so number five is talking about well how can we try to treat this disease well the bad news is we have no cure as of yet but we do have medications known as anti retr viral therapy known as art or art art is a combination of a few types of drugs by the way uh and what do these drugs do so these drugs while they cannot destroy the HIV pathogen we remember the pathogen can insert its genetic material into the helty lymy or sometimes when the virus is latent or sleeping or inactive inside the uh lymy it can become active again and start destroying helty lymphocytes that's how the pathogen works right well the the drug number one it can prevent the viral genetic material from entering the nucleus of the helper T lymphocytes okay so it keeps the T lymphocytes safe and number two it keeps the virus in the latent phase which means to say it keeps the virus inactive so while this medication is not a cure it helps to protect and prevent the helper T lymphocytes from being destroyed and therefore these medications prevent the progression towards AIDS because if you remember in the previous video I did say that aids is what div velops when the patient's immune system is extremely weak uh so in this case the drugs prevent AIDS from developing in the HIV patients so the good news here is by the way if the patient starts taking ARS which are the medications look at what happens to the concentration of the virus the concentration of the virus or the viral load becomes extremely low and because your helper lymphocytes are protected it starts to increase again this is a good thing and by the way you don't need to memorize this graph it's just it's just a way to tell you what art does the only problem with this medication here is they have to be taken daily for it to be effective it's very time sensitive time sensitive meaning to say when the person is supposed to take it uh at 11: a.m. they have to continuously take it at 11:00 a.m. every single day it cannot be like oh Monday I'm going to take it at 11:00 in the morning um Tuesday I'm going to to take it at 9:00 in the morning um Wednesday I'm going to take it at I don't know 3:00 p.m. or 3: in the afternoon uh that doesn't work you have to be consistent with the timing and this is where it can be a little bit difficult if you do not have proper access to the medication right because uh so that is why we always uh advise people with HIV if you uh have HIV and you have to take the medication uh there are apps there are apps on your phone that can help you you that can help remind you hey it's time to take your medication so we have while that's while it's a problem to take the medication every single day uh we have ways to circumvent and um you know overcome this problem so this is a good thing right but more importantly is how we prevent the disease if you remember these are the ways in which HIV can actually spread they are blood related uh sex related breastfeeding related or also pregnancy related by the way so let's focus on the first one the blood related one okay so remember blood related means the HIV positive person donates blood and the contaminated blood is transfused into another person or the contaminated needle that contains the HIV pathogen is shared with another person well um the first way in preventing blood related transmission is by testing the blood that are donated so let's say two people donate blood A and B and both the blood are tested for the HIV pathogen we do have technology to test the blood for HIV and also other different types of infectious disease by the way in fact we do we have to do that um and let's say blood uh from donor a is fine uh and that blood can be given to other patients but the for blood from donor B it contains the HIV pathogen so in that case that blood will be rejected okay so it cannot be given to other patients at all because we do not want to risk transmission and also donor B will be informed about their status the hospital or the clinic will call them and say hey we have found the HIV pathogens in your blood you might want to come to the clinic uh to get further testing to confirm if you actually have HIV or not so that's how people find out about their HIV status another way is to prevent needles from being shared with other people people uh for infra venous for IV drug users we have something called needle exchange programs so as you can see here one person with HIV positive okay they use a needle and they might share the needle with three other people so to prevent the transmission of HIV through sharing of needles um what can happen is each person each of those three people if they are drug users they can go to certain types of clinics to get clean sterile needles so they do not share the needles at all and once they use the needles to inject their drugs they will actually give the needle back to the clinic and get a new needle out of it so what this does is this prevents needles from being shared from one person to another now a lot of students might go wait a second I thought drugs are illegal well yes drugs are illegal but a lot of countries namely like Switzerland uh for example instead of punishing people their main goal is to rehabilitate them so if they are if these people are addicted it is much better to have them receive the drugs in a safe Manner and one such safe manner is by giving them sterile needles and preventing them from actually sharing the needles with other people so it cuts down the transmission of HIV through contaminated needles as well of course another way is the sex related way which is the transfer of the uh contaminated semen or vaginal fluid so in that case unprotected sex through the oral vaginal or anal root uh in this case you can actually use condoms fidom or dental dams which prevent contact with semen and vaginal fluid another way is actually called Contact tracing now a lot of my students love to ask me what exactly is contact tracing so let's look at a situation now let's say person a has HIV and they are unaware of their status which means to say they don't know that they have HIV now they have unprotected sex with multiple people b c and d now person B however let's say uh because they had unprotected sex person B was a little bit uh worried or paranoid and person B decides to go to the clinic or the hospital to get tested and when person b gets tested uh sadly they found out that yes the the doctor tells them that you have HIV okay and what happens then is in that case the doctor or the nurse will then ask them would you be able to tell us uh your sexual partner that means who did you have sex with and of course person B will say uh well I had sex with uh person a okay I had sex with a um so this is not victim blaming this is not blaming or such so what the hospital or clinic will do in such situation is they will call a okay they will get the information from B and they'll call a and they'll say hello um we we had a patient come to the hospital they had sex with you and they are now HIV positive so we think you might be HIV positive as well so would you come to the hospital so then a gets informed a is like oh God I need to go get tested so in that case a gets tested too and now he now person a is aware of their HIV status and in this case they can start having they can start taking medications and having protected sex so contact tracing just basically means identifying people with HIV to inform them of their risks in spreading the disease now the third way I'm going to put breastfeeding Rel related and pregnancy related together because they can spread through the breast milk or through the or through the placenta of the mother um so to prevent mom to child of mom to fetus transmission something very interesting can happen here remember if you give Arts which are the medication to the patients uh to the people with HIV positive you reduce the viral load based on this graph the viral load is so low that it will cut down the transmission from mother to child or mother to fetus to almost zero% so the goal here is if a woman is HIV positive and she's pregnant before she's pregnant or she wants to get pregnant it is very important to start them on the art because the art will not cure them but it will prevent them from actually transmitting the virus to their feters or child and that is one of the most important things that we can do with HIV in fact it is also good to prevent uh to start people with HIV on AR as soon as possible because when they start on Al their viral load is so low that the transmission of HIV through sex is almost 0% I would like you to understand this yeah so when a person with HIV when a person is HIV positive when they start the medication and their viral load is at an undetectable level um if they were to even have unprotected sex chances of them transmitting the virus to another person is 0% by the way so this so the the art works as a treatment for the PE for the people with HIV positive but it also works as a preventive method to stop the spread of HIV to other people as well so as you can see here what I'm going to show you you don't need to memorize this one here but these are three different studies that were done okay in large groups of people to prove that when a person starts with Arts their viral load will be undetectable and the chances of them transmitting the virus to another person is 0% so that's the main goal for the people with HIV to start them on medication as soon as possible and that that will actually that would help to prevent the transmission but of course then comes the question like always why is it difficult to eradicate this disease well the first thing is Art is not a cure even though we have AR and it has to be taken daily to be effective and while it does a brilliant job uh suppressing the viral the concentration of the virus if the patient were to suddenly stop the art for whatever reasons the virus concentration will immediately start to increase again and that's a problem and the person might develop AIDS due to the extremely low concentration of helper T lymphocytes um and the AR can have a lot of undesirable side effects okay uh it can cause uh side effects to the kidney to the liver we are getting better at dealing with the side effect effect by the way and there are other limitations of prevention U may include stigma or shame of getting tested that is the main thing by the way when it comes to HIV a lot of people might think or might suspect that they have HIV but they are scared to go to the clinics or hospitals because they might think what would people say there is shame in getting tested because um in some parts of the world getting diagnosed with HIV might get you fired from your job which is uh depending on the type of job you have look um we've had cases where um the person uh I can't I can't name names because of privacy issue but the person was uh working in a high paying position uh and it was nothing to do with um you know they were not doctors or nurses they did not work in the hospital they were working in financial institutions but because their company found out that they have HIV they were terminated from their position okay so so so this is why this is a problem people are still you know a little bit iffy about getting tested because they're scared about what might happen next condoms fidom and dental DS are not 100% effective they might break and uh you know um they might cause the other person to be exposed to the uh vaginal or cement vaginal fluid or cement and of course the third initial symptom terms of HIV are mild or absent and because they are mild or absent so you have three people here who have HIV but um the person a might have a slight fever person B might have body ache and person b c might not have symptoms at all so they might think uh just a normal infection so they might not go get tested right and three and and the and the next one is ARS can be expensive for people in poorer countries uh so it can be a a problem so art is one of the best ways the goal standard to reduce the concentration of the virus and prevent them from transmitting it to other people but ARS need to be taken daily and it can be a bit of a burden on people financially if they have to spend money on these medications so this can be a little bit of a problem but I would still like to emphasize that art is still fantastic because when you are on art with an undetectable viral load it cuts down the transmission through unprotected sex from Mom to fetus and such so conf instead of um punishing people with HIV or instead of uh shaming and stigmatizing people with HIV they should put aside their Prejudice to people with HIV and help treat the Disease by treating the disease it also helps prevent the transmission