For many years after the AIDS crisis of the 80s and 90s, being HIV-positive was considered a death sentence. Many of those who discovered they had the virus – which slowly attacks the immune system – were shunned, unfairly associated with immoral behaviour, and considered too "contagious" to be around.

Today, attitudes towards those who are HIV-positive have changed for the better, in no small part due to the incredible medical advances that have been made.

Currently, an HIV-positive person can expect to live a long and healthy life, provided they are diagnosed early enough, follow a healthy lifestyle and take the recommended antiretroviral medicines. For this reason, it’s now relatively uncommon for an HIV-positive person to develop AIDS, the final stage of infection where the immune system becomes totally compromised.

Of course, while many advances have been made with HIV treatment, a full cure still eludes scientists. However, recent research could play a hugely important role in the development of a working vaccine.

New Antibody Research

According to two new studies published in Science Translational Medicine, antibodies could be the key to the HIV vaccine. Antibodies are proteins created by the immune system and sent out whenever antigens (harmful bacteria or viruses) enter the body. Antibodies identify and bind to a specific type of antigen; this allows the immune system to identify the "intruder" and destroy it. Researchers have long stressed the importance of antibodies in the fight against HIV; these new studies have revealed that antibodies could be even more important than first thought.

One of the studies saw scientists create a special type of antibody that seeks out hidden HIV cells. When cultured together with an "HIV-killer" cell, these antibodies proved effective in destroying previously hidden cells of the virus.

The second study discovered three different antibodies that have a "neutralising" effect on HIV. It's hoped that this means that they can be administered to HIV-positive patients to prevent the virus from progressing.

With studies like this going on all the time, it is possible that we will see an HIV vaccine within the next decade. Currently, however, there are many treatments available to keep HIV infection properly managed and under control. To find out more, read on.

Diagnosing, Treating & Preventing HIV 

The first thing to know about HIV is that it is spread through bodily fluids (semen, vaginal and anal fluid, blood and breast milk). The most common mode of transmission is unprotected vaginal or anal sex.

HIV can also be spread in the following ways:

• sharing drug needles or other injecting equipment
• from mother to baby before or during birth
• from mother to baby when breastfeeding

The instance involving mother and baby can be controlled so the risk is higher where the mother is infected and it is not known.

If you think you might have been exposed to the virus, or if you fall into an at-risk group (men who have sex with men, black African men and women), you should get tested for HIV.

There are different types of HIV test available – normally you will have your blood taken at a clinic and sent away for testing. Order a home test kit through The STI Clinic and you can take a blood sample at home and return it to our lab for testing; our test can detect HIV as early as 10 days after exposure but a negative result is not considered conclusive until 6 weeks after the point of potential infection.

If you think you have been infected in the past 72 hours, you should talk to a doctor about getting post-exposure prophylaxis (PEP); an emergency treatment that can prevent infection from setting in.

For people who are diagnosed with HIV, the treatment programme will involve regular blood tests to monitor the amount of virus in your system, and how healthy your immune system is. At a certain point, you will start treatment with antiretroviral medicines, which work by preventing the virus from multiplying. 

If you’re concerned about contracting HIV, make sure you always use condoms when having sex with someone who may be infected, and never share needles. If your partner is HIV-positive, it is possible to have safe sex – consult the resources available at Terence Higgins Trust to learn more.

The STI Clinic has launched a testing service for HIV. The test uses the latest detection technology and can provide a reliable result 6 weeks after a risky event. The test looks for antigens and antibodies and is capable of early detection. In some cases the antigens associated with HIV are detectable in the blood after 10 days. We recommend that people get tested as early as possible following exposure to a risky event, but if the result is negative, we will recommend a retest at the 6 weeks mark.

Early detection and diagnosis of HIV are key aspects related to a better prognosis in HIV. However, there are many reasons why individuals may get diagnosed long after their infection. For instance, some individuals may consider themselves to be low risk and not bother to get tested. Similarly, the choice of getting tested is not a privilege offered to everyone across the globe and testing can be expensive. However, this may soon change, as researchers from the Royal Institute of Technology in Sweden suggest that it may be possible to use modified DVD players for HIV testing.

Their findings were recently published in Nature, where the team explained the key alterations that needed to be done in further detail. Essentially, rather than having a light sensor that reads DVDs, the equipment would require a light sensor that could read information from blood samples. In addition to that, there would be a need for a semi translucent disc, which would hold the sample. Lastly, there would be a need for a different type of software. (In other words, not a DVD player at all but they clearly wanted a headline…).

The early prototype that has been developed appears to be functional and if this apparatus were to go further to be developed for clinical use, there could be many benefits. In addition to being made at a low cost ($200 in contrast to $30 000 or more), it would also be portable and easy to use. Perhaps most importantly, it would make fast and reliable results a reality in more clinics across the globe.

We were intrigued to hear about this report, as we have long been aware of the problems related to a delayed diagnosis. We were particularly glad to hear that the report was coming from the Royal Institute of Technology, which has a strong standing in research. As such, we are inclined to think that the research community will give serious consideration to these findings and that there will be more research dedicated to making the development of this equipment a reality.

Circumcision has often been the cause of numerous debates, with some reports of the effects of unconventional practices even becoming substantial legal controversies. However, it has also been a perspective to consider when researching the spread of HIV among men. What most studies appear to have found is that circumcision is related to a lower risk of getting HIV by up to 60%. Now a recent study has confirmed this and explained the underlying mechanisms for why this may be.

The study, which was published in mBio, was a prospective observational intervention study. In total, 156 uncircumcised men took part. After the researchers obtained baseline levels of bacteria in the genital area from all of the men, they were randomly split into two groups. In one of the groups all the men received circumcision, whereas the other group did not receive any intervention. Both groups were then followed up a year later, with the same measurements being taken to see the levels of bacteria in the genital area. These results were then compared to the initial baseline levels as well as between groups. The key findings indicated that the circumcised men had a non-significant increase in aerobic bacteria levels and an average of 81% decrease of anaerobic bacteria levels. Based on this the researchers concluded that circumcision positively affected the men’s penile ecosystem as a result of increased oxygen reaching previously covered skin. As a result, the prevalence of anaerobic bacteria levels decrease, which reduces the risk of inflammation that has been associated with making HIV infections more likely.

Several aspects of this study are commendable, with its prospective design perhaps also being its strongest point. Theoretically speaking the findings are useful to rule out other competing theories within this field. Although the findings certainly appear robust, it is also important to bear in mind that understanding underlying mechanisms within biological research requires in depth research to rule out variables and competing theories. As such, the most ideal scenario would be if these findings were replicated in another study. However, it is questionable whether this is feasible given that the execution of this type of research may be rather difficult. Nevertheless, if further studies were to gain an understanding of the underlying mechanisms for this phenomenon, then it would have a substantial impact on developing interventions.

We were not surprised to read about these findings as we are already well aware of other studies where male circumcision was associated with a lower incidence of HSV-2 lower risk of transmission of STIs (such as HPV and Trichomonas Vaginalis infections) to their female partners. Therefore, it should not come as a surprise if we write other significant studies within this field in the future.

A little while ago we wrote about a baby that had been functionally cured of HIV, but that these findings were not applicable to adult cases. Now a new study claims that their adult patients were functionally cured.

The study, which was published in Plos Pathogens, was an observational study that followed up 14 patients who had been infected with HIV in the 1990s or early 2000s. All of the participants had been treated with combination antiretroviral therapy (c-ART) within ten weeks of infection. They had ceased to use this treatment after 36 months on average, but not had the virus return. This is unusual, as the virus tends to return as soon as the treatment is ended.

In order to explore how and why they remained functionally cured, the researchers aimed to assess whether these patients had common similarities beyond their early intervention. In order to do so, they compared the types of infection the participants had presented with, variations in cell count and differences in how their T-cells responded to treatment. This was done by analysing blood samples, with the results being statistically analysed. The researchers also compared their findings to other published findings, as well as with hospital records of other patients that had started c-ART therapy early but were still having the treatment. The key findings indicated that their participants had a low T-cell activation and that they had a very low HIV reservoir levels. The latter was suggested to decline for several years after treatment cessation. In comparison to other patients that had received c-ART therapies, the researchers argued that their study group most likely represented 15% of those cases.

This study was well executed, and it was clear that it aimed to put their sample in context with other studies and other patient groups. The basis of the study reflected that the researchers were well aware of their limited sample, and that their findings were in their infancy. Nevertheless, by focusing on a functional cure for HIV, the authors made a realistic and valuable contribution to the field. Clearly, there is a need to follow up these patients and conduct extensive assessments that were beyond the scope of this study.

From our point of view, we are intrigued to see what discussions will form concerning the clinical implications of the findings. While the study forms an argument for early intervention, there are some concerns regarding the long-term toxicity it could lead to, the potential for viruses to develop resistance and for the cost of a lengthy treatment. On the other hand, there are recent studies that have illuminated that the c-ART treatments on the market are well tolerated and reduce the risk of resistance. Moreover, it is worth noting that early treatment reduces the risk of HIV-1 transmission and that it would be highly unethical to deny patients early treatments. Overall, diagnosing and treating early is absolutely key to successful outcomes and we advocate regular testing for high prevalence groups.

Given the devastating long-term effects of the HIV virus if undiagnosed, and the challenge it has put forward to science, it is not surprising that news regarding a potential cure for HIV has hit the headlines. Here we take a look at the recent case of an infant who is claimed to have been cured of HIV in an effort to tease out potential implications for adults with HIV.

Essentially, the infant was the offspring of a woman who not too long ago had found out that she was HIV positive. As a result of not knowing about the virus, the mother had not received prenatal treatment for HIV, which increased the risk of the infant being infected with HIV. Once the baby was born it was tested for HIV, and before the lab results had returned, the medical team had already put the baby on a cocktail of common treatments for HIV. What happened next was remarkable. The infant’s immune system responded astoundingly well to the medications, and within 29 days of starting treatment the baby was considered functionally cured of HIV. After having received further treatment for ten months, the baby was followed up with two blood tests and several tests for HIV-specific antibodies. All of these indicated that there were no detectable levels of HIV.

This is only the second time a person has been cured from HIV. The first case was the infamous “Berlin Patient”, who was an adult that had been cured as a result of his cancer treatment in which he received blood stem cell transplants that contained delta 32 (a known genetic mutation found to increase resistance towards HIV).

Although this is only the second time that a person has been cured from HIV, the implications are in stark contrast to each other. Obviously, an infant’s immune system is very different from an adult’s immune system. Furthermore, most adults do not find out about their HIV infection until months or even years after they have been infected. It is not speculative to assume that the virus may have expanded more after a few months than after a few days, and that the treatment options are likely to be more complex in adult cases especially if previous co-morbidities exist.

It also appears that the implications of the baby case do not fit into the two lines of research that are looking into the cure for HIV for adults. The first line of research is based on considering whether cancer drugs may have an effect on the virus. The second line of research is based on the Berlin Patient case and exploring the genetic mutation that he received. Both of these require extensive, time-consuming studies and results could be years off.

While these studies and the news from the USA may be exciting, there is currently no cure. Safer sex is the only way that you can minimise the risk of HIV transmission and at risk groups are advised to get tested regularly as the sooner a person is diagnosed and put on treatment, the greater the chance of a normal life expectancy. The STI Clinic advocates condom use as this is the only way to minimise the risk of sexually transmitted infections.