Critical Review Of HIV As An Emerging And Remerging Disease Threat

The Role of the Pathogenic Agent

Question:

Discuss about the Communicable Disease.

The essay deals with the communicable disease treat Human Immunodeficiency Virus or HIV. HIV is recognised to be the chronic disease and has produced one of the largest pandemics in history. This disease has caused severe economical and social impact associated with unexpected illnesses and deaths.  As a result of the advances in the treatment process the chronic disease has changed in the last three decades (van de Laar & Richel, 2017). In the last decade, after the HIV was declared by the United Nations as unprecedented human catastrophe, the prevention and treatment of AIDS disease more accessible. There are effective and safe and integrating of HIV services into existing health systems. It led to dramatic decline of the major health problems due to HIV. However, there are new HIV infections emerging that marks AIDS as public health threat (Montaner et al., 2014).  In response to 1.6 million new HIV infections and 600,000 deaths per year, new targets are set by WHO. There is a growing body of literature working to identify the emergence and re-emergence of HIV infections as it has become the health problem for significant proportion of the population (Jones et al., 2014). The incidence of this emerging disease has increased in last 20 years and could increase more in near future. The reason for this new outbreaks or re-emergence of infections is the complex interaction between the host and the pathogen, which is influenced by the natural and the social environment. Further, there is the change in the climate and the ecology that led to the environmental modification and imbalances.  This increased the chances of human contact with the virus in new forms which created favourable conditions for emergence of new HIV infections (Serrano-Villar et al., 2014). This constitutes the rationale for the topic chosen for this essay. The aim of the essay is to perform the critical review of the literature on HIV, which is the emerging and remerging disease threat. The literature review includes the role of the pathogenic agent, host and environmental factors, and the potential policy responses.

The role of the pathogenic agent comes from the trick evolving capacity of virus. The evolving capacity of the infection was observed when the virus was found to jump from one primate host to other that can be human or chimpanzee. The origin of the virus is traced back to sub-Saharan Africa (60–70 years ago). The pathogenic agent is clever enough to transmit itself via infected blood and related products. The virus is transmitted effectively from maternal circulation to fetal blood before or during delivery. Therefore, its transmission is highly facilitated by the sexual promiscuity, poverty, and prostitution and consequently the spread of infection. The virus propagated throughout world by sex tourism, increase in gay community, and intravenous drug abusers. The mode of transmission of the virus is significantly variable across the region and the most prominent mode of transmission was heterosexual. Extensive spread of HIV is possible through travel from rural areas to cities and internationally through air travel (Lowenthal et al., 2014).   These studies to some extent give an hint of why HIV virus can emerge, but are not sufficient in explaining its detailed role as pathogenic agent.

The Role of the Host

As per the immunological studies conducted using the HIV viruses it was found that the virus displays cunning fitness. The virus has evolved to attack the human immune cells that destroy the body emergency response system to fight off the invading organisms. The role of the virus is to destroy the CD4 cells. It is often called as T cells. The virus rapidly destroys this cells overtime that it becomes difficult for the body to fight of the infection. When the condition is untreated, the number of the CD4 cells in the body reduces giving chance to opportunistic infections. Cancers are other disease that takes advantage of the weak immunity (Morens & Fauci, 2013).     

The role of the pathogenic agent comes from its capability to enter the host as cell free virions or infected cells. The route of transmission alters the course of HIV infection subsequently.  The pathogenic agent has long incubation period. Together with multiple mode of transmission, the virus has the ability to defiance the efforts of vaccine development. During the acute HIV infection, within    2-4 weeks, there is only flu like symptoms. At this stage most people are unaware that there blood consist of large amount of virus and is very contagious. It is difficult to diagnose as at this stage a person may not feel sick at all. The virus also transmits itself to other hosts during the antiretroviral therapy. In most cases the HIV infection is not detected by the HV tests. This nature of the virus may be considered one of the factors for emergence (Mumtaz et al., 2014). Due to vulnerable population, the chance of HIV emergence increases. It has been found in many observational and case control studies that HIV once introduced in the vulnerable population spreads rapidly from one member to other increasing the infections. HIV was found to have the capability to sustain within the population which facilitates its emergence after spreading rapidly (Marston et al., 2014). The drawback of these studies includes fewer hints on the specific property of the virus to remerge.   

The re-emergence of the HIV is the outcome of the acquired resistance of the pathogens to the antimicrobial medications. Studies on re-emergence of the virus showed that virus can change its structure over time. As a result the drugs administered previously no longer work against it. Due to change in the structural protein, the virus becomes resistant to the drugs. This pathogenic agent plays a crucial role in mutation.  A particular strain can mutate itself at a rate that is more rapid than the mutating rate of influenza. Therefore, it is troublesome to design vaccine against HIV. Moreover, the virus has the capacity to hide from different components   of the immune system (Wu et al., 2013). This findings were confirmed by the genetic and molecular biology studies that showed that reverse transcriptase being error prone and lack of proofreading activity, distinct viral variants are generated. Further, the virus can irreversibly transform a cell into virus producer by integrating the viral gene into the transcriptionally active domains of host domains. This can be aligned with the new emerging recombinant HIV-1 strains in Chinese population (Wu et al., 2013). However, there is still a need of more detailed studied to understand the role of the pathogenic agent and design vaccines accordingly and prevent re-emergence of the disease. 

Environmental Factors Associated with Re-Emergence of the Disease

It has to be understood that there is a distinct infection mechanism that affects the immunity system of the body in case of the accumulation of AIDS. This infection mechanism is heavily linked with an intricately linked genetic network that governs the innate immune response of the human body. As per the data discovered by the scientific research, the human immune deficiency virus effects three different types of immunity cells of the body, these cells are the dendritic cells, helper T cells and the memory cells. However the most significant action that ultimately alters the immune response of the body and makes the body was able to various kinds of diseases is the genetic altering of the CD4+ cells by the CC4 immuno repressor receptor protein encoded by the viral transcripts. One of the most significant contribution factors behind the escalating accounts of remittance of HIV infection time and time again that the exact in which CDR4+ memory cells are altered to become dysfunctional is still not completely understood. The sake of any knowledge regarding how the virus can affect the most important memory immune cells of the human body is the key facilitator behind the uncontrolled and outbreaks of HIV and the reemergence of the disease time and time again (Beyrer et al., 2012).

Another very important fact that can be considered while discussing the host analysis for HIV infection is the fact that viral transcripts belonging to the HIV1 family are highly stable as compared to the rest of the viral entities causing this kind of disease. Although the truncation mutation of the host gene CDR4 has known to stop the activation of Infection procedure for some patients, while it is not equivocally true for all victims (Van Sighem et al., 2012). This restrictive function can be due to the fact that CDR4 in activation is facilitated by the chemokines secreted by the viral transcripts once inside cell, these protein structures are dynamic and can change their alignment in order to gain better just cell response, and hence can counteract the mutation, which can be mother prime reason behind the re-emergence (Morens & Fauci, 2013).

This is the case for the antiretroviral therapies that the patients receive in order to prevent and control of the speed of HIV infections. However, as the key structural proteins are not yet completely characterized, the changing configuration in different states in different times render the anti retribution therapy completely useless. Lastly the gene make up of the victim also plays a key role in defining the susceptibility to HIV infections. In most cases the genetic predisposition and lifestyle choices are deciding elements for accumulation of this majorly sexually transmitted communicable disease (van Griensven et al., 2013).

Policy Responses and Conclusion

There are various environmental factors associated with  re-emergence of a communicable disease, these factors can be socio-cultural,  socio-economic or strictly environment related. It has to be considered in this context that HIV infection is heavily interlinked with lifestyle choices and societal status; hence the impact of living conditions and socio-economic status is pivotal. First and foremost, one of the most important factors associated with the prevalent re- emergence is the deterioration of the living conditions in the remote rural areas. According to the Pathela et al., 2013, the reason behind the abundance of HIV infections in the remote areas is the absolute lack of health and hygiene literacy and basic health education. As HIV is a highly contagious infectious disease that is easily spread by the means of any body fluid contact, the lack of any health literacy or basic knowledge regarding preventative protocols are significant contributing factors behind the rapid re- emergence (Halkitis, Wolitski & Millett, 2013). As per the article of Wilson, 2012, the poor living conditions with lack of sanitized drinking water, basic hygienic food and lack of health care services further contribute to not just escalating the possibility of re-emergence but also complicated the health conditions of the victim.

Another highly influential contributing factor to this communicable disease is the alarming predominance of this infection in the female population. The rate of women suffering from HIV infection is frighteningly higher than that of the men and there are multiple reasons behind it. Firstly, the stand of the women in the patriarchal society makes them more vulnerable to this infection and the societal stigmatization regarding this disease also complicated the possibility of the women confronting their HIV infection and seeking adequate care. As a result the infection continues to escalate the incidence rate of this disease and escalated the possibility of frequent re-emergence of this disease by the means of transferring during childbirth (Fauci & Morens, 2012).

Poverty is another Key contributing factor to the escalating re-emergence of communicable diseases. It has to be understood that communicable diseases require extensive preventative protocol and health promotional activities to be controlled which can only be considered extremely difficult to attain while the setting is impoverished and devoid of any social economic wealth (Rothenberger et al., 2015). It can also be stated in this context, AIDS is the kind of infection which is much more frequently observed or reported in rural and remote areas of South Africa where the accessibility of Healthcare services and health literacy is extremely limited and the condition of living is also poor and compromised. Many research studies have indicated sir impoverished living conditions to be influential contributing factor behind the accumulation on emergence of such communicable infections (Van Sighem et al., 2012).

Lastly the climate changes are the least of the environmental factors that contribute to the emergence of such communicable diseases. According to a recent study, the changes in the warmth of the atmosphere have enhanced the stability of the viral transcripts effectively. In the much warmer climate of the present day viral transcripts can survive much more easily and their relevance of gases in the city has been observed to escalate as well (Halkitis, Wolitski & Millett, 2013).

As per the obligations to the Human Rights the government bodies were legally responsible to formulate policies and programs. These policies were found to reduce the spread of the impact of the HIV. To respect the people’s rights, the government is taking steps to help children with HV/AIDS to attend school. Human rights in the context of HIV are protected by making policies to help adolescents receive reproductive health education.  State governments in different countries are taking legislative actions and making judicial and administrative polices to fulfil the rights of people with HIV. There is an increased attention to both HIV/AIDS and human rights after the declaration by the U.N. Commission on Human Rights and the 1998 International Guidelines on HIV/AIDS (Decker et l., 2015). National Red Cross and Red Crescent Societies in response to the HIV/AIDS supports individual project. It has been found to be effective in  scaling-up prevention of HIV, advocacy and destigmatisation and other services of HIV particularly to vulnerable population. The national society ensures that all the health programs adhere to WHO policy and those promulgated by the UNAIDS for prevention, treatment and control protocols (Stines, 2013).

In Australia there has been proactive response to HIV and AIDS by federal and state governments since 1982. The National HIV strategy by Australia is recognised as one of the best in the world. This strategy was effective in harm reduction by the implementation of needle and syringe exchange programs. This strategy increased the peer education program, which lowered the HIV/AIDS prevalence among gay, sexual workers and Aboriginal and Torres Strait Islander people. The mandatory HIV testing laws in the south and western Australia, prevents people from maltreating the HIV infected patients. However, the disadvantage of this law includes increase in misunderstanding of HIV and other BBVs.   Further the sex work law reform ensures decriminalisation of sex work in every state and territory in Australia. This law protects people with anti-discriminatory protect at federal and state levels (Holt et al., 2014).  Australia prevents the punitive drug treatment approaches through “The Australian Injecting and Illicit Drug User League (AIVL)”. With this law reform Australia expanded the drug treatment options, including injectable Pharmacotherapies. This act decreases the source of transmission of HIV. The public health policy in Australia allows the medical practioners in each state to mange people with HIV and one at risk of transmitting HIV to others. This policy ensures that health care providers implement series of intervention involving counselling services (Madden & Wodak, 2014).  These policies were found to show positive results in reducing the HIV rates.

The seventh National HIV strategy 2014-2017 is found to be useful in decreasing the trends of new HIV diagnosis. With this strategy Australia is working towards virtual elimination of HIV transmission by 2020. This strategy is working with discrete targets which are informed by the “United Nations 2011 United Nations Political Declaration on HIV/ and AIDS”   (Kidd, 2014). These policy although could not prevent emergence but was helpful in decreasing incidence and prevalence to great extent.

Despite of HIV being one of the most highly contagious and threatening communicable disease, there are a few recommendations that can help in preventing and controlling the extent of the outbreaks (Pathela et al., 2013).

• First and foremost it has to be understood that is essentially a sexually transmitted disease, hence the best preventative action is the widespread understanding and usage of preventative protections. Along with that, in the remote and rural areas, the lack of any health literacy provokes the spread of the disease; hence a basic HIV safety and preventative education can help in reducing the incidence rate of the disease (Davis et al., 2013).
• Antiretroviral therapy despite its flaws still continues to be one of the most effective clinical therapies to prevent AIDs. There is need for an effective strategy involving the antiretroviral therapy as a nation-wide preventative strategy for controlling the spread of the infection (Smith et al., 2013).
• Another very important strategy in this case can be the pre – exposure and post – exposure prophylaxis strategy, as long with that circumcision can also be another effective strategy to help in the prevention of the disease.
• As this disease is primarily transmitted sexually, the nation- wide use of microbicides can also help in preventing the transmission of the disease as well (Politch et al., 2012).
• Lastly, blood transfusion is another very common route of transmission for the HIV infection, safe injection program and needle change protocol is another very effective strategy to control the infection and even prevent it to some extent (Rothenberger et al., 2015).

Conclusion:

The right to good health is one of the most basic rights for human life; however it is treated as own of the commodities to be purchased. That is the reason behind the predominance of such deadly communicable disease in the lower economic classes. Despite the astounding innovations and revolutionary progress of the healthcare industry, there is a significant gap left behind in the overall mindset of the society regarding the communicable diseases, especially the ones that are somewhat linked with the lifestyle choices.

Autoimmuno deficiency syndrome is one of those communicable diseases which are seen in a questionable light in the society, due to the fact that this disease is more frequently transmitted sexually. Social stigmatization regarding the HIV infection victims bring about social isolation, negligence and discrimination for the HIV positive patients. Care should be taken so that these discriminating false ideas regarding communicable diseases can be overcome and the patients can be given a chance to seek out the treatment they need without the added fear of social rejection and discrimination. AIDS continues to be one of the most highly deadly communicable diseases with a frightening fatality rate for each outbreak, the societal restrictions and lack of health literacy is one the major reasons that facilitate the frantic re emergence of this disease. As mentioned above, there are a variety of factors that contribute to the rate of re-emergence and co-morbidities accompanied by it. Hence care should be taken to bring forth a strong national level preventative strategy for HIV infections taking the entire different social sector into consideration, overcoming the age, gender and socio-economic status associated biases. 

References

Beyrer, C., Baral, S. D., Van Griensven, F., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., & Brookmeyer, R. (2012). Global epidemiology of HIV infection in men who have sex with men. The Lancet, 380(9839), 367-377.

Davis, D. H., Smith, R., Brown, A., Rice, B., Yin, Z., & Delpech, V. (2013). Early diagnosis and treatment of HIV infection: magnitude of benefit on short-term mortality is greatest in older adults. Age and ageing, 42(4), 520-526.

Decker, M. R., Crago, A. L., Chu, S. K., Sherman, S. G., Seshu, M. S., Buthelezi, K., … & Beyrer, C. (2015). Human rights violations against sex workers: burden and effect on HIV. The Lancet, 385(9963), 186-199.

Fauci, A. S., & Morens, D. M. (2012). The perpetual challenge of infectious diseases. New England Journal of Medicine, 366(5), 454-461.

Halkitis, P. N., Wolitski, R. J., & Millett, G. A. (2013). A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men. American Psychologist, 68(4), 261.

Holt, M., Lea, T., Murphy, D. A., Ellard, J., Rosengarten, M., Kippax, S. C., & De Wit, J. B. (2014). Australian gay and bisexual men’s attitudes to HIV treatment as prevention in repeated, national surveys, 2011-2013. PloS one, 9(11), e112349.

Jones, A., Cremin, I., Abdullah, F., Idoko, J., Cherutich, P., Kilonzo, N., … & Schwartlander, B. (2014). Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention. The Lancet, 384(9939), 272-279.

Kidd, M. R. (2014). Australia’s Seventh National HIV Strategy and the AIDS 2014 Legacy Statement. Med J Aust, 201(5), 247-248.

Lowenthal, E. D., Bakeera-Kitaka, S., Marukutira, T., Chapman, J., Goldrath, K., & Ferrand, R. A. (2014). Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. The Lancet infectious diseases, 14(7), 627-639.

Madden, A., & Wodak, A. (2014). Australia’s response to HIV among people who inject drugs. AIDS Education and Prevention, 26(3), 234-244.

Marston, H. D., Folkers, G. K., Morens, D. M., & Fauci, A. S. (2014). Emerging viral diseases: confronting threats with new technologies. Science translational medicine, 6(253), 253ps10-253ps10.

Montaner, J. S., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … & Hogg, R. S. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the “HIV Treatment as Prevention” experience in a Canadian setting. PloS one, 9(2), e87872.

Morens, D. M., & Fauci, A. S. (2013). Emerging infectious diseases: threats to human health and global stability. PLoS pathogens, 9(7), e1003467.

Morens, D. M., & Fauci, A. S. (2013). Emerging infectious diseases: threats to human health and global stability. PLoS pathogens, 9(7), e1003467.

Mumtaz, G. R., Riedner, G., & Abu-Raddad, L. J. (2014). The emerging face of the HIV epidemic in the Middle East and North Africa. Current Opinion in HIV and AIDS, 9(2), 183.

Pathela, P., Braunstein, S. L., Blank, S., & Schillinger, J. A. (2013). HIV incidence among men with and those without sexually transmitted rectal infections: estimates from matching against an HIV case registry. Clinical infectious diseases, 57(8), 1203-1209.

Politch, J. A., Mayer, K. H., Welles, S. L., O’brien, W. X., Xu, C., Bowman, F. P., & Anderson, D. J. (2012). Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men. AIDS (London, England), 26(12), 1535.

Rhodes, T., & Abdool, R. (2016). Drug harms and drug policies in Sub-Saharan Africa: Implementation science and HIV epidemics. International Journal of Drug Policy, 30, 1-6.

Rothenberger, M. K., Keele, B. F., Wietgrefe, S. W., Fletcher, C. V., Beilman, G. J., Chipman, J. G., … & Schmidt, T. E. (2015). Large number of rebounding/founder HIV variants emerge from multifocal infection in lymphatic tissues after treatment interruption. Proceedings of the National Academy of Sciences, 112(10), E1126-E1134.

Serrano-Villar, S., Sainz, T., Lee, S. A., Hunt, P. W., Sinclair, E., Shacklett, B. L., … & Van Natta, M. L. (2014). HIV-infected individuals with low CD4/CD8 ratio despite effective antiretroviral therapy exhibit altered T cell subsets, heightened CD8+ T cell activation, and increased risk of non-AIDS morbidity and mortality. PLoS pathogens, 10(5), e1004078.

Smith, M. K., Rutstein, S. E., Powers, K. A., Fidler, S., Miller, W. C., Eron Jr, J. J., & Cohen, M. S. (2013). The detection and management of early HIV infection: a clinical and public health emergency. Journal of acquired immune deficiency syndromes (1999), 63(0 2), S187.

Stines, S. A. (2013). Meaningful Involvement of People Living With HIV/AIDS in Tanzania’s Structural Approaches to HIV/AIDS Prevention (Doctoral dissertation, Howard University).

van de Laar, T. J., & Richel, O. (2017). Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus. Sex Transm Infect, 93(5), 368-373.

van Griensven, F., Thienkrua, W., McNicholl, J., Wimonsate, W., Chaikummao, S., Chonwattana, W., … & Tappero, J. W. (2013). Evidence of an explosive epidemic of HIV infection in a cohort of men who have sex with men in Thailand. Aids, 27(5), 825-832.

Van Sighem, A., Vidondo, B., Glass, T. R., Bucher, H. C., Vernazza, P., Gebhardt, M., … & Fraser, C. (2012). Resurgence of HIV infection among men who have sex with men in Switzerland: mathematical modelling study. PloS one, 7(9), e44819.

Wilson, D. P. (2012). HIV treatment as prevention: natural experiments highlight limits of antiretroviral treatment as HIV prevention. PLoS medicine, 9(7), e1001231.

Wu, J., Meng, Z., Xu, J., Lei, Y., Jin, L., Zhong, P., … & Su, B. (2013). New emerging recombinant HIV-1 strains and close transmission linkage of HIV-1 strains in the Chinese MSM population indicate a new epidemic risk. PloS one, 8(1), e54322.