THE Human Immunodeficiency Virus (HIV) was first identified in 1983, with the connection between it and the development of Acquired Immunodeficiency Syndrome (AIDS) established in 1984.

Despite the promise at the time of a vaccine within the next two to three years, almost four decades later that goal has not yet been reached.

Sadly, in this time there have been almost eighty million cases of AIDS identified worldwide, with almost forty million deaths.

It remains a disease that strikes fear into the hearts of most, and if not identified or treated, remains a death sentence.

Thankfully, in the intervening thirty years, massive strides have been made with regard to treatment of HIV. Highly active antiretroviral therapy (HAART) was first introduced in 1996.

At the time, the life expectancy of a twenty-year-old with HIV was 10 years. Today, medicines are commenced early enough, that twenty-year-old can hope to reach 70. Indeed, they are more likely to die from a non-HIV illness than an HIV-related one.

Despite this success, a vaccine still remains the holy grail. HAART and its subsequent incarnations remain a vastly expensive medication. A good outcome relies not on only getting tested early enough, but once confirmed as HIV positive, adhering to a lifelong treatment regimen.

You may wonder why the development of an HIV vaccine has taken so long given the success of the Covid immunisations, which were rolled out in a record-breaking time of less than 12 months.

This is the exception to the rule. Most vaccines are in development for at least five to ten years, before coming to the market.

Several aspects have made vaccine development difficult. Firstly, there is no state of natural immunity after HIV. The only persons to have been cured of HIV received stem cell transplants. So, it is difficult to look for a marker in the blood that might indicate a cure.

Unlike other viruses that may be shed after a matter of weeks, HIV remains in the body lifelong. When it enters a person, it hides inside sugar molecules. Most antibodies attack by recognising something foreign that doesn’t belong to the body. By concealing itself inside the body’s own tissues, this will not occur.

Every time HIV replicates it changes itself slightly. In an untreated individual, there may be thousands of different variants of HIV, and worldwide hundreds of thousands of different subtypes of HIV. Contrast this against the coronavirus, where there may be between five to ten alternate strains at any one point.

Thankfully researchers have never given up despite these hurdles. Since 1984 there have been over 250 trials, with more than 20 ongoing at the present time.

There have been modest breakthroughs along the way. The largest trial, conducted in Thailand, with 16,000 study participants, developed a vaccine with around 30 per cent success rate. Sadly, this is too low to be acceptable.

Ongoing studies have looked at making broadly neutralising antibodies, which would hopefully be able to identify several strains of HIV at any one time.

There are some individuals who never become HIV positive, despite repeated exposure to the virus. Others, who become HIV positive do not develop AIDS, in the absence of any treatment. These are known as super controllers. Much research has focussed on these two groups with the hope that they may hold some of the clues to a vaccine.

In reality, most experts in the field agree that a working vaccine that can be rolled out to all, remains at least five if not ten years away.

Perhaps the biggest challenge to HIV still remains the stigma attached to the condition. We have moved a long way from the days where the medical profession found it acceptable to call it GRID, or gay related immune deficiency. It is not a disease confined to any race or community. A surprising statistic is that all STIs including HIV are on the rise in white, middle-aged individuals who would classify themselves as heterosexual.

Although Pre-exposure and Post-exposure prophylaxis do exist, perhaps the best way of preventing any sexually transmitted disease is to practice safe sex. If you are worried that you may be at risk of HIV, early testing remains vital. If treatment is started soon after a positive result, the picture is far brighter. There are many support groups available for anyone who is concerned, or simply wishes to know more about the condition.

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