The world is getting closer to achieving one of the most important public health goals of our time: eradicating HIV. And to do this, we won’t even have to cure the disease. We simply have to stop HIV from being transmitted until eventually it fizzles out.
Svijet se bliži ostvarenju jednog od najbitnijih ciljeva javnog zdravstva: iskorjenjivanju HIV-a. Da bismo ovo postigli, ne moramo čak ni izliječiti bolest. Jednostavno moramo zaustaviti prijenos HIV-a s osobe na osobu, dok jednog dana ne nestane.
Once, this goal would have seemed impossible. HIV has caused millions of deaths and is one of the most devastating diseases that humanity has ever known. But we’re now at a point where new advances such as one-pill, once-a-day medications are helping us tackle HIV in effective ways.
Taj cilj se prije činio nemogućim. HIV je odnio milijune života i jedna je od najgorih bolesti s kojom se čovječanstvo susrelo. Sada smo došli do trenutka kada napredak poput jedne tablete, tablete koju uzimate jednom dnevno, pomaže da se učinkovito borimo s HIV-om.
HIV is a retrovirus– meaning it integrates copies of itself into an infected cell’s DNA, allowing it to replicate and infect other cells. HIV has evolved numerous ways to evade the human immune system, which makes it difficult to cure.
HIV je retrovirus, što znači da ugrađuje svoje kopije u DNA zaražene osobe te se tako množi i zarazi okolne stanice. HIV je razvio brojne načine kako izbjeći imunosni sustav čovjeka, što ga čini teškim za liječenje.
But by developing ways to block HIV replication, we can stop the spread of HIV itself. That’s where antiretrovirals– a.k.a. ARVs– come in. ARVs are a group of drugs which work in different ways to combat HIV. Some block HIV’s access into immune cells, and others work by stopping the virus itself from replicating.
Ali razvijajući metode kako zaustaviti razmnožavanje HIV-a, možemo zaustaviti širenje HIV-a. Antiretrovirusni, tzv. ARV pomažu. ARV su grupa lijekova koji na različite načine djeluju na HIV. Neki blokiraju ulazak HIV-a u imunosne stanice, dok drugi rade zaustavljajući razmnožavanje virusa.
ARVs also work preventatively in people who don’t have HIV. This type of approach is called pre-exposure prophylaxis, or PrEP. PrEP works by accumulating in a person’s body and preventing HIV from establishing itself. That means an HIV-negative person who may be at risk of contracting the disease can take certain ARVs to protect themselves, before they become exposed.
ARV-i također djeluju preventivno kod ljudi koji nemaju HIV. Takav način davanja se zove preekspozicijska profilaksa ili PrEP. PrEP djeluje tako da se nakuplja u tijelu osobe i sprječava napredak HIV-a. To znači da HIV negativne osobe koje su u riziku od oboljenja mogu koristiti ARV kako bi se zaštitile prije nego se izlože virusu.
Here’s where it gets especially interesting: In people with HIV, ARVs can also dramatically reduce HIV transmission. This is called “Treatment as Prevention.”
Ovo je zanimljivo: ARV drastično smanjuju prijenos HIV-a kod osoba koje su zaražene HIV-om. Ovo se zove "Liječenje kao prevencija."
On a global scale, this has the potential to end the HIV epidemic. It’s based on the idea that someone with HIV who takes ARV’s can lower the virus level in their bodies until it becomes undetectable. That doesn’t mean the virus is gone; it could still be lurking within cells, ready to reactivate if treatment stops. But so long as it’s kept dormant with drugs, HIV remains undetectable. And when HIV is undetectable, it’s untransmittable, too.
Na globalnoj razini, ima potencijal zaustaviti HIV epidemiju. Ideja je da osobe s HIV-om koje uzimaju ARV mogu smanjiti razinu virusa u svome tijelu do granice nemjerljivosti. To ne znači da je virus nestao, i dalje je možda u stanicama, čeka reaktivaciju ako liječenje prestane. Ali dok je god pritajen zbog lijeka, HIV je nemjerljiv. A kad je HIV nemjerljiv, onda je i neprenosiv.
In theory this means that by testing everyone who’s at risk of HIV and treating those who test positive, we could stop transmission and eventually eradicate HIV.
U teoriji, to znači ako se sve osobe koje su rizične za HIV testiraju te se tretiraju one koje su pozitivne, mogli bismo zaustaviti prijenos i s vremenom iskorijeniti HIV.
In the real world, however, things are more complex. Many at-risk HIV negative people across the world do not have access to PrEP or ARVs, and those who are HIV positive may experience challenges to taking ARVs. These problems are often greatest in countries where the burden of HIV is highest. Getting these medications depends on access to a functioning healthcare system– and this isn’t something everyone has. That’s part of the reason why stopping the spread of HIV for good will require a significant investment of resources to improve those systems. One study carried out by the UNAIDS estimated that between 20-30 billion dollars per year would be needed to achieve a nearly 90% reduction in new HIV infections by 2030. This investment would ensure more people would get tested in the first place, and more would be able to access and maintain treatment. Achieving this goal and improving healthcare in general is in everyone’s best interest, from individual people to society as a whole.
U stvarnom svijetu stvari su složenije. Mnoge rizične HIV negativne osobe diljem svijeta nemaju pristup PrEP-u ili ARV-u, i oni koji su HIV pozitivni možda ne mogu uzimati ARV. Ti problemi su često izraženi u državama gdje je pojavnost HIV-a najveća. Dostupnost lijekova ovisi o funkcionalnosti zdravstvenog sustava, što često nemaju svi dostupno. To je djelomično razlog zašto će za trajno sprečavanje širenja HIV-a biti potrebno uložiti u te sustave. Jedno istraživanje UNAIDS-a pretpostavlja da bi trebalo oko 20 do 30 milijardi dolara na godinu kako bi broj novih HIV infekcija do 2030. godine pao za 90 posto. Ulaganje bi osiguralo da se više ljudi zapravo testira i više njih bi imalo pristup terapiji. Postizanje ovog cilja i unapređenje zdravstvenog sustava općenito je bitno svima, od pojedinaca do cjelokupnog društva.
We have roadmaps that could allow us to bring the HIV epidemic to an end in the near future, with the possibility of eradicating the disease altogether several generations in the future. In the period from 1996 to 2017 we almost halved the number of new HIV infections, and for the millions of people who still live with the virus, ARV treatments enable most to lead long and healthy lives. With continued and increased investments, we can get transmission rates low enough to end HIV once and for all. A world without HIV is no longer inconceivable: it’s closer than ever.
Imamo planove koji bi doveli do završetka epidemije HIV-a u bliskoj budućnosti, s mogućnošću iskorjenjivanja bolesti u svega nekoliko generacija. U razdoblju od 1996. do 2017. godine gotovo smo prepolovili broj novih HIV infekcija, i za milijune ljudi koji žive s virusom, ARV terapija im omogućuje dugačak i zdrav život. Daljnjim i povećanim ulaganjima mogli bismo smanjiti stope prijenosa i time zaustaviti HIV zauvijek. Svijet bez HIV-a više nije nezamisliv, bliži je nego ikad.