YOUR HIV QUESTIONS ANSWERED

People living with HIV are not excluded from HIV clinical trials. This allows researchers to find new or better ways to prevent, detect, and treat HIV and AIDS.³ Every currently approved HIV treatment has been studied through a number of clinical trials.³

It's important to include people from different backgrounds in clinical trials to make sure everyone gets the same access to healthcare, especially marginalised groups. Including people living with HIV in clinical trials is important as it can lead to safer and more effective treatments. This is due to genetic, metabolic, and physiological differences that can affect how drugs work in people, leading to variations in safety and efficacy of treatments.⁴

People living with HIV are sometimes excluded from other clinical trials outside of HIV research studies due to potential risks and complications. For example, people living with HIV may have compromised immune systems or have other infections, such as hepatitis. There is also a risk of drug interactions. These factors may affect the results of clinical trials, particularly those involving immunomodulatory drugs (drugs that change how your immune system works). However, studying treatments in diverse populations, including people living with HIV, is important. So, in recent years there has been a shift towards greater inclusion of HIV-positive individuals in clinical trials.^5,6 ViiV works to show the importance of clinical trial diversity by prioritising the communities most impacted by HIV. We do this by enhancing the recruitment, engagement, and retention of diverse populations in clinical trials to accurately reflect the groups we serve.

It is important to note that the science surrounding blood donations and transfusions is frequently changing, and the information around this science may differ even country to country. However, people living with HIV are currently not eligible to donate blood, regardless of their viral load. This is because HIV can be transmitted through blood transfusions, and donating blood could potentially put the recipient at risk of contracting the virus. For more detailed information, we recommend contacting your local blood transfusion service.

Although ART has transformed HIV from a fatal disease to a manageable chronic condition, it does not cure the virus. Patients are on long-term medications and are affected by problems such as incomplete viral suppression, social stigma, drug resistance, side effects, and high costs.⁹ Therefore, finding an HIV cure is crucial. Current research areas involve:⁹

• The ‘shock and kill’ method uses small molecules to wake up the HIV virus that lays dormant in cells while patients are on ART. This makes the virus visible to the immune system, making it easier to eliminate.
• The ‘block and lock’ approach uses small molecules to change the environment around the dormant virus, putting it into a ‘deep latency/sleep’. This means that when the ART treatment has stopped, the virus won’t reactivate.
  
• Immunotherapies, such as neutralising antibodies, are being researched that work to possibly prevent the virus from coming back or to destroy cells with the reactivated virus.
  
• Gene therapies that can either remove the integrated HIV provirus from the genome entirely or cause mutations that will deactivate the virus.

While there has been a lot of progress in treating and managing HIV, eliminating the virus from the body completely is still a difficult challenge.

To find out more about the search for an HIV cure, read our page, “HIV/AIDS cure: The goal to end the HIV epidemic”.

Recent advancements in HIV treatment hold promise for reducing age-associated effects and improving overall well-being. Individuals living with HIV can take proactive steps, such as adhering to treatment plans, adopting a healthy lifestyle and scheduling regular medical check-ups, to optimise their health and potentially reduce the impact of age-related concerns. Although HIV itself does not directly cause ageing, there’s an increased risk of developing chronic-age related diseases. Some reasons as to why this may happen are:^10,11

• Chronic inflammation: HIV weakens the immune system, which may lead to chronic inflammation. Persistent inflammation can be linked to some age-related conditions such as cardiovascular disease, osteoporosis and certain cancers.
• Immune activation: HIV can cause changes to the immune system as people age, contributing to age-related health problems like dementia, frailty, and cardiovascular disease. The immune system is continually activated in response to HIV, but as people age, its performance decreases.
  
• Antiretroviral therapy (ART): ART has significantly improved the life expectancy and quality of life for people living with HIV. However, long-term use of some antiretroviral medications may be associated with side effects such as an increased risk of osteoporosis and diabetes.¹² Some of these may mimic age-related issues.
  

Find out more about growing older with HIV here

HIV affects both males and females, but the impact can vary by region and population. Globally, the distribution of HIV cases between males and females is relatively balanced. However, in certain regions or among certain demographic groups, one gender may be more affected than the other. In Ethiopia, for example, women account for 60% of all HIV infections.^13,14

HIV affects women’s health similarly to men’s but may result in certain health outcomes specific to women such as gynaecological health problems, higher likelihood of cervical cancer, an elevated risk of heart disease and infertility.^15,16

Factors such as social and economic conditions, access to healthcare, and cultural practices can influence the prevalence of HIV in different populations. It’s essential to consider specific contexts when assessing the impact of HIV on males and females.^15,16

Head to our page on HIV in women to learn more. To hear empowering stories from women living with HIV across the globe, read our page, HIV and women: Stories that inspire.

Typically, male to female vaginal sex involves a lower risk of contracting HIV compared to male to male anal sex. How hard it is to get HIV from a woman varies depending on the country and income level. In high-income countries, the risk of transmission from females to males is lower than from males to females. In these countries, the estimates for female-to-male rates are 0.04%, while male-to-female rates are 0.08%. However, in low-income countries, both transmission risks are comparatively higher, male-to-female and female-to-male transmission rates are 0.38% and 0.3%, respectively.^17,18

In general, the majority of transmission cases occur from males to females. However, several factors can influence the likelihood of transmission:^17,18

• Viral load: The level of HIV in the blood is called a viral load.¹ Higher viral loads are generally associated with an increased risk of transmission. Conversely, undetectable viral levels of HIV mean the virus cannot be transmitted. Undetectable = untransmittable (U=U).
• Stage of infection: The risk of transmitting HIV is higher during the acute phase of infection when the virus rapidly replicates, however, there is still a risk during the chronic stage when the virus is actively replicating in the body even without noticeable symptoms.¹
• Condom use: Consistent and correct use of condoms during sexual activity is an effective way to reduce the risk of HIV transmission.
• Pre-exposure prophylaxis (PrEP): Taking PrEP medication helps prevent HIV infection and can significantly reduce the risk of transmission.¹⁹
  

HIV prophylaxis is divided into two categories: pre-exposure (PrEP) and post-exposure prophylaxis (PEP).

1. PrEP is the use of antiretroviral drugs in HIV-negative individuals in order to prevent future HIV infections.¹⁹
2. PEP is the administration of antiretroviral therapy to an HIV-negative person who may be exposed to HIV. This may involve either occupational post-exposure prophylaxis (oPEP) or non-occupational post-exposure prophylaxis (nPEP). Occupational post-exposure prophylaxis is where individuals may have been exposed to HIV in the workplace, such as in a laboratory, and non-occupational exposure is associated with situations such as sexual or intravenous (IV) drug exposures.¹⁹

Drug-to-drug interactions are a complex and crucial aspect to consider for individuals managing various health conditions, especially those living with HIV who may require multiple medications. A drug interaction can happen when two or more medications are taken at the same time. This may affect the way that the drugs are absorbed, distributed, broken down or eliminated by the body. These interactions can lead to changes in the concentration of the drug in the body, potentially causing unwanted adverse reactions or reducing how effective one or more of the drugs are.²⁰

The drug interactions of HIV treatment/prevention drugs and other medications include:^20,21

• Anticoagulants such as warfarin
• Hormonal contraceptives
• Antimalarial medications
  
• Blood cholesterol and blood pressure medications
  
• Recreational drugs, herbal and alternative treatments such as St. John’s Wort and echinacea