HIV/AIDS and COVID-19 are alike in some ways – both are caused by potentially lethal RNA viruses. In 1998 I remember reading that HIV Infection was the most rapidly moving field in Medicine and I am sure that the same can be said about COVID-19 today.
As a pharmacist who specialised in HIV/ AIDS prevention and treatment since 1996, I cannot help but have a sense of déjà vu, as regards the medical approach towards the current pandemic. I feel that every effort is being made to find the prevention and cure for COVID, but the scientists are on a steep learning curve as they were with HIV/AIDS. The comfort I gain from this comparison is that the number of new cases of HIV is significantly less today than it was in the 1990’s.
In the early 1980’s, identifying the cause of a rare type of pneumonia (PCP), an aggressive cancer (Kaposi’s sarcoma) and severe immune deficiency amongst people who injected drugs, haemophiliacs (who needed blood transfusions regularly) and homosexual men was a major challenge for the health experts. They named the disease AIDS in 1982.
All major routes of transmission of the HIV virus were identified by the CDC in 1983 and by September they ruled out transmission by casual contact, food, water, air or surfaces. Then there was the debate about transmission by sweat, kissing or sharing toothbrushes. The public education messages initially said that you could get it via these means; then with new knowledge much later on, they said that it was unlikely.
Having identified the methods of transmission, prevention strategies took a while before the knowledge was perfected. The experts suggested that use of a condom would prevent sexual transmission. Persons using condoms made with animal skins were still contracting HIV. The message was changed to “Use a latex condom during sex and you will not contract HIV”. One message that I sent was “If you’re having sex with a known HIV-infected partner, use two condoms”. I changed this message later with new knowledge that the use of two condoms increased the risk of both of them tearing. Regarding vertical transmission from mother to child, knowledge evolved rapidly. During the early 1980’s it was known that an HIV-positive woman could pass HIV to her child during pregnancy and childbirth.
The wonder drug azidothymidine (AZT) was tested in 1986 and was FDA-approved for the treatment of HIV in 1987. FDA's stringent testing requirements meant that most new drugs took several years from drug development to the drug entering the market. AZT was placed on a “fast track” and in less than 2 years it had been passed.
Azidothymidine gave persons living with HIV some hope; although its side effects were many, patients took it anyway since there was nothing else. After several months of AZT “monotherapy”, patients did not seem to improve; in fact they were dying faster than those who were not being treated for HIV.
In that same year the WHO confirmed that HIV-positive mothers who gave birth to HIV-negative babies were passing HIV to them via breastfeeding – yet another method of HIV transmission.
Several years later it was discovered that HIV-positive nursing mothers who gave breast milk ONLY (as opposed to formula feeding plus breast milk) to their HIV-negative babies, did not transmit the virus.
In 1987 the US Public Health Service placed a ban on persons living with HIV/AIDS entering the country. This policy was reversed in 2010.
By 1990 the FDA approved azidothymidine (AZT) use in children living with AIDS. Didanosine (1991) and zalcitabine (1992) were added to the short list of drugs used to treat HIV. These were toxic and added small benefit to patients. Meanwhile the HIV virus was taking a rapid and devastating toll on every country in the world – the number of persons living with, and dying from HIV/AIDS was exponential.
In 1994 the drug azidothymidine was found to be very effective in preventing the transmission of HIV from mother to child, taken five times per day throughout most of the pregnancy and given during childbirth.
The real game-changers arrived in 1995 and 1996 – protease inhibitors like saquinavir and indinavir. Lamivudine and nevirapine entered the treatment equation as combination therapy with none other than the same old azidothymidine. Patients who were on the verge of dying, experienced a “Lazarus effect” within 30 days of taking the drugs. The combination of 3 or more of these, known as Highly Active Anti-Retroviral Therapy (HAART), is significantly less toxic, better tolerated and has transformed HIV infection into a chronic disease.
Then came abacavir, ritonavir, delavirdine and efavirenz, in quick succession in the late 1990s. Integrase inhibitors like raltegravir (2007) and dolutegravir (2013) emerged.
Initially the advancement in HIV treatment was bitter-sweet for developing countries – the vast majority of patients living (and dying) with HIV, were not able to afford HAART and there were millions of deaths. The cost of HAART was significantly reduced by 2005, which improved accessibility to treatment and saved many lives.
Post-exposure prevention (PEP) against HIV arrived in 2005 in the form of the same combination therapy. PEP is very effective in preventing HIV transmission if administered within 3 days of the exposure.
In 2012 FDA approved pre-exposure prophylaxis (PrEP) a combination therapy consumed by HIV-negative persons before they have “risky” sex, to prevent them from contracting HIV.
In 2021, cabotegravir and rilpivirine are available HIV treatments administered once every two months.
With COVID-19, we have many questions about the origins of this virus, how this virus was transmitted, and how to prevent transmission. Can the virus be transmitted in warm weather, cold weather, on clothing, surfaces, fruits, vegetables and supermarket items? Then there is the mask debate. If the virus is so small can it penetrate the pores of a cloth mask, a surgical mask and a particulate respirator mask? How about soaking the mask in brine first? New knowledge about the virus came with new public health messages. Wear any mask, ensuring that it covers your nose and mouth. If you vaccinate you will not get the virus and you will not have to wear any masks. If you vaccinate you will still have to wear the mask and you may still get the virus, but you will not require hospitalisation. If you vaccinate you may require vaccination but you will not die from the effects of COVID. If you vaccinate you may need an annual booster. After six months the effect of the vaccine wanes, so you will need to boost. You are not regarded as being fully vaccinated until you take the booster. The elderly and immune-compromised are priority for boosting. On Friday November 19, 2021 the breaking news in the USA was that the CDC recommended boosters for all adults.
COVID-19 treatment has had its fair share of debates too. How does Ivermectin work (or not)? What role do vitamins and herbal therapy play in preventing and treating COVID-19? Can early treatment with products that stop the disease process prevent and reduce mortality? How effective is natural immunity that one acquires from contracting COVID-19, in preventing future COVID-19 infection?
References:
1.History of
HIV/AIDS Overview – https://www.avert.org/professionals/history-hiv-aids/overview
2. Gregory,
Andrew - New HIV Jabs Taken Two Months Apart Hailed as Huge Step Forward –The
Guardian- Nov 20, 2021 – https://www.theguardian.com/society/2021/nov/18/new-hiv-jabs-taken-two-months-apart-hailed-as-huge-step-forward?CMP=Share_iOSApp_Other
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1 comment:
Well i hope this piece is correct because for me i strongly believe that this covid could morph into a disease simular to that of hiv in coming months, wont say how i come to this thoughts as yet, hoping i am wrong.
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