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2022/02/16 17:16:31

HIV and AIDS

The problem of HIV is huge, it is acute in many countries, including Russia.

Content

Main article: Viruses

HIV (human immunodeficiency virus) is a slow-progressing disease caused by the human immunodeficiency virus.

Despite the enormous danger of the HIV virus, under a microscope it harmlessly resembles an outlandish flower.

HIV destroys the human immune system gradually and over time (in most people - after 5-10 years) causes a condition called AIDS - acquired immunodeficiency syndrome.

AIDS manifests itself in different ways. Some people have infections of the upper respiratory tract, others have cancer and skin infections. Often, against the background of AIDS, people get tuberculosis.

The most devastating epidemics in human history at the beginning of March 2020

Virus Types

WICH1 and WICH2 and their rapid mutation

HIV has enormous genome variability - the ability to mutate very quickly - much faster than, for example, the influenza virus. That is why HIV is so difficult to fight: the development of vaccines and effective therapy rests on the fact that the virus is ahead of scientists.

To solve these problems, it is necessary, first of all, to know who we are dealing with - that is, to know about the whole variety of the virus, and how it changes.

This is important to understand for the purposes of practical medicine: if, for example, a new group, subtype or variant of HIV has appeared, diagnostic systems are needed that can determine them.

By June 2016, two types are known to exist - HIV 1 and HIV 2. HIV 1 is the most common type and is divided into groups - M (this group is the most common), N, O and P. Group P was discovered in 2009 in a woman from Cameroon who came to France. There are also many subtypes in group M. At the same time, new options are constantly being formed. It is possible that new groups and subtypes of the virus will soon arise.

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HIV mutates extremely quickly. Much faster than the flu virus. For example, in 5-6 years, in one person with HIV, the diversity of the virus becomes comparable to the diversity of the flu virus among all humanity in the world, says Abbott's John Hackett.
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This mutation rate occurs for several reasons. First, when HIV copies itself, "errors" or mutations appear in its genetic sequence, which increases its diversity.

Secondly, HIV replicates (multiplies) unusually quickly: in a patient who does not receive treatment, up to ten billion viral particles are formed per day.

Thirdly, the virus has the ability to recombine: for example, if a person is infected with different sub-types of HIV, they recombine among themselves in the human body, which leads to the formation of a new version of the virus.

2022: New HIV strain is spreading rapidly in Holland

In early February 2022, in the Netherlands, a study led by scientists from the Institute of Large Data of the University of Oxford revealed a new strain of human immunodeficiency virus under the designation VB.

After analyzing the nature of genetic variation among samples, the researchers suggested that the VB variant first arose in the late 1980s and 1990s in the Netherlands. In the 2000s, it spread faster than other HIV variants, but since about 2010 its spread has declined. The research team believes that the VB variant arose contrary to widespread treatment in the Netherlands, as effective treatment can suppress transmission of the virus.

A new strain of HIV is spreading rapidly in Holland

Individuals infected with the new VB variant (for virulent subtype B) showed significant differences prior to initiation of antiretroviral therapy compared to individuals infected with other HIV variants:

  • In people with the VB variant, the viral load (virus level in) blood was 3.5-5.5 times higher;
  • The rate of reduction in CD4 cells in people with the VB variant was twice as high, resulting in a much higher risk of developing AIDS;
  • People with the VB variant also had an increased risk of transmitting the virus to other people.

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Our findings highlight the importance of World Health Organization recommendations that people at risk of contracting HIV should have access to regular testing for early diagnosis, followed by immediate treatment. This limits the time that HIV can damage a person's immune system and endanger their health. It also ensures that HIV will be suppressed as quickly as possible, which will prevent it from being transmitted to other people, said Christophe Fraser, senior author of the study, professor at the University of Oxford Big Data Institute and Nuffield Faculty of Medicine.
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After starting treatment in people with the VB variant, immune system recovery and survival were the same as those with other HIV variants. However, the researchers emphasize that since the VB variant causes a faster decrease in the strength of the immune system, this makes early diagnosis and early initiation of treatment extremely important. Further research aimed at understanding the mechanism that causes higher transmissibility and damage to the immune system in the VB variant could reveal new targets for new generation antiretroviral drugs. Variant VB is characterized by many mutations spread throughout the genome, which means that at this stage it is impossible to determine a single genetic cause.

People with the VB variant had typical characteristics for people living with HIV in the Netherlands, including age, sex and prospective mode of transmission. This indicates that the increased transmissibility of variant VB is due to the property of the virus itself, and not to the characteristics of people with this virus.[1]

HIV diagnosis

Abbott was the first company to create an HIV antibody test in 1985, that is, a test that made it possible to diagnose a virus in the blood.

When it became clear to doctors and scientists that the diversity of HIV is so great, there was a need to create diagnostic systems that could not only identify all known types, groups and subtypes, but also identify new ones. After all, otherwise you can get a false negative result by missing virus variants in the sample, which the diagnostic system simply does not know.

В рамках Международной программы Abbott to monitor and detect new mutations of HIV and hepatitis virus, the company is constantly working to ensure the safety of blood supplies, identifying new viruses and diseases, as well as emerging strains of HIV, hepatitis B and hepatitis C, to include the definition of such viruses in the blood test process.
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Before donor blood is used, it is checked for infectious diseases. With Abbott equipment, 60% of the world's donor blood is screened for 2016, says John Hackett.
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2021

Large-scale genomic study among HIV-infected and HIV-exposed people in Africa

Scientists from the Center of a genomic variety of ITMO and the Center of a genomic bioinformatics of F.G. Dobrzhansky of St.Petersburg State University together with the Botswanian and Harvard institute of AIDS (Botswana-Harvard AIDS Institute) and also Harvard and Yale the universities conducted a large-scale genomic research among HIV-positive people and the HIV-exhibited inhabitants of Africa. As a result, bioinformatics found that certain genomic variants affect the risk of infection and the pathogenesis of the disease. This was reported by ITMO on November 23, 2021.

Scientists analyzed data from 1,173 patients provided by the Botswana-Harvard AIDS Institute.

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By 1996, it had become apparent that AIDS in Africa had become an epidemic and threatened most of the population of the region. We began trying to find genes that are associated with the risk of contracting HIV and getting AIDS back in the 90s. We found about 50 such genes. But the problem was that almost all studies related exclusively to the white population of the United States and Europe and the HIV-1B variant. There was very little work about the African American population. The current publication is devoted to a large-scale study of Africans, "said Professor Stephen O'Brien, Scientific Director of the NOC Genomic Diversity at ITMO University.
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During the work, scientists identified three genes, the presence of certain variants of which in the human genotype increases the likelihood of getting AIDS. Each of these genomic variants is also present in previously conducted studies among American and European patient groups, which confirmed the hypothesis of the authors of the work.

The AP3B1 gene plays a crucial role in HIV virus replication and release from cells. PRPRA encodes membrane receptors and is part of the protein-tyrosine phosphatase enzyme group, which also includes genes responsible for cancer development. Finally, NEO1 encodes proteins on the surface of cells and plays an important role in the inflammation processes provoked by HIV infection. Also, this gene is involved in the coding of antibodies that are part of human defense mechanisms.

As Professor O'Brien noted, AP3B1 is of greatest interest among the three genes. He is also responsible for such a rare genetic disease as Hermansky-Pudlak syndrome. Outwardly, this syndrome manifests itself in the form of albinism and is often the cause of death.

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Why do we think this gene is particularly important? When analyzing the genome of the inhabitants of Botswana, we found that a mutation of this gene leads not only to albinism, but also to immunodeficiency. And also that no homozygotes were found for this mutation, and neither among the inhabitants of this region, nor among all the genotypes collected during the Thousand Genomes Project (1000 Genomes Project). This fact may indicate the lethality of the option when it is present in two copies. The risk of getting AIDS is influenced precisely by the homozygosity or heterozygosity of this gene. This is very interesting from the point of view of genetics, I would like to study this in more detail, "said Stephen O'Brien.
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Botswana is part of the region of Africa that suffers the most from HIV (namely, its variety of HIV-1C). Among the total population of this country (about 3 million people), 25% are HIV-positive. Among 38 million people infected around the world, the proportion of people in the African region is 65-70%. At the same time, large-scale genomic studies of African patients and the African variety of the virus have not previously been carried out.

An important outcome of the study is that its results were repeated for African Americans. This made it possible to clarify the role of not only the three already mentioned genes, but also another 13 previously studied genes, which, according to scientists, can give the carrier resistance against a deadly virus. The work done will allow a much deeper study of the HIV-1C variant - and therefore, to develop a method of its treatment.

Launch of production of the world's first combined tests for HIV, hepatitis and syphilis in the Russian Federation

At the end of April 2021 Russia , production began on the world's first combined test for four infections: HIV, hepatitis types B and C and. syphilis A test system called "" Multiskrin is produced by a company "," Biopalette which is a resident of a special economic zone. "" St. Petersburg More. here

HIV vaccines

Main article: HIV vaccines

How the disease develops

Human immunodeficiency virus is a retrovirus that directly affects the human immune system.

The virus attaches and affects precisely those cells that protect the human body from infections and tumors, mainly T-lymphocytes. When the virus interacts with the lymphocyte, the virus penetrates into the cell and is embedded in its genetic material, remaining there for life, and when the cell is divided, it is transmitted to the offspring. In this mode, the cell cannot live long and dies over time.

At first, the body compensates for the loss by producing new lymphocytes, but this mechanism is not enough for a long time. Gradually destroying immune defense cells, the virus causes acquired immunodeficiency syndrome (AIDS) and a person can die from a banal cold.

Treatment

The virus multiplies inside immune cells and causes their death and immunodeficiency. Even with the complete suppression of reproduction, the virus is stored in the depot, so it is unfortunately impossible to completely get rid of it. Exceptions are extremely rare.

However, as of June 2020, many drugs have been developed in the world that operate at various stages of the virus's life cycle. They allow you to keep it depressed, maintain the immune system and prevent the development of immunodeficiency. For the maximum result, lifelong treatment is necessary.

2022: Scientists managed to clear hidden HIV reservoirs

Scientists managed to clear hidden reservoirs of HIV, where the virus is usually always dormant. These results prove that HIV is curable. The results now need to be confirmed in larger animal models to then proceed to clinical trials. This became known on January 17, 2022.

HIV patients are forced to constantly take antiretroviral therapy (ART) to keep the virus under control. Treatment prevents replication of the virus and reduces it to an undefined level, but in the body it is preserved in the so-called hidden reservoirs in a dormant state. At any moment, for example, if treatment is stopped, the virus reactivates again.

A few years ago, scientists found the compound SUW133, which activated sleeping HIV so that antiretroviral drugs could find and kill viral cells. Then in a day it was possible to destroy up to 25% of these cells. Now the authors have improved the approach and achieved 100% of the result.

In addition to SUW133 and ART, T-killers were added that target and destroy the virus. This combination made it possible to completely destroy viral reservoirs in 40% of rodents.

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These results support the concept of a therapeutic strategy to completely eliminate HIV from the body - a task that has been almost insurmountable for many years, said study author Jocelyn Kim.
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Her team now intends to modify the approach to eliminate the disease in all animals. As of January 2022, preclinical studies are already underway in primate models, after which it will be possible to plan therapy testing in humans.

Meanwhile, another team of researchers has previously unveiled a technology that also removes infected cells from the body by stimulating the immune system, leaving the virus no chance[2]

2021: A rare group of people with controlled HIV has been found that can help find the key to treating the disease

Abbott scientists have found a rare group of people with controlled HIV that could help find the key to treating the disease. The company announced this on March 2, 2021.

A group of scientists found an unusually large number of people in the Democratic Republic of the Congo (DRC) with a positive HIV antibody test result, but a low or undetected blood concentration of the virus. At the same time, none of the group received antiretroviral treatment. These people were called HIV controllers. The findings could help researchers identify biological trends in this population and contribute to progress in the treatment of HIV infection and possibly vaccine creation.

Researchers at Abbott, Johns Hopkins University, the National Institute of Allergy and Infectious Diseases at the University of Missouri in Kansas City and Protestant Congo University found that the number of HIV controllers in the DRC is 2.7-4.3%, compared with 0.1-2% worldwide. The study initiates additional research aimed at understanding this immune response, and the findings could bring researchers closer to their goal of ending the HIV pandemic by finding links between the body's natural suppression of the virus and future treatments.

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Finding a large group of HIV controllers in the DRC is important given that HIV is a lifelong chronic disease that usually progresses over time, said Tom Quinn, MD, director of the Johns Hopkins Global Health Center, head of the National Institute of Allergy and Infectious Diseases' International HIV/AIDS Research Unit at the National Institutes of Health and co-author of the study. - Prior to this study, only rare cases were identified where the infection did not progress in humans, but such a high frequency of detection is unusual and indicates that something interesting is happening at the physiological level in the DRC that is not accidental.
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Since the global AIDS pandemic began, 76 million people have been infected with HIV. As of March 2021, 38 million people live with this virus. Abbott was the first company to develop an FDA-approved HIV test more than thirty years ago, and understands the importance of viral research. The company operates the Global Diversity Surveillance Program to detect HIV mutations and hepatitis viruses, which ensures the relevance of Abbott diagnostic tests. As the origins of the HIV pandemic are found in sub-Saharan Africa, in particular the DRC, the region is of particular interest to the scientific community. The results, obtained by Abbott researchers and partners, are a continuation of efforts to find viruses that led to the identification of a previously unknown HIV strain at the end of 2019.

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Work in the field of global epidemiological surveillance of viral diversity allows us to outstrip infectious diseases. Specifically in this case, we realized that we had found something that could be another step toward discovering a cure for HIV, "says Michael Berg, PhD medical , research fellow in infectious disease research at Abbott and author of the study. - The global research community still has a lot of work to do, but using the data findings from this study and sharing results with other researchers brings us closer to other treatments that could possibly defeat HIV.
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Plasma samples taken from an epidemiological follow-up conducted in 1987, 2001-03 and 2017-19 in the DRC, the homeland of the oldest known HIV strains, allowed researchers to rule out false positive results due to shifting collection geography, high genetic diversity and antiretroviral treatment as causes of undetected viral load in 10,457 patients tested from 2017 to 2019. Abbott ARCHITECT HIV Ag/Ab Combo tests and m2000 RealTime HIV-1 tests were used in the study to detect HIV antibodies and viral load ranges in participants.

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Each finding in the HIV study is another piece of the evolutionary puzzle we are trying to understand, says Carol McArthur, PhD, professor at the University of Missouri-Kansas City, director of pathology research residency at Truman Medical Center and one of the study's authors. Each of the fragments gives us a little more clarity, shows the direction in which we must move on, and contributes to the knowledge base that all researchers will turn to in the next stage of our work.
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2020: The second time in history cured an HIV patient

In March 2020, it became known that for the second time in history, an HIV patient was completely cured. How this happened was reported by a group of researchers led by Ravindra Gupta from the University of Cambridge. More details here.

Where HIV/AIDS is the leading cause of death

Infectious diseases that cause the most people to die or lose health, as of 2021
  • lower respiratory tract infections;
  • HIV/AIDS;
  • tuberculosis;
  • diarrhoeal diseases;
  • malaria;
  • measles.

According to 2018 data

The situation in Russia

Main article: HIV and AIDS in Russia

IN THE UNITED STATES

2020: 1.2 million people in the United States are infected with HIV

According to approximate estimates, as of August 2020, 1.2 million people in the United States are infected with HIV.

2018: HIV mortality in the US decreased by 36.6%

According to the US Centers for Disease Control and Prevention, between 2010 and 2018, HIV deaths in the country decreased by 36.6%, although survival rates among women and people of non-European races did not improve so significantly, and the mortality rate in the southern states was about twice as high as in the northeastern United States.

According to the researchers, the number of people using the services of HIV centers decreased during the pandemic, but experts believe that the decrease in mortality was the result of measures taken to treat and prevent the disease.

Age-adjusted ratios of total deaths, human immunodeficiency virus (HIV) related deaths, and non-HIV related deaths among people aged ≥13 with diagnosed HIV infection - USA, 2010-2018.

The Director of Infectious Diseases at the University of Alabama at Birmingham, Dr. Jeanne Marrazzo, attributed the success to investments in HIV patient care, including through Ryan White's federal HIV/AIDS program, which provides nutrition, social and psychological care services and others.

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It's not just medication. Success was ensured by the entire patient support infrastructure, "said Dr. Marazzo.
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Overall mortality among people with HIV infection, the analysis showed, fell by about a third. However, mortality directly related to HIV decreased by almost half, by 48.4%, while the number of deaths from other causes among HIV-infected people decreased by only 8.6%.

Age-adjusted rates of HIV-related deaths among people aged 13 years and older with diagnosed HIV infection by residence at the time of death

Experts remind that the sooner the diagnosis is made, the faster patients will be able to receive proper care and treatment that suppresses the replication of the virus in the body. For example, the proportion of young people dying from HIV infection is higher than among older people, because young people are less likely to seek medical care or do not have health insurance, which reduces the detection of the disease. In addition, women and black people with HIV are considered vulnerable groups, who, unlike white gay men, come from a wide range of backgrounds and often refuse support. Experts note that they still have wide-ranging work to do to build patient confidence.[3][4]

In the world

2022: First HIV patient cured by transfusion of infant's "mutant" blood resistant to virus

In mid-February 2022, doctors from the United States cured a patient of human immunodeficiency virus by transplanting stem cells and transfusing the infant's "mutant" blood. The patient became the fourth person in the world to defeat the disease, as well as the first to be cured in this way.

A team of researchers revealed some details of the case at the Conference on Retroviruses and Opportunistic Infections in Denver. In 2013, the patient was diagnosed with HIV. In 2017, the patient was diagnosed with leukemia. During a procedure known as a haplocord transplant, which is necessary for the treatment of cancer, the patient was transfused with umbilical cord blood from a partially suitable donor. The woman was transfused with the blood of a newborn with strong immune cells. In addition, he had an HIV-resistant mutation.

For the first time, an HIV patient was cured by transfusing the "mutant" blood of an infant resistant to the virus

A close relative also provided her with blood to strengthen her immune system during the transplant. At the second stage adult stem cells are additionally introduced into patient. These stem cells grow rapidly, but over time they are replaced by cord blood cells. After a transplant performed on a woman in August 2017, the patient was in remission from leukemia until 2021. Scientists note that since 2020, the patient has stopped treating HIV, and until February 2022, the woman did not face a resurgence of the virus.

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In the US, we estimate that approximately 50 patients per year may benefit from this procedure. The ability to use overlapping cord blood grafts significantly increases the likelihood of finding suitable donors for such patients. The fact that she is of mixed race and that she is a woman is very important from a scientific point of view and very important from the point of view of influencing society. Such patients serve as a source of inspiration for scientists, as well as a roadmap for this area, "said Koen van Besien, one of the doctors involved in the treatment of the patient.
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Despite the fact that more than half of the 35 million HIV cases in the world are women, women make up only 11% of participants in drug trials. Although umbilical cord blood is more adaptive than adult stem cells, it is not sufficient to effectively treat cancer in adults. Therefore, with a haplocord transplant, an additional stem cell transplant helps to fill the shortage of cord blood cells. The role of adult donor cells is to accelerate the process of early engraftment and facilitate and increase the safety of transplantation. The possibility of partial overlap could open the potential for treating patients who have both HIV and cancer, as well as those belonging to more diverse racial groups.[5]

2021:680 thousand people died of HIV and AIDS

Deaths from coronavirus and other diseases in 2021

2020

Countries with the highest number of new HIV infections

9 countries, accounting for half of all new HIV infections worldwide, 2020

37 million HIV patients

According to WHO, in 2020 the number of patients with HIV in the world amounted to more than 37 million people.

2018: Epidemic in Africa

Proportion of adults living with HIV in the population, data for 2018

2017: 36.9 million people with HIV infection

According to UNAIDS, since the beginning of the HIV epidemic, 77.3 million cases of HIV infection have been recorded worldwide. By 2017, the number of people living with HIV was 36.9 million people, 21.7 million people received therapy, which reduced the mortality rate due to AIDS by 51% compared to the peak rate of 2004[6].

2016:34 million people with HIV infection, 2.7 million new cases per year

By June 2016, more than 34 million people worldwide live with HIV infection, and more than 2.7 million new cases are recorded each year.

Notes