GS Paper III

News Excerpt:

The estimated 1.3 million new HIV infections in 2022 were the fewest in decades, with the declines especially strong in regions with the highest HIV burdens.

Status of HIV Globally:

• Globally, 39 million people are living with HIV, with 2.4 million in India. In 2022, 1.3 million new HIV infections occurred globally and 63,000 in India.
• Most transmissions occur in the key population, including female sex workers, men having sex with men, transgender community and injecting drug users.
• Acquiring HIV leads to compromised immune systems, leading to opportunistic infections like tuberculosis, fungal meningitis, pneumonia, diarrheal diseases, skin lesions, and certain cancers.
• These conditions result in advanced HIV disease and death.
• Tuberculosis was a leading killer among those with HIV in 2022.
• In 2022, 650,000 people died due to these conditions, while AIDS caused 42,000 deaths in India.
• Many of these opportunistic infections are preventable and treatable.
• The decline in infections is particularly due to the combination of effective antiretroviral therapy, which resulted in community viral suppression and the introduction of PrEP to prevent HIV acquisition.

Various Methods for HIV Treatment: 

Anti-Retroviral Therapy:

• Chennai's Voluntary Health Services Infectious Diseases Medical Centre participated in the landmark global START clinical trial.
• Analysis shows that initiating early antiretroviral therapy soon after diagnosis is cost-effective and cost-saving, and based on the results, WHO guidelines recommend rapid ART initiation for maximum benefit.
• People with HIV who are on these antiretroviral medications can lead a normal, healthy lifestyle without developing opportunistic infections, and modelling studies have shown their life expectancy is almost similar to persons who don’t have HIV.
• Antiretroviral Therapy (ART) can result in an undetectable viral load for those PLHIV on treatment within just a couple of months, and by now, it is amply clear that ‘Undetectable is Untransmittable’ or U=U based on other research led by my team.
• Long-acting antiretrovirals have been recently approved for treatment, and this is a boon for individuals who have issues with oral medication adherence.
• With all these newer antiretroviral therapies, HIV disease is yet another chronic manageable condition.

Pre-exposure prophylaxis (PrEP) medications:

• These are effective in preventing HIV acquisition, but daily adherence is crucial.
• Cabotegravir, a long-acting injectable PrEP medication, has been developed to address this issue.
• Cabotrgravir injections can be taken every two months instead of the daily oral pill, showing higher efficacy in HIV prevention.
• Two HIV medicines are approved by the U.S. Food and Drug Administration (FDA) for use as PrEP: Truvada and Descovy.
• Many African countries have implemented this innovative tool, and the Indian National HIV program should accelerate its implementation to combat AIDS in India.

Initiatives taken to fight HIV:

• India's ability to produce and supply generic HIV medicines has significantly contributed to the global AIDS fight, with over 90% of antiretrovirals consumed globally coming from India, demonstrating its proven capacity for manufacturing HIV diagnostics and medicines.
• The National AIDS Control Organisation (NACO) under is the overall body for framing policy, guidelines and strategies for program implementation.
• It also releases funds to various states and reviews the progress under various components of the program.
• State AIDS Control Societies (SACS) have been constituted throughout the country with the responsibility of program implementation.
• In high HIV prevalent districts, District AIDS Prevention Control Unit (DAPCU) has been set up for direct supervision at the ground level.
• In 2020, UNAIDS released a new set of ambitious targets for 2025, calling for-
• 95% of all people living with HIV to know their HIV status,
• 95% of all people with diagnosed HIV infection receive sustained antiretroviral therapy and
• 95% of all people receiving antiretroviral therapy will have viral suppression by 2025.
• In 2022, these percentages were 86%, 89% and 93%, respectively.
• Access to condoms and sterile syringes: Research has shown that increasing the availability of condoms and sterile syringes is associated with reductions in HIV risk.

Way forward:

• The World Health Organization has developed guidelines for Advanced HIV to prevent and diagnose opportunistic infections, but these guidelines are not widely implemented globally. Healthcare programs must implement these in-expensive guidelines, especially in lower and middle-income countries.
• Newer short-course TB preventive treatments with Isoniazid and Rifapentine have proven effective in clinical trials, but many countries struggle to implement them.
• Non-communicable diseases (NCDs) are becoming more common in people with HIV, leading to complications like diabetes, hypertension, stroke, and kidney disease.
• To maintain longevity, developed guidelines recommend individuals aged 40 and over take a statin to reduce their risk of heart disease.
• The REPRIVE study found that daily pitavastatin intake reduced the risk of major cardiovascular events by 35% in people with HIV.
• Despite extensive research, there are no vaccines for HIV, and involving communities and making them the focus will help prevent infections.

Prelims PYQ

Q. Which of the following diseases can be transmitted from one person to another through tattooing? (UPSC 2013)

1. Chikungunya
2. Hepatitis B
3. HIV-AIDS

Select the correct answer using the codes given below.

(a) 1 only

(b) 2 and 3 only

(c) 1 and 3 only

(d) 1, 2 and 3