Status: 01.12.2022 04:39 a.m
Anyone who is HIV-positive today can lead an almost normal life: medication lowers the viral load so that one is no longer contagious. Nevertheless, infected people often encounter prejudice and discrimination.
Manuel, 33 years old, sits in the Café Regenbogen in Munich and talks about his everyday life. For example, about how difficult it is for him to get a dentist appointment: “Most of the time you got appointments at the very end of the office hours. If you got an appointment at all, it was always difficult. At the latest, after ticking the questionnaire that you are HIV positive.”
Uncomplicated therapy
As an HIV-infected man, Manuel repeatedly finds himself in situations where he feels discriminated against. Apparently people are afraid of him and the potentially deadly disease. A completely normal life is now possible with the HI virus, says Johannes Bogner from the German Center for Infection Research at the LMU Munich: “From a medical point of view, people who have an HIV infection are healthy and stay healthy. Everything has become possible because there are now very effective antiviral combination therapies.”
Effective therapies against HIV have been around for about 25 years. They are agents that prevent the virus from spreading further in the body and preventing AIDS from breaking out. Various drugs are combined with each other. The patients therefore have to take tablets every day. “For a long time it was very stressful for the patients, because the number of tablets, capsules and juices that they had to take was high. But we have now reached the standard that three different active ingredients are administered in one tablet. That’s what the therapy does so easy now.”
Therapy goal: Below the detection limit
In addition, the treatment is better tolerated. Instead of the daily tablet, specialized doctors and ambulances can now administer a so-called depot injection, explains Bogner: “The big advantage of this two-month injection is that you don’t have to think about it every day and that you aren’t reminded of your infection every day . And for people who live in shared accommodation, for example, it can also be an advantage that the neighbor does not see the medibox and the illness becomes apparent.”
Nevertheless, the medication can put a strain on the body in the long term. That is why it is important that the affected people go to the doctor regularly. The virus cannot be completely removed from the body. The therapy goal is therefore: A viral load below the detection limit: “People who achieve this therapy goal are not contagious. This means that the test that detects the virus RNA in the blood falls below a lower limit.”
Same high life expectancy
The virus is then no longer detectable in the blood and the patients are no longer contagious – neither during sex nor at the dentist. Another major advance is the development of pre-exposure prophylaxis, i.e. a preventive HIV drug for people at high risk of infection.
And a post-exposure prophylaxis. To put it bluntly: a kind of morning-after pill. “It is always recommended when there has been exposure to the virus, that is, when we teach ourselves a needlestick injury in the clinic or a cut in the operating room with a patient who has a lot of virus. Then it is necessary and effective on the It’s best to start an HIV-triple combination within two hours so that the infection doesn’t even kick in. And you can do the same thing after sexual exposure or after rape.”
Statistics show that the life expectancy of HIV-infected people who are treated is now quite normal. And maybe it could even be better than with non-infected people – albeit for a different reason, says Bogner: “You go to the doctor every three months. Cholesterol and blood pressure are treated there, you recognize diabetes in good time, they go very reliable for early detection tests. No group of patients is given as good medical care as our HIV-infected people. Maybe that’s why they end up living longer.”
Prejudice almost stronger than illness
Because of his difficulties getting a dentist appointment, Manuel went to the Munich Aids-Hilfe. A social worker there helps him: “We actually recommend the dentist because you are below the detection limit. There is no risk of infection, so there would be no issue for the current dentist either. But it should be a relationship of trust.” It is possible that medical development went faster than the reduction of fear and prejudice.