The arrival of Highly Active Antiretroviral Therapy (HAART) proves to be one of the medical research achievements in controlling the drastic increase of mortality rates due to HIV infection. The revealing effects of HAART in people living with HIV include: weakened actions and effects of HIV in infected individual, recovered immune system; increased CD4 count; lowered viral load; reduced the presence of opportunistic infections; inhibited faster progression to AIDS; and significantly increased overall quality of life.
In able to understand how HAART works and what contributes to its success requires many factors to take account of.
The fate of human HIV-infected cell without HAART intervention
HIV is composed generally of genetic materials, proteins, specific viral enzymes, and protective envelop. The genetic material is composed of two single-stranded RNA that contain all genetic code and information needed to survive, reproduce and replicate. Proteins from the viral envelop are used primarily for attachment to human cell. Different enzymes contribute in structuring another viral cell. Once the viral genetic material is infused to human cell, reproduction of the virus will never stop until that cell dies.
HIV does not bind to any type of cell in the body. The virus requires specific receptors from the surface of host cell to be able to attach itself, penetrate, and release its contents to the human cell.
Viral enzymes needed to perform deception
There are three viral enzymes necessary to succeed in generation of new HIV cell:
•Reverse transcriptase
In order to trick the human cell, HIV uses this enzyme to convert its viral RNA to viral DNA (because DNA is the genetic material of the human cell; making a replica of host DNA will enable the virus to accomplish the replication instruction encoded in viral RNA). What a devious plan, isn’t it?
•Integrase
It is the second enzyme needed to perform the deceit. The successful transcription of HIV from viral RNA to viral DNA, the enzyme integrase will integrate the newly-transcripted viral DNA to human DNA. In this condition, the human cell does not recognize the newly-incorporated viral DNA and what is worst—the human DNA considers the viral DNA as its own genetic material. Now the viral DNA can execute into effect (freely) the generation of HIV components (viral RNA and viral proteins) without any inhibition.
•Protease
It is an enzyme needed to assemble the newly-formed viral RNA and viral proteins to produce new HIV. Even though numerous new HIV cells bud and leave to infect another cell, the viral DNA will permanently remain in the host cell and continue its function until the cell dies; the cell dies without knowing the enemy’s deception.
Another fate of an HIV Infected cell
There is another fate of HIV infected cell (particularly the CD4 T cell) besides death – those CD4 infected cells that managed and survived the effects of HIV turns into a resting memory state or into a latency state. In this condition, the latently infected cell manages to live ineffectual. Even though nonfunctional and non-reproductive, the viral DNA attached to human DNA—which is still competent for replication— remains unscratched and nevertheless, capable to be reactivated and accomplish immune system destruction.
Though the fate for the HIV-infected cell is studied and documented, still there’s no reason not to hope. The understanding of the functions of these three enzymes provides the structural basis of antiretroviral drugs and the success of HAART in debilitating the capabilities of HIV to further destruct the immune system. The determination and the willingness of the medical researchers to help and procure a cure must not be underestimated.
Glimpse of hope provides a better future
Once HIV DNA is already fused with human DNA, the human body provides a factory for viral replication, but once HIV is still on the outside of the host cell or just recently binded to the surface of the host cell (but not reversely transcribed and integrated), the body’s immune system has still the capability to detect it as an antigen. The problem is the faster actions and effects of HIV outwit the production of antibodies against the virus. Before the antibodies have been produced into the circulation, numerous HIV cells had already been created and HIV mutation more possibly existed—ready to destroy the outsmarted human defenses. Now, where is the hope lies in these sentences?
The hope lies when HIV is still on the outside of the cell—when the virus is not integrated into human cell. There’s still the capability of producing antibodies against (and primarily) the un-mutated HIV cells. That those antibodies (no matter how sluggish and outmaneuvered they were formed) are still antibodies! This is the basis of many recent researches done today—like the manufacturing of vaccines against HIV; an eradication strategy that can destroy HIV reservoirs and thus can result to find a potential cure for HIV.
The Fate of Human HIV-infected Cell with HAART Intervention
HIV antiretroviral (ARV) drugs are drug regimens that counteract the effect of HIV. Each antiretroviral drug is purposely and specifically designed to inhibit the action of each viral enzyme. Two or more antiretroviral drugs taken at the same time is called combination therapy. Combination of three or more anti-HIV drugs is called Highly Active Antiretroviral Therapy (HAART)—meaning, it is a combination of therapeutic effects offered by each specific drug to block a specific viral enzyme.
Antiretroviral drugs are classified as:
•Reverse Transcriptase Inhibitors
Reverse Transcriptase Inhibitors are medications that block the enzyme reverse transcriptase. These prevent the transcription of viral RNA to viral DNA—without viral DNA; viral replication is inhibited. These drugs include Nucleotide/Nucleoside Reverse Transcriptase Inhibitors and Non-nucleoside Reverse Transcriptase Inhibitors.
•Integrase Inhibitors
Integrase Inhibitors are medications that block the enzyme integrase.These drugs obstruct the viral DNA to incorporate itself to human DNA—which also promote viral reproduction failure.
•Protease Inhibitors
Protease Inhibitors are drug regimens that block the enzyme protease; thus, prohibit the assembly of new HIV cells inside the host cell.
•Fusion inhibitors
Fusion inhibitors are medications that block the binding and fusion of HIV to human cells (HIV’s strength and capability to do its function is when inside a host cell)—and thus, prevent damage to the immune system.
Success From Within
HAART success is well-documented and well-proven. The understanding of how the specific antiretroviral (ARV) drug works against the virus and the therapeutic combination of two or more drugs will and can contribute to a total adherence of people living with HIV to HAART; and thus, reduce the number of HIV drug resistants (one reason why resistance to antiretroviral drugs occur is the non-adherence to HAART).
Most HIV-infected people take the ARV drug without knowing the importance and function of each drug in the battle with HIV. They just know it is an anti-HIV drug; and so adherence to HAART is not one of their priorities. But if the infected person acquires substantial knowledge of how HIV attacks the body and how HAART fights against the actions and effects of HIV (by incorporating considerable information in public health education for HIV-infected people), they will understand how important adherence is and the consequences of being non-adherent.
The start of a cure for all diseases does not commence from things but it originates from within. HIV infected people must not be satisfied only to take ARV drugs without understanding the functions, the importance and consequences of HAART; and must not be content to the shadows of drug resistance.
Maybe it’s time that basic but significant scientific knowledge does not only remain in the grasp of people in the medical field—how HIV attacks, how HAART battles with HIV, and how ARV drug resistance occurs. People living with HIV also have the determination and will power to help themselves; and thus possess strength to survive—strength that cannot be taken away from them.
