‘Give HIV the Finger’

HIV is a virus that attacks the immune system, the body’s defence against infectious organisms and other invaders. If HIV is left untreated, a person’s immune system will get progressively weaker until it can no longer fight off life-threatening infections and diseases. However, the rate at which HIV progresses varies depending on age, general health and background. Testing regularly for HIV means you can get antiretroviral treatment if you need it and stay healthy.

The ‘give HIV the finger’ pun refers to the free postal finger-prick test that people can receive for testing without attending a clinic.

 

HIV in the United Kingdom

The United Kingdom (UK) has a relatively small HIV epidemic, with an estimated 101,200 people living with HIV in 2015. Just over 5,000 people were diagnosed with HIV in 2016, according to the data from Public Health England. This is an 18% decline from 2015.

The epidemic is largely concentrated among certain key populations, including men who have sex with men and black African populations. 54% of diagnoses were among gay and bisexual men; 19% and 22% among heterosexual men and women, respectively.

Late diagnosis is an important predictor of morbidity and premature death in people with HIV. In 2016, 42% diagnoses were made at a late stage of infection when treatment is less effective.

 

Current Screening Tests

HIV postal test kits allow people to take a finger-prick blood sample themselves. The samples are sent to a local laboratory for HIV testing. The test is highly accurate and can detect HIV within four weeks after infection.

These tests give a result of ‘reactive’ (positive) or ‘non-reactive’ (negative); reactive results are further classified into ‘high’ and ‘low’ reactive tests. A highly reactive result is suggestive of a HIV infection.

Patients providing a specimen reactive in the screening assay, but not confirmed to be consistent with HIV infection, should be retested using a fresh blood specimen collected at least two weeks later.

Ideally, a HIV antibody test should be performed on venous blood. Most laboratories in the UK use ‘fourth generation’ HIV screening tests. They detect anti-HIV (nearly all can detect the three main Ig classes: IgM, IgG and IgA) and p24 antigen. All patients whose first specimen indicates evidence of HIV infection must have their HIV status confirmed by tests on a second sample collected at another time.

HIV home sampling could potentially improve our ability to identify cases of HIV by targeting people at risk who do not use traditional testing venues such as sexual health clinics. The results data collected between 2015 and 2016 showed that 1.1% of tests submitted via the national postal testing scheme were ‘reactive’ and 0.7% were ‘high reactive’, compared to just 0.3% of tests finding HIV positive results from specialist sexual health clinics.

 

What is the difference between HIV and AIDS?

The definition of AIDS (acquired immune deficiency syndrome) is based on a potentially life-threatening infection or cancer seen in the immunosuppressed. Patients who have been diagnosed with AIDS have a greater risk of opportunistic infections. The most common AIDS-defining illnesses include:

  1. Tuberculosis
  2. Recurrent bacterial pneumonia
  3. Pneumocystis jiroveci pneumonia
  4. Kaposi’s sarcoma
  5. Lymphoma
  6. Cerebral toxoplasmosis
  7. Cryptococcal meningitis
  8. Intestinal cryptosporidiosis

Patients diagnosed late during HIV infection are at an increased risk of developing AIDS and are more likely to transmit HIV to others. This is one of the key challenges facing the UK, despite rates of late diagnosis being on the decline. In 2017, 428 people died from AIDS-related illnesses due to being diagnosed late. Nevertheless, the number of people diagnosed with AIDS-defining illnesses is declining and fell by 25% from 2015 to 2016.

 

Counselling

Patients identified as being at high-risk for HIV or those with concerns should be offered more in-depth discussion or counselling, in addition to a test. A brief pre-test discussion, explaining that routine HIV testing is recommended, is appropriate, with the aim of obtaining informed verbal consent.

 

Other methods to increase the uptake of testing

The Department of Health recommendation is that patients who come from countries where prevalence of HIV infection is high (>0.5%), all adults presenting to the emergency department in the UK should be tested (with consent). Also, all new patients registering at a GP should be tested. Testing in other outpatient departments, e.g. colposcopy and dermatology should also be carried out.

All patients attending sexual health clinics should be offered a HIV test on an ‘opt-out’ basis, and an information leaflet should be used to increase uptake of HIV antibody testing.

 

The future

Not too long ago, a diagnosis of HIV and AIDS was considered to be a death sentence. This has fortunately changed over the past decade, owing to significant progress made in the provision of antiretroviral treatment and gradual upliftment of the stigma that is attached to the condition.

Progress is still to be made, however, as late diagnosis rates continue to be high. People living with an undiagnosed infection have worse health outcomes and pose a public health risk as they are more likely to pass the virus on to others. Homosexual men and black Africans are still at a heightened risk of HIV. Further, the younger generation has lost some fear of HIV because of the success of treatment, causing them to engage in risky behaviours. These issues can be rectified by narrowing the gaps in HIV prevention and education schemes.

If you have any concerns or questions, you can get help from sexual health clinics, charities, or your GP.

YOU MIGHT ALSO LIKE
I intended to write this article on the first day of summer. But as I
According to the World Health Organisation (WHO), there are nearly 10 million new cases of
Obesity is a very important public health problem. The rates are now very high, with
espresso-regulate-blood-glucose-levels

Can An Espresso Regulate Blood Glucose Levels?

Coffee and healthA cup of coffee after a meal may soon be a way to adjust glucose levels in a person with diabetes.

 

 

 

 

 

 

 

 

 

 

 

What is diabetes?

There are two types of diabetes mellitus: type 1 and type 2. Both types are characterised by having higher than normal blood sugar levels, but the cause and development of the conditions are different.

Type 1 diabetes is an autoimmune disease, which means that the immune system mistakenly attacks insulin-producing beta cells in the pancreas. Patients with this condition need to inject themselves with insulin to compensate for the loss of their beta cells, rendering them insulin-dependent.

In contrast, type 2 diabetes is characterised by the body losing its ability to respond to insulin, which is known as insulin resistance. Diabetes affects more than 400 million people worldwide, and associated health costs amount to about 630 billion GBP per year.

Some people manage diabetes by taking frequent pin prick samples to measure their blood sugar levels. Type 1 diabetes is managed with insulin injections as well as lifestyle changes. Type 2 diabetes may be managed with non-insulin medications, insulin injections, or lifestyle changes.

However, scientists in Switzerland are developing a pioneering method that may render insulin injections unnecessary. Headed by Professor Martin Fussenegger, a biotechnologist at ETH Zurich, the researchers created genetically modified cells that are introduced into the body and release insulin as soon as they detect the presence of caffeine.

(Read more about the research)

 

Synthetic biology and gene circuits

The team took human kidney cells and engineered them to produce insulin. They did this by creating synthetic receptors on the kidney cells that sense caffeine. Once caffeine is detected, the cells produce synthetic human glucagon-like peptide 1 (shGLP-1), which stimulates the pancreas to produce insulin, thus lowering blood glucose levels.

Scientists introduced an implant with hundreds of thousands of modified cells under the skin of ten diabetic mice. After giving them caffeine with their food, they found that the experimental animals were now able to control their blood sugar levels, just as well as those mice that did not have diabetes.

Further, the automated bio-system seemed to safely keep the mice from accidentally overdosing on insulin. The risk of accidentally triggering insulin secretion is very low, as the only source of caffeine in our diet is coffee, tea or some energy drink. And if the insulin dose needs to be increased, it would be sufficient to increase the amount of caffeine, e.g. with a larger cup of coffee.

The cellular implant that responds directly to caffeine is estimated to last for six months to one year, before a replacement is needed. But it should be tested further on animals and humans before it is ready for use, which may take even a decade until it is safe and effective.

If, however, it works for humans just as well, then it is a candidate to replace insulin injections. Something particularly promising for the more than 400 million people around the world who have diabetes. Fortunately, as many people already drink some sort of caffeinated beverage, this therapy can be integrated with lifestyle, thus minimising the issue of non-compliance.

 

Conclusion

This work demonstrates a promising potential in the field of synthetic biology, which can improve healthcare with minimal disruptions to lifestyle. Drinking a cup of coffee after breakfast, lunch or dinner, depending on how much insulin is required, could be enough to bring blood glucose levels back within the normal range.

YOU MIGHT ALSO LIKE
Health officials are amplifying their recommendation that people refrain from using e-cigarettes or vaping, particularly
The discovery adds further evidence to support the prenatal sex steroid theory of autism first
Increased red meat intake — especially processed red meat — is tied to increased risk