The global challenge of HIV/AIDS remains one of the most pressing public health issues today. According to the latest data from UNAIDS, around 38.4 million people worldwide are living with HIV/AIDS, underlining the need for not only medical intervention but also comprehensive awareness, education, and social change. Despite the significant strides made in treatment and prevention, the confusion surrounding the relationship between HIV and AIDS still persists.

Young people have become influential advocates in the fight against HIV/AIDS. Research from UNICEF shows that youth-led initiatives can lower HIV transmission rates by as much as 45% in targeted communities. These young activists utilize digital platforms and peer-to-peer education to dispel myths, promote safe practices, and foster supportive environments for those affected by HIV/AIDS.

Dr Gowri Kulkarni, an expert in Internal Medicine, explains that while the terms HIV and AIDS are often used interchangeably, they are distinctly different. "HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, whereas AIDS (Acquired Immunodeficiency Syndrome) is a condition that occurs when HIV severely damages the immune system," she clarifies. To understand the implications of these differences, it's important to explore the fundamental distinctions between the two.

1. HIV is a Virus; AIDS is a Syndrome

HIV is the virus responsible for attacking the body’s immune system, specifically targeting CD4 cells, which are crucial for the body’s defense against infections. As HIV progresses, it destroys these cells, weakening the immune system over time. If left untreated, this continuous damage can lead to AIDS.

AIDS, on the other hand, is a syndrome, not a virus. Dr Kulkarni further elaborates that AIDS is a collection of symptoms and illnesses that emerge when the immune system is severely compromised due to prolonged HIV infection. It represents the most advanced stage of HIV, and is characterized by very low CD4 counts or the onset of opportunistic infections like tuberculosis, pneumonia, or certain cancers.

2. Not Everyone with HIV Develops AIDS

A key distinction to remember is that not everyone with HIV will progress to AIDS. Thanks to advancements in medicine, particularly antiretroviral therapy (ART), individuals living with HIV can manage the virus and maintain a healthy immune system for many years, or even decades, without ever developing AIDS. ART works by suppressing the virus to undetectable levels, effectively preventing the damage HIV would otherwise cause to the immune system.

Without treatment, however, HIV progresses through three stages:

- Acute HIV Infection: This stage occurs shortly after transmission and may include symptoms like fever, fatigue, and swollen lymph nodes.

- Chronic HIV Infection: Often asymptomatic or mildly symptomatic, the virus continues to damage the immune system but at a slower rate.

- AIDS: This is the final stage, marked by severe immune damage and the presence of infections that take advantage of the compromised immune defenses.

3. HIV is Transmissible; AIDS is Not

Another key distinction between HIV and AIDS is the way in which they are transmitted. HIV is highly contagious and can be transmitted through the exchange of bodily fluids such as blood, semen, vaginal fluids, and breast milk. It is primarily spread through unprotected sexual contact, sharing needles, or from mother to child during childbirth or breastfeeding.

AIDS, however, is not transmissible. It is not a disease that can be passed from one person to another. Rather, AIDS is the result of untreated, advanced HIV infection and is a direct consequence of the virus’s damage to the immune system.

4. Diagnosis Methods Differ

HIV and AIDS are diagnosed through different methods. HIV is diagnosed through blood tests or oral swabs that detect the presence of the virus or antibodies produced by the immune system in response to the virus. Early detection of HIV is crucial, as it allows for timely intervention and treatment, which can prevent the virus from progressing to AIDS.

AIDS, on the other hand, is diagnosed using more specific criteria. Dr Kulkarni notes that the diagnosis of AIDS is made when the individual’s CD4 cell count falls below 200 cells/mm³, or when opportunistic infections or certain cancers (such as Kaposi's sarcoma or lymphoma) are detected. Diagnosing AIDS involves a more thorough assessment of the individual’s immune function and overall health, as opposed to just the detection of HIV.

5. Treatment Goals Are Different

The treatment goals for HIV and AIDS differ significantly, although both involve antiretroviral therapy (ART). For HIV, the primary treatment goal is to suppress the virus to undetectable levels, thus maintaining a strong immune system and preventing further transmission of the virus. People living with HIV can often live long, healthy lives if they adhere to ART.

For individuals diagnosed with AIDS, the treatment plan becomes more complex. While ART remains an essential part of managing the virus, treatment for AIDS also focuses on addressing the opportunistic infections and secondary health complications associated with severe immune suppression. The goal of treatment for AIDS is not only to manage the HIV virus but also to improve the quality of life and extend survival by treating these secondary health issues.

Role of Community Engagement in Combatting HIV/AIDS

While the medical community has made great strides in managing HIV, the battle to curb its transmission is also a social and cultural issue. Dr Daman Ahuja, a public health expert, highlights that HIV/AIDS awareness and education are vital to reducing transmission rates and supporting those affected by the virus. "Young people, especially, have become key advocates in the fight against HIV/AIDS," says Dr Ahuja. "Research from UNICEF shows that youth-led initiatives can lower HIV transmission rates by as much as 45% in targeted communities."

Additionally, grassroots activism plays a significant role in raising awareness and addressing stigma. As the World Health Organization reports, community-based interventions have been proven to increase HIV testing rates and improve treatment adherence, which are crucial in the fight against the pandemic.

The ultimate goal of organizations like UNAIDS is to eliminate the HIV/AIDS pandemic by 2030. Achieving this requires global collaboration, from medical treatment advancements to public health strategies, education, and advocacy. Dr Kulkarni’s insight underscores the importance of early detection, treatment adherence, and community support in the fight against HIV/AIDS.

Dr Gowri Kulkarni is Head of Medical Operations at MediBuddy and Dr Daman Ahuja, a public health expert and has been associated with Red Ribbon Express Project of NACO between 2007-12.

Squirrels could be natural hosts of the mpox virus (MPXV) -- that causes monkeypox disease -- according to a recent study by German researchers.

The team from the Helmholtz Institute for One Health (HIOH) identified the fire-footed rope squirrel (Funisciurus pyrropus) as a likely natural reservoir of the MPXV.

The study published in the journal Nature revealed that sooty mangabeys – a primate found in West Africa -- can contract mpox by eating infected squirrels. The disease may present mild lesions, but it can also cause more severe skin lesions or even be fatal.

"Identifying the animal sources of the virus and the exposure routes that lead to inter-species transmission are key steps towards understanding spillover mechanisms and developing effective prevention measures to mitigate the risk of transmission to humans," said Livia V. Patrono, one of the senior authors at HIOH.

Squirrels Suspected MPXV Hosts

While squirrels have long been suspected as potential reservoirs for MPXV, their role was confirmed after an investigation of an mpox outbreak among wild sooty mangabeys (Cercocebus atys) in Côte d'Ivoire.

During the outbreak, reported in early 2023, nearly one-third of the primates showed clinical signs of disease, and four infants died.

The team conducted viral genome sequencing and found that the infected monkeys carried a virus that was nearly identical to an MPXV strain identified in a fire-footed rope squirrel found dead 12 weeks earlier nearby.

Further, the team analyzed fecal samples from the mangabeys. A sample collected eight weeks before the outbreak's onset contained DNA from both the virus and the rope squirrel. This provided strong evidence of interspecies transmission at that moment.

Sooty mangabeys have been previously observed catching and eating fire-footed rope squirrels, which provide a direct route for the transmission of viruses.

Mpox Continues To Spread Globally

Although mpox is no longer a public health emergency, outbreaks of clade I and clade II strains of the mpox virus are continuing in many countries around the world, especially in Africa.

Last week, Madagascar announced the country's first death from mpox, a 3-year-old girl from the island nation’s eastern city of Toamasina.

The WHO has also confirmed that two cases of the recombinant strain – combining genomic elements of clades Ib and IIb of the monkeypox virus (MPXV) – have been identified to date: one in the United Kingdom and one in India.

Mpox is an infectious disease caused by the monkeypox virus (MPXV), part of the Orthopoxvirus genus, which also includes the virus that causes smallpox.

It spreads through close physical contact, including sexual contact, and in some cases through contaminated materials or respiratory droplets.

Symptoms typically include fever, swollen lymph nodes, rash, and/or lesions.

The global health body has also urged all countries to “remain alert to the possibility of MPXV genetic recombination.” It has also urged for continued epidemiological surveillance, sequencing, vaccination of at-risk groups, and infection prevention and control measures.

An international group of scientists has created an artificial intelligence tool that can estimate a woman’s likelihood of developing breast cancer within the next four years.

The AI tool, known as the BRAIx risk score, analyzes mammogram images to generate an individualized risk assessment and flag women who may face a higher chance of developing the disease.

It may not only show the current risk but also predict the future risk, enabling early detection and treatments for a better outcome.

According to the findings published in The Lancet Digital Health journal, nearly one in 10 women ranked in the top 2 percent of risk by the AI tool were diagnosed with breast cancer within four years. This was despite previously receiving a clear screening result.

“These risk scores enable future development of personalized screening pathways to transform population breast cancer screening and save lives,” said corresponding author Helen M. L. Frazer of the University of Melbourne.

Frazer noted that identifying women who appear cancer-free but carry very high risk -- comparable to those with inherited BRCA1 or BRCA2 mutations -- will unravel both hereditary and non-hereditary causes of breast cancer.

From one-size-fits-all screening to personalization

Breast cancer screening programs have significantly lowered mortality rates -- by roughly 40-50 percent among women aged 50 to 74. However, most screening systems still apply the same approach to all women, regardless of individual risk.

Traditional screening tools use genetics, breast density, and questionnaires to estimate breast cancer risk. On the other hand, new AI-based screening tools, such as BRAIx personalizes screening by gathering information already present in breast scan images to better identify who is at higher risk.

“Our results show that conventional mammographic density is a far weaker predictor of breast cancer risk than the BRAIx risk score, even for interval cancers,” the researchers said in the paper. Interval cancers are aggressive tumors diagnosed after a negative mammogram.

The BRAIx Tool

The BRAIx risk score was developed using mammograms from nearly 400,000 women. To prove its efficacy, the AI tool was tested on data from almost 96,000 women from Australia and then confirmed in an independent Swedish population of over 4,500 women.

The findings showed that:

• The BRAIx risk score estimated breast cancer risk more accurately than the traditional risk factors, such as breast density, country of birth, and even family history.

• For the top 2 percent of women with the highest BRAIx risk score, the probability of a cancer diagnosis within 4 years was 9.7 percent -- a risk level exceeding that typically seen in women with inherited BRCA1 or BRCA2 mutations.

The BRAIx risk score can:

• Make breast screening more personalised,
• Improve early cancer detection,
• Reduce false alarms,
• Save lives without increasing costs

Global Breast Cancer Burden

Breast cancer continues to be the most common cancer among women worldwide.

A recent study published in The Lancet Oncology journal predicted that the number of new cases of the deadly disease will reach more than 3.5 million globally in 2050 -- rising by a third from 2.3 million in 2023.

Annual deaths from the disease will also rise by 44 percent -- from around 764,000 to 1.4 million.

However, not smoking, getting sufficient physical activity, lowering red meat consumption, and having a healthy weight can help prevent over a quarter of healthy years lost to illness and premature death from breast cancer.

People who survived a COVID-19 infection can be at significant risk for kidney disease, acute kidney injury, and chronic kidney disease. compared to individuals who were not infected, according to a study.

The study, published online in the journal Communications Medicine, revealed that COVID patients have

• a 2.3-times higher risk of acute kidney injury
• a 1.4-times higher risk of chronic kidney disease
• a 4.7 times higher risk of kidney failure

“While we’re in the post-pandemic era, this shows that COVID-19 history is an important variable when considering the long-term impact of the infection on kidney function and disease,” said first author Yue Zhang, who was at Pennsylvania State University, US, while conducting the study. Zhang is currently a postdoctoral scholar at Johns Hopkins Bloomberg School of Public Health.

How Was The Study Conducted?

For the study, data on over 3 million working-age adults in the United States were analyzed.

The team compared the effect of influenza, another common viral infection that affects kidney health, and people with a history of COVID infection on kidney infections.

Using a machine learning model, the individuals were followed between 180 and 540 days for the emergence of new acute or sudden kidney disease.

The results showed that:

• Both COVID and the flu can worsen kidney health
• Flu caused a mild and temporary effect
• COVID increased the risk of acute kidney injury for a longer duration
• COVID survivors developed kidney disease within a few hours to a few days
• COVID patients had a longer-term chronic and end-stage kidney disease.

How COVID Worsens Kidneys Health

The Penn State researchers explained that kidney cells express high levels of the primary protein receptors that SARS-CoV-2 uses to enter and infect cells. Kidney cells also produce specialized enzymes that help viruses enter cells.

According to Kidney Health Australia, an acute COVID infection can impact the kidneys with fevers and respiratory symptoms, and/or worsening blood sugar control.

The US National Institutes of Health stated that renal dysfunction is an increasing clinical indicator of COVID propagation.

Citing several studies, the NIH said that the most common clinical manifestation is proteinuria -- found in more than half of the COVID patients. In addition, hematuria, elevated blood urea nitrogen, and elevated serum creatinine are other common features in Covid survivors with poor kidney health.

Nasr Ghahramani, Professor of Medicine at Penn State College of Medicine, stressed the need for COVID survivors, especially those with diabetes and high blood pressure, to take "more frequent and more prolonged monitoring of their kidney function" to enable early detection and better outcomes.