Nepal saw its first case of HIV/AIDS in 1988. Since then AIDS has become a worldwide epidemic, expanding in scope and magnitude as it affects different populations and geographic regions. Once infected, individuals remain infected for life. If left untreated, the vast majority of HIV-infected individuals develop fatal infections as a result of HIV-induced deficiencies in the immune system.Expansion of antiretroviral therapy (ART) has resulted in a stark reduction of AIDS-related deaths. ART was started in Nepal in February 2004 from Sukraraj Tropical and Infectious Diseases Hospital, Teku. Currently, ATR service is being provided from 61 sites in 55 districts and the regular counting of CD4 cells is done at 28 centres. It's been 34 years after the first case of HIV and increasingly effective preventive efforts have reduced the numbers of new infections.
Since the epidemic's peak in 2004, the number of deaths has fallen by 42 percent, with some 7.8 million lives being saved over the past 15 years, according to a new WHO report. The number of new infections has fallen by 35 percent since the turn of the century. Over the last 15 years, scale-up of ART has been most dramatic in Africa where more than 11 million people are receiving HIV treatment, up from 11,000 at the turn of the century. People living with HIV in Africa are more likely to receive treatment than people living in most other parts of the world. Globally, in June 2015 close to 16 million people out of a total of 37 million people living with HIV were on ART.
A safe and effective vaccine offers the best hope of controlling the global AIDS epidemic. Viral vaccines are typically preventive, given to uninfected individuals to prevent either infections or disease. However all candidate HIV vaccines tested as of 2009 have proved ineffective at preventing infection. Development of vaccine is difficult because HIV mutates rapidly, is not expressed in all cells that are infected and virus is not completely cleared after primary infection.
Without control by drugs or vaccines, the only way to avoid epidemic spread of HIV is to maintain a lifestyle that minimizes high risks factors. There is a risk of infecting others by sexual intercourse (vaginal or oral), by oral-genital contact and sharing of needles. In case of Nepal, unsafe sex accounts for 85 percent HIV transmission. Consistent and proper condom use can reduce transmission, though protection is not absolute.
At the end of 2014, according to official data, there are 39,249 HIV-infected people in Nepal: 25,449 are male, 13,800 are female and 59 are third-gender. Age distribution shows that the highest incidents are in the 15-49 years group, with 28,809 positive cases while age group 0-14 includes 1,968 and age group above 50 years includes 8,412 positive cases. Altogether 11,089 Nepali patients with HIV are on ART as of July, 2015.
The UNAIDS has focused on the fast-track 90-90-90 treatment target: 90 percent of those living with HIV will know their HIV status, 90 percent of all those living with HIV will receive antiretroviral therapy, and 90 percent of all of those receiving antiretroviral therapy will have viral suppression (this means HIV can no longer be detected in their blood and they can consider themselves 'non-infectious).
The 90-90-90 targets refer to the pathway by which a person is tested, linked and retained in HIV care, and initiates and adheres to antiretroviral drugs. One of the most successful prevention methods in the market today, PrEP, is vital to defeating HIV. It stands for Pre-Exposure Prophylaxis and consists of a pill taken once a day, which, when taken correctly, virtually eliminates the chances of getting HIV.
AIDS researchers have released a call to action for a worldwide shift in HIV treatment, to providing medication immediately after diagnosis instead of first watching for signs of illness. Immediate antiretroviral treatment more than doubles an individual's prospects of staying healthy and surviving. New research shows immediate treatment prevents infected people from passing on the infection, while preventive therapy effectively protected people at risk through prophylactic use. HIV infections have dropped by 35 percent from 2000 but the world needs to dramatically step up investment to for once and all beat this global scourge.
The author has MSc in Medical Microbiology from Tribhuvan University
binod@kuhs.edu.np
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