AUTHOR DETAILS:
Chanchal Maheshwari¹, Shehroz Khan²,
Name : Chanchal Maheshwari
Affiliation : Karachi Medical And Dental College
Email : maheshwarichanchal586@gmail.com
Orcid ID : 0000-0002-3714-7554
Name: Shehroz Khan
Affiliation: Jinnah Medical & Dental College Karachi
Email: dr.shehrozkhan@outlook.com
Orcid ID: 0009-0008-9134-7128
To the Editor,
Human Immunodeficiency Virus (HIV) is a pandemic between the pandemics,
a global entity threatening the entire world. Despite 40 years of
combating this illness the cases are still on the surge. According to
the Joint United Nations Programme on HIV/AIDS, 38.4 million people were
living with HIV in 2021, with 1.5 million newly infected and 650,000
dying, a slight decrease from 1.7 million new infections and 690,000
deaths in 2019. HIV is a retrovirus that primarily infects CD4+ immune
cells, HIV1 being the most common strain. The Acquired Immunodeficiency
Syndrome (AIDS) is caused by HIV in its end stage. Its transmission
occurs through the exchange of bodily fluids, sexual contact, mother to
the fetus, breast feeding, and sharing syringes. Among the population,
sex workers and their clients, homosexual men, people who inject drugs,
transgenders and their sexual partners accounted for 70% of HIV
infections globally in 2021 along with young women aged 15 to 24. (1,2)
Global numbers conceal regional differences. East and southern Africa
continue to be the center of the pandemic, accounting for 54% of all
HIV-infected people and 43% of incident HIV infections and deaths. Asia
and the Pacific have the second highest burden with India being the
world’s third-largest HIV epidemic with 65,000 new cases in 2019. A
state in India’s northeast, Mizoram has the second-highest AIDS death
rate at 23.34 per 100,000 people. Despite the effort worldwide, HIV
incidence has not decreased; little accomplishment has been observed in
Central Asia ,Eastern Europe and the Middle East. Moreover, amongst the
high-income countries The United States remains at the top with 37,881
new HIV infections reported in 2018, with regional differences. The
South had the highest rate of new infections reporting to be twice that
of the Midwest, having the lowest. The rate among African Americans
showed twice the number than Hispanics and eight times that of
Caucasians.(1,3)
HIV is a global burden causing mortality and morbidity, we write to
highlight the constant HIV incidence, its misdiagnosis and associated
factors causing lack of eradication despite being an actively targeted
disease worldwide utilizing US $20-29 billion per year. From the
pandemics aggravating immunosuppression to the revolution of the world
through increased practice of homosexuality, multiple partners and drug
abuse, major concern of HIV is more than ever.
The COVID-19 and monkeypox pandemics also hampered HIV progress due to
the shift of focus and resources. According to a Lancet global health
study, HIV deaths in low and middle-income countries are expected to
rise by 10% over the next five years due to the disturbance caused by
the pandemic. The highest impact was calculated to be interruptions in
antiretroviral therapy, poor testing and screening strategies, lack of
access to hospitals owing to rising fear, reduced capabilities of the
health system due to an overwhelming demand for patient care, and
financial instability (4,5). A study done in Italy showed newly
diagnosed HIV cases in pre and post COVID- 19 era having a significant
decline in newly diagnosed cases attributed to reduction in checkup of
HIV patients or hospital visits being replaced by telemedicine. It also
revealed 51 subjects out of which 19 were diagnosed pre-COVID and 31
subjects during COVID-19 era. Those with HIV were either older
population or at their early stages diagnosed previously. COVID -19 led
to decrease in the number of new cases possibly due to social
distancing. Various countries faced shortage of antiretrovirals due to
restricted trade and safety restrictions imposed. Other factors being,
common symptoms among COVID and HIV patients leading to confounding
effects for the underdiagnosis of HIV conditions that could have led to
acute infection or leading AIDS defining illness. (5)
We also want to emphasize on the contrasting causative agents of the
disease in developed versus developing countries showing the issue in
our approach to eliminate HIV through one single method, which might not
be sufficient. Rise of aids in developed countries such as The United
States is mainly due to premarital or unprotected intercourse, common
practice of sex workers, clubs and homosexuality, taboo of sharing HIV
status with your partner and increased alcohol intake ultimately
clouding decision making whereas in developing countries particularly
Pakistan which as of june 2019 shows, out of 165000 cases only 24331
cases were registered with the National Aids Control Program (NACP),
majority of these cases were found in Punjab and Sindh along with a
second grade emergency outbreak of HIV in Larkana district. Target
causes identified were different than the United States including needle
transmission, unsterilized surgical instruments, limited testing and
antiretroviral therapy drugs, unawareness amongst rural class, lack of
protective intercourse, mother to child transmission, undiagnosed cases
due to limited healthcare facilities and social stigma (6).
Healthcare system and governing authorities need to stress on the steps
to be taken against HIV eradication. In the absence of any curable
treatment, there is an urgent need to raise the community’s awareness
through campaigns and social media. Rehabilitation centers should be
improved to handle drug abusers who are more prone to HIV. Medical staff
should be trained to sterilize needles and surgical instruments along
with having strict surveillance in blood donation centers. Proper sex
education and information on sexually transmitted diseases should also
be provided in institutions due to the prevalence of sexual activities
among youth. HIV resistance is another threat which can be prevented by
combining effective antiretroviral drugs which reduces viral
replication. Highly Active Antiretroviral Therapy (HAART) can transform
HIV into a manageable condition. Furthermore, mother to child
transmission should be prevented through elective cesarean and
availability to one dose of nevirapine as well exploring alternative
methods for breastfeeding. Worldwide, pregnant HIV negative females with
HIV positive male partners, need oral use of tenofovir/emtricitabine for
one month before and after the conception. Sexual transmission should be
prevented through usage of condoms and sexually active individuals
should verify their HIV status breaking the taboo surrounding this
condition (6,7).