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Every year World AIDS Day is observed on Dec 1 and the theme by WHO for this year is ‘Equalize’, meaning equalize access to essential HIV services to high risk group but who have limited access to healthcare. These group of people are men who have sex with men (MSM), transgender people, people who use drugs, sex workers, prisoners and migrants – and their partners. This is a large group of undiagnosed and untreated HIV. As per WHO, in 2021, around 650 000 people died from HIV-related causes and around 1.5 million people acquired HIV.

To break the chain of transmission and reduce newly acquired HIV, we need to achieve the most difficult target, which is to increase the number of people living with undiagnosed HIV to get tested, diagnosed and initiated on ART (antiretroviral therapy) at the earliest. HIV is not transmitted if a person’s sexual partner is virally suppressed on ART, so increasing access to testing and starting ART is an important component of HIV prevention. Partner screening is another big hurdle in HIV diagnosis.

If we have overcome the biggest hurdle of getting tested and diagnosed with HIV then comes the treatment initiation and continuation life-long. The proposed goal by UNAIDS by 2025 is the 95-95-95 targets meaning 95% know their status, 95% receive sustained treatment and 95% get their HIV viral load suppressed.

Prevention is equally or more important than treatment. Some important approaches for HIV prevention, which are often used in combination, include:

male and female condom useeducate and try to bring in behavioural changes in those who use drugs, share needles ensure safe and aseptic practises when getting a tattoo elimination of mother-to-child transmission (MTCT) of HIV by appropriate treatment of the mother and the newborn use of antiretroviral drugs (ARVs) for prevention – pre (PrEP) and post exposure (PEP). Though this mode of prevention using pill is becoming more popular it has its own risks. It offers protection only as long as it is followed. It does not offers protection against other sexually transmitted infections, so using condoms is essential

Current antiretroviral therapy (ART) does not cure HIV infection but suppresses viral replication and allows an individual's immune system recovery to strengthen and regain the capacity to fight off opportunistic infections and some cancers.

From multiple pills couple of decades ago, we have now moved to single combination pill offering excellent control of HIV infection, if continued without skipping pills. Most importantly since 2016, WHO has recommended ‘Treat All’, that all people living with HIV be provided with lifelong ART, including children, adolescents, adults, pregnant and breastfeeding women, regardless of clinical status or CD4 cell count.  With ART, good viral suppression will be achieved and gradual improvement in immunity as determined by CD4 count will be noted. Slowly the patient improves and gains weight. At this point it is important to monitor other metabolic conditions like diabetes, high cholesterol, hypertension, heart disease etc.,

which any other person can develop. It is important that HIV infected person once regaining normal or near normal immunity starts exercising regularly and eat healthy to keep away metabolic problems. They need to check for some lab tests and follow-up with their clinician regularly. Women are advised to have regular follow up with gynaecologist to screen for sexually transmitted infections but also cervical cancer screening related to human papilloma virus (HPV). It is also important to take vaccines against important and indicated vaccine preventable diseases. Thus HIV infection has now become a manageable chronic health condition, enabling people living with HIV and on appropriate treatment to lead long and healthy lives.

Dr. A. Rajalakshmi,
Senior Consultant in Infectious Diseases, KIMSHEALTH, Trivandrum

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