One tablet a day – this can usually keep the human immunodeficiency virus (HIV) at bay. The immunodeficiency disease AIDS does not break out with early and consistent treatment with anti-HIV drugs. Then the virus cannot be transmitted to other people. Over the course of over 30 years of research, the pharmaceutical industry has developed various active ingredients against HIV, most of which are well tolerated and easy to use. And research continues: on new forms of application, on a vaccination against HIV and on the use of the so-called genetic scissors. But it is already true now: “Those affected can grow old with HIV without developing AIDS,” says Dr. Matthias Wilken, pharmacist and managing director of Market Access at the Federal Association of the Pharmaceutical Industry (BPI). Good news for World AIDS Day tomorrow!
The HIV virus was discovered 40 years ago. It damages or destroys certain cells of the immune system. If left untreated, an HIV infection can lead to the immunodeficiency disease AIDS (“Acquired Immunodeficiency Syndrome”) and be fatal: The weakened immune system can then no longer fight even harmless germs and viruses or prevent other diseases. Those affected die, for example, from cancer or infections such as pneumonia or fungal diseases. Around 40 million people worldwide have lost their lives as a result of AIDS. “But thanks to the numerous therapy improvements in the field of HIV therapeutics, HIV has developed from a fatal to a chronic disease,” says BPI expert Wilken.
Medicines against HIV viruses
Over 90,000 people live with HIV in Germany. Over 90 percent of those affected say they are able to live “well” with the infection, and three quarters feel that their health is not or only slightly impaired. This is shown by a scientific online survey conducted by the German Aid Aid Agency in collaboration with the Institute for Democracy and Civil Society. “With the help of the therapeutics, those affected neither get AIDS nor pass on the virus,” says Wilken. A lot has happened since the first medicine against HIV was introduced in 1987: various active ingredients are now available for therapy. “The medicines prevent the virus from multiplying in the body,” explains Wilken. “To do this, they work in various places: for example, they prevent HIV from incorporating its genetic material into the body’s cells. Or they don’t allow the virus to enter the cell in the first place.”
New forms of application
Most of the time, those affected take a combination of three active ingredients so that the treatment is as effective as possible. A so-called “fixed combination” in the form of a single tablet daily simplifies handling enormously. Depot preparations have also recently been on the market: the active ingredients only need to be injected every one to two months. In addition, pharmaceutical companies are developing other new forms of application, such as implants or microneedle patches, which release the active ingredients over a long period of time. Regardless of whether it is a pill, patch, injection or implant: the therapeutic agents work so well that the viruses can no longer be detected in the blood. At the same time, the immune system recovers, which can be demonstrated by the number of helper cells. “The prerequisite for living with HIV as symptom-free as possible is an early diagnosis, early start of treatment and consistent therapy,” emphasizes Wilken. “This also means that people should get tested for HIV after high-risk situations.”
Medicines for prevention
Some of the HIV therapeutics can even prevent infection. “Pre-exposure prophylaxis”, or PrEP for short, can then protect against a possible HIV infection. Statutory health insurance companies cover the costs for people with an increased risk of HIV.
Genetic scissors and vaccination
Until now, patients have had to take the therapeutic drugs for life because the drugs cannot completely remove the virus from the body. “HIV embeds itself in the genome of immune cells and is protected there from drugs,” explains Wilken. If you stop taking the therapeutic drugs, the infection can flare up again at any time. Researchers therefore have great hope in the so-called genetic scissors: With their help, the viruses can be tracked down in their hiding places and their genetic material can be cut out of the DNA of human cells.
The vaccination approach is just as impressive: research into HIV vaccines has benefited from the rapid development of vaccines against Corona, more precisely SARS-CoV-2. But HIV vaccination is still a headache for researchers because there are countless forms of the virus that are extremely adept at hiding from the immune system. But studies in animal models have so far been promising.
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