Status: 01.12.2022 04:39 am
The corona pandemic has lost sight of AIDS. Hundreds of thousands of people continue to die every year. How is the situation in Germany? And what new treatment options are there?
By Ulrike Till and Ralf Kölbel, SWR
How many people are affected by HIV?
According to the World Health Organization (WHO), more than 38 million people are currently infected with the HIV virus; around 1.5 million people are infected annually worldwide.
According to the Robert Koch Institute (RKI), around 1,800 people were infected with the HIV virus in Germany last year, the same number as in 2020. It is interesting to look at the details: infections among gay and bisexual men are continuing to decline – a development welcome. However, since 2010, more and more drug addicts have been infected. Meanwhile, however, the numbers are also stagnating here.
German Aidshilfe is concerned that some drug addicts in particular probably don’t even know they are HIV positive. You can easily infect others. According to the RKI, around 90,800 people with HIV were living in Germany at the end of 2021. According to projections, around 8,600 infections remain undiagnosed.
Why is AIDS so dangerous?
Anyone with AIDS suffers from an immune deficiency. This is caused by an infection with the HI virus – HIV for short. Viruses enter the body’s helper T cells, a subset of white blood cells. These will be damaged or completely destroyed. The fewer helper T cells we have, the worse our immune system works.
People with (untreated) HIV therefore often get sick. In poorer countries in particular, an AIDS diagnosis is usually only made when so-called AIDS-defining illnesses occur. These include, for example, tuberculosis, encephalitis and tumours. If not treated, AIDS is usually fatal. AIDS has been recognized as an independent disease since 1981. For many, the history of AIDS begins in the early 1980s. In fact, the HI virus is probably 100 years old.
What’s special about HI viruses?
The surface of the HI virus is structured differently from the surface of the corona virus, for example: there are fewer “anchor points” for antibodies. Also, there is a very high mutation rate, which means these anchor points are constantly changing. Antibodies formed against HI virus surface proteins are ineffective after only a few virus generations.
The so-called escape mutations of the HI virus present major challenges to researchers: HIV can form several million mutations during treatment in just one patient’s organism. Furthermore, the virus continues to develop resistance. This increases viral load and therapies need to be adjusted again – a race against time. HI viruses can survive unnoticed in “sleeping cells” for a long time, for example in lymph nodes or bone marrow. These treacherous reservoirs cannot be detected with antibody tests.
What therapies are there for AIDS?
Although HIV is not yet curable, it can be treated. For example, with drugs that stop the HIV virus from spreading further. People with HIV can usually live without major restrictions – and they are not contagious. According to Hanna Mathews, an infectiologist at the University Hospital Hamburg-Eppendorf, they do not transmit the virus to their children even during birth. However, regular visits to the doctor are necessary for the medication to be properly adjusted. Because its effect may decrease or intolerances may develop.
There are also preventive measures such as PrEP, the so-called pre-exposure therapy. This pill therapy with the medicine Truvada has an effect similar to a vaccination, but not permanently. HIV-negative people can take the pills if they know they are at greater risk of infection. If you consistently take the pills, the risk of infection drops significantly. But there’s also a downside: some people don’t use condoms because of this – since the introduction of PrEP, other sexually transmitted diseases have become more common again.
Bone marrow transplants, which have led to a rare cure in several patients, are only considered in exceptional cases. And incorporating HIV immunity into embryos using CRISPR/Cas gene scissors, as a Chinese scientist is said to have done, is out of the question for many for ethical reasons.
Are there vaccines against HIV/AIDS?
HI virus is much more mutable than corona viruses. That is why the search for a vaccine is also very complicated and has lasted almost forty years. With classic vaccines, the balance is currently mixed: most vaccines developed so far have not shown much effectiveness.
Cautious hope now rests on mRNA vaccines: Moderna started the first series of trials in January 2022. BioNTech is also developing a vaccine against the AIDS pathogen. Hopes are high, but it remains to be seen whether the virus can actually be defeated one day with the help of mRNA technology.
Dr Philipp Schommers of Cologne University Hospital has found another promising approach. He discovered a universal antibody in individual infected people that was able to prevent the virus from mutating – a possible first step towards vaccination. In 2021, Philipp Schommers received the Körber Foundation German Studies Prize for his research.
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