Born on what would eventually be recognized as World AIDS Day in the 1970s, Dr Mike Emerson, now affiliated with the National Heart and Lung Institute, relocated to vibrant London during the early 1990s amidst the fervour of the Britpop era. In the backdrop of Blur and Pulp melodies, 1990s London faced the AIDS crisis. Three decades later, he is at the helm of a team investigating cardiovascular ailments in people with HIV. In this piece, Dr Emerson reflects on the advancements in HIV diagnosis and therapy, and reiterates the ongoing importance of National HIV Testing Week.
I was born on what was to become World AIDS day way back in the 1970s, and moved to the big smoke in the early 90s. London was exploding with Britpop excitement, and in the absence of mobile tech, we went out every night to the sounds of Blur and Pulp. 90s London was also the epicentre of the UK’s bit of the global AIDS crisis. People in their early 20s, as I was, were dying (of ignorance the government told us). I quickly learnt not to hold birthday celebrations in Soho; celebrating and mourning young friends and sons don’t mix well. Exactly 30 years later, I lead a team investigating cardiovascular disease as people live with HIV for decades and succumb to the diseases of old age. This week is HIV testing week, so it’s a good time to reflect on how far we have come and remind ourselves of the importance of HIV testing.
Back in 1981, a couple of obscure articles noted incidences of fatal pneumonia and rare skin cancers in otherwise healthy young American men. Oddly, these men were all gay. Within months, there was an explosion of terrifying fatal illness amongst the gay communities of New York, San Francisco and, not far behind, London. People became infected with HIV following blood transfusions, and babies were born with the condition and died. When HIV tests became available, the prospect of one was terrifying, involving a week-long wait for results and a recommendation to take a friend when results were due to be delivered.
HTLV-1 PrEP Open Letter to Gilead & ViiV
Human T Lymphotropic/Leukaemia Virus-1 (HTLV-1) is a sexually transmitted infection (STI) closely related to human immunodeficiency virus-1 (HIV-1). HTLV-1 causes chronic infection, can be transmitted from mother to baby and is associated with significant disease burden and mortality, preceded by years of suffering and poor quality of life for victims.
Therefore, HTLV-1 is one of the 2030 elimination targets of the World Health Organization’s global STI elimination strategy.
Although there is currently no drug or vaccine available to cure HTLV-1, we now know that the very same drugs that effectively treat patients with HIV or prevent people from getting HIV-1, called HIV PrEP, also prevent the transmission of HTLV-1 in our laboratory testing (Reviewed in Bradshaw and Taylor, Frontiers in Medicine 2022). We believe that these compounds are likely to block the transmission from mother to child.
It is well known that many HIV PrEP clinical trials are conducted in countries where HTLV-1 is common. So, by adding in HTLV-1 testing to these HIV-PrEP trials we could measure if the HIV PrEP drugs also prevent HTLV-1 transmission. The beauty of such an outcome would be that these HIV-1 drugs are already licensed to be used in humans.
Despite major progress in treatment and prevention, being diagnosed with HIV can have a big emotional impact on individuals. People with HIV have higher rates of mental health problems than those seen in the general population. One reason for this may be HIV-related stigma, explains Professor Alan Winston from the Department of Infectious Disease.
Since the late 1990s, I have been treating people living with HIV and been involved in HIV clinical research. Many things we read about HIV are success stories, and quite rightly we should celebrate these tremendous scientific and medical advances. Life expectancy for someone with HIV is now similar to that of the general population. Antiretroviral therapy generally has manageable side effects and for most individuals, does not incur that many tablets per day. Indeed, many HIV treatments involve taking only one tablet per day. So, why then do so many people with HIV suffer from depression, other mental health conditions, and a poorer quality of life?
Experience in clinic
Most people living with HIV, once on a stable treatment, will attend their treatment centre twice per year. Often appointments rotate between a consultant or medical doctor once per year and a nurse specialist on the other occasion. As we can’t cure HIV, our patients attend for life, and we get to know them very well. At consultations, in addition to routine monitoring, we ask people how they are keeping. What stands out are the number of individuals who report symptoms of depression and other mental health conditions such as anxiety. Whilst many of us suffer from mental health complaints, the burden of these complaints in people living with HIV is very high. Thankfully, we do have help in clinic and have a specific clinic run by a psychiatry nurse specialist we can refer patients to.
This festive period Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.
While HIV is no longer the death sentence that it once was, lifelong treatment is still required and there is no cure – yet. Professor Sarah Fidler from the Department of Infectious Disease discusses how a new type of HIV treatment holds promise as a longer-lasting alternative to current complex drug regimens.
Despite extraordinary political and medical advances, HIV, the virus that causes AIDS, remains one of the world’s most serious public health challenges. Since its discovery in 1983 by researchers at the Pasteur Institute in France, 84 million people worldwide are estimated to have become HIV-positive and 40 million people have died from an HIV-related illness. Today, there are around 38 million people living with HIV globally, with 1.5 million new infections in 2021.
Advocacy and close collaboration between clinicians, scientists and the HIV-affected community has inspired and driven the research and drug development and access agenda. Without these close working relationships, the development of HIV treatments would have been markedly slower and many more lives would have been lost.
There are currently 38 million people infected with HIV worldwide with up to a million deaths each year. During National HIV Testing Week, we hear from Dr. Catherine Kibirige who has developed a highly sensitive HIV-1 test that can detect a single infected cell with high precision.
Meet Dr. Fred Nsubuga, he manages the Diagnostics Laboratory at Jinja District Hospital in Uganda. His laboratory is not equipped for HIV-1 treatment monitoring, so, when patients come in who need a viral load test, he must collect, process and store their blood samples, batch them together, then send them on a truck to the national HIV testing laboratory in Kampala, the capital city, 44 miles away. Despite the availability of this state-of-the art facility which boasts a Roche Cobas 8800™ high-throughput instrument with a good computer-based laboratory management system, it can take months for the results to get back to him. Sometimes, they go missing.
This festive period Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.
Our second is Dr Julia Makinde, an HIV researcher at the IAVI Human Immunology Lab, who makes the case for translating science into policy.
A dearth of advisers
A section of the nativity story portrays Herod the Great as something of a tyrant. A man who sanctioned an order to wipe out every male infant born in and around Bethlehem in a pre-emptive action to eliminate the threat of a new-born king. As difficult as it is to imagine anyone, let alone a political leader, endorsing the massacre of innocent children, the story presents an interesting metaphor of complex political motivations and the outcome of a breakdown in the process of policy making.
With vaccinations, climate change and access to healthcare taking centre stage in the global debate, the intersection between science and policy has never been more relevant. Whilst I started out in research with the desire to help create solutions to global healthcare challenges, I have come to understand that the actions taken to disseminate research outcomes are just as important as the process of discovery itself. (more…)
Originally published on the Imperial College Healthcare NHS Trust blog, Professor Jonathan Weber, Dean of our Faculty of Medicine, shares the story of his career working with people affected by HIV/AIDS.
In April 1982, I was a young doctor with an interest in infectious diseases when my mentor, Professor Philip Marsden, mentioned a new disease he’d seen in New York, which was affecting young gay men and had all the hallmarks of a sexually transmitted infection. He suggested it would be interesting to look for this new disease in London and he thought St Mary’s Hospital might be a good starting point. So in August 1982, I joined Dr Willie Harris’ Praed St Clinic, looking at the immune system of gay men who visited the clinic, guided by immunologist Professor Tony Pinching and virologist Professor Don Jeffries.
I was fortunate to be able to work on my research full-time from early 1983, thanks to a fellowship from the Wellcome Trust; I had gathered a cohort of 400 gay men at the clinic and examined their immune systems. What my colleagues and I discovered was that all the men in the cohort had abnormal immune systems; they all had a low number of CD4+ T-lymphocytes and low CD4:CD8 T-cell ratios. They also had enlarged lymph nodes in their necks, armpits and groin, which is usually a sign that the body is trying to fight an infection. These observations led us to believe that all the patients in this cohort had an early manifestation of AIDS; it was a chilling insight into the scale of the unfolding AIDS epidemic. (more…)
Rising rates of STIs has fuelled a debate about whether growing PrEP use might be propelling the STI epidemic. Oli Stevens and argue why this narrative is misleading and damaging.
The UK recently celebrated two landmark achievements in the ongoing fight against HIV. It is now the seventh country to reach the United Nations target of 90-90-90: that 90% of people living with HIV know their status, of whom 90% are on antiretroviral treatment, and of whom 90% are unable to transmit the virus to others.
Also, London became the first city in the world to achieve 95-95-95. These are remarkable achievements and are a testament to the tireless, collective work of doctors, activists, policymakers and civil society organisations.
Zeroing in on the progress made in reducing new HIV infections between men who have sex with men (MSM), particularly the nearly one-third decrease between 2015-2017, two likely contributors stand out: a scale-up in HIV testing, rapid progress to treatment and pre-exposure prophylaxis (PrEP).
PrEP, sometimes discussed in hushed terms as a potential means of ending HIV transmissions, is a pill taken once daily or around higher-risk sex that markedly reduces the risk of contracting HIV.
This recent success also invites us to take stock and reflect on our failures, the perhaps unexpected costs of progress and the emerging roadblocks on the horizon.
The decrease in HIV transmissions has not been matched with a decrease in sexually transmitted infections (STIs). Instead, new diagnoses have risen year-on-year. The causal factors fuelling this increase are complex, driven by social and political changes. (more…)
Dr Kirk Taylor looks back at over 30 years of the HIV epidemic, from the advent of preventative therapy to the impact of HIV stigma that continues to plague forgotten populations.
Thirty years on from the first World AIDS Day we have seen enormous global progress towards ending the epidemic. The change that has happened within my lifetime is astonishing; HIV has gone from being a death sentence to a manageable condition with strategies to prevent transmission altogether. This World AIDS Day, I highlight the milestones achieved and where there is still work to do. (more…)
To mark World AIDS Day 2017, we have published a series of blog posts to highlight the important and varied research that takes places at Imperial. Three experts from Faculty of Medicine share their interest in HIV/AIDS which spans from the elusive vaccine to the economics of the epidemic.
World AIDS Day takes place annually on 1 December as an opportunity for people worldwide to unite in the fight against HIV and to show support for people living with HIV/AIDS.
Where are we in the battle against HIV/AIDS?
The past thirty years have seen enormous gains. We’ve seen the development of highly effective therapy that today can ensure the health of an HIV positive individual for rest of their natural lifespan. We used to speak of HIV/AIDS as if they were the same thing, now you can be HIV positive and never develop AIDS (Acquired Immunodeficiency Syndrome). Globally over 18 million people are now receiving life-saving drugs, preventing millions of deaths each year. Treatment also dramatically reduces the risk of passing on the infection. Excitingly, recent studies have shown that taking a daily pill (known as pre-exposure prophylaxis or PrEP) can prevent people from contracting HIV infection and this is now being made available in the UK. (more…)