

• 630 000 people succumbed to HIV-related causes

• 1.3 million people acquired HIV

This calls for widespread testing, treatment accessibility, and public health campaigns.

The awareness, World AIDS Day raises about HIV/AIDS impacts millions globally. HIV infections remain a public health challenge despite progress being made in prevention, treatment, and care.  

1st December, World AIDS Day, is a call for education, access to life-saving medications, and eliminating stigma and discrimination against those living with HIV.  This year's theme is “Take the rights path: My health, my right!”.

By centering human rights and fostering global solidarity, we can realize the WHO vision of ending AIDS as a public health threat by 2030

References

1.“World AIDS Day 2024.” Accessed November 29, 2024. https://www.who.int/campaigns/world-aids-day/2024.

2. Sepkowitz, Kent A. “AIDS — The First 20 Years.” New England Journal of Medicine 344, no. 23 (June 7, 2001): 1764–72. https://doi.org/10.1056/NEJM200106073442306.

3. Elizabeth Glaser Pediatric AIDS Foundation. “Advanced HIV Disease - Elizabeth Glaser Pediatric AIDS Foundation.” Accessed November 29, 2024. https://pedaids.org/our-expertise/advanced-hiv-disease-and-opportunistic-infection/.

By Dr. Swati Sharma