HIV in 2021

Question 1

When did HIV first arise and where did it originate from?

Answer 1

HIV arose in 1890 from chimpanzees in a village called Brazzaville in Congo.

Question 2

How did HIV spread from central Africa to other parts of the world?

Answer 2

Between 1890 and 1950, the virus spread, mostly by iatrogenic means (e.g., malaria/smallpox vaccine needles) throughout central Africa. It spread north to the Americas with air travel, although mostly unsuccessfully.

Question 3

What is the transmission pattern of HIV, and how does it differ in acute and chronic forms?

Answer 3

HIV is non-transmissible in chronic form but highly infectious in acute form. It rapidly spread south from the 1980s, mainly through sexual transmission.

Question 4

What analogy is used to explain HIV treatment and disease progression?

Answer 4

The analogy of a train on a train track is used. CD4 count represents the length of the track, while viral load represents the speed of the train. ARVs are likened to moving the train backward, recovering CD4 count.

Question 5

What CD4 counts are associated with adverse outcomes, and how has the approach to treatment changed over time?

Answer 5

CD4 counts above 350 or 500 are associated with adverse outcomes, especially if poor. Treatment is now started as soon as possible, even on the day of diagnosis, whereas in the past, high drug toxicity was weighed against cost and the risk of disease.

Question 6

How has HIV impacted the tuberculosis (TB) epidemic, particularly in South Africa?

Answer 6

HIV has fueled the TB epidemic, but TB incidence is falling, and prevention efforts are proving to be very effective, especially in South Africa.

Question 7

What is the current situation regarding HIV prevalence and treatment in South Africa?

Answer 7

In South Africa, there are 7.9 million HIV-positive patients, with 5 million on ARVs. Life expectancy has increased by a decade due to effective treatment.

Question 8

What are the key methods of HIV prevention?

Answer 8

Prevention is achieved through treatment to bring the viral load down to 0, circumcision, needle exchange interventions, mother-to-child prevention, PEP, PrEP, and programs focusing on risk groups, as well as promoting condom use.

Question 9

What surprising finding challenges previous beliefs regarding HIV prevention?

Answer 9

Contrary to previous beliefs, “sugar daddies” are actually highly protective against HIV. Anti-sugar daddy campaigns present an interesting case of medical morality.

Question 10

In which region is the HIV epidemic concentrated, and among which demographic?

Answer 10

In KwaZulu-Natal (KZN), the HIV epidemic is concentrated among men and women in their late 20s to early 30s.

Question 11

U =

Answer 11

U=U (undetectable=untransmissible)

Question 12

f ARV tx is started when CD4 count > 500 →

Answer 12

normal life expectancy

Question 13

 In _____, HIV life expectancy is longer than that of general population (due to increased health behaviour in
patients)

 Epidemic of chronic disease has emerged after previous efforts to ______ infectious diseases (which used to be the main health burden)

Answer 13

Uganda
eradicate

Question 14

 HIV drugs treat other illnesses like _____ for free (e.g. Tenofovir)
 Tenofovir increasingly becoming regarded as a _____drug

Answer 14

Hep B
Legacy

Question 15

Problems with 1st line drug regimen: (2)

Answer 15

 TDF/Tenofovir is costly & toxic

 EFV is costly, has low resistance barrier, large pill size, d/I with oral contraception

Question 16

What major development occurred in HIV treatment in 2019?

Answer 16

In 2019, Dolutegravir (DTG) took over as a preferred HIV treatment option. It has no contraceptive drug interactions and is cheaper compared to previous options.

Question 17

What is the likely replacement for Tenofovir Disoproxil Fumarate (TDF)?

Answer 17

TDF will likely be replaced with Tenofovir Alafenamide (TAF), an analogue with similar efficacy but potentially fewer side effects.

Question 18

What emerging challenge is associated with HIV treatment?

Answer 18

A major emerging challenge with HIV treatment is obesity, as antiretroviral drugs (ARVs) are causing weight gain in patients.

Question 19

How does HIV drug adherence compare to adherence in other chronic diseases?

Answer 19

HIV drug adherence is generally good compared to adherence in other chronic diseases such as diabetes and hypertension.

Question 20

What era of HIV treatment is the current focus, and what direction is treatment moving toward?

Answer 20

Currently, the focus is on the Integrase Era of HIV treatment, with a shift toward injectables and implantables for medication delivery.

Question 21

How has HIV research impacted research and access advocacy for other diseases?

Answer 21

HIV research has transformed research and access advocacy for other diseases such as Hepatitis B & C, oncology, coronavirus, and diabetes.

Question 22

How has HIV impacted broader discussions about health and medicine?

Answer 22

HIV has mobilized unprecedented resources for health, made evidence central to medicine, opened up discussions about sex and sexuality, and accelerated drug discovery efforts.