Words by Eleanor Deane, Science and tech editor

‘It’s A Sin’, the 5-part Channel 4 miniseries, depicts the lives of a group of friends living in London throughout the height of the HIV crisis in the 80s. Today, an undetectable viral load means the virus cannot be passed on – an important message from the ‘U = U’ campaign. However, for many, the stigma and personal health battles including medication side-effects remain. There remains an on-going struggle to see preventative medications (known as ‘PrEP’) become more widely accessible.

The retelling of the misinformation and rumours of the early 1980s draws an eerie parallel to current misinformation surrounding Covid-19. HIV (human immunodeficiency virus) is a virus that infects the cells of the immune system. Over time, this causes immunodeficiency. 

The series shows the increasing fear over unexplained reports of Kaposi’s Sarcoma and PCP (Pneumocystis pneumonia). Kaposi’s Sarcoma may be recognised by discoloured patches on the skin or inside the mouth. PCP is a type of pneumonia caused by a fungus which may cause an infection when the immune system has been weakened. 

In 1985 an antibody test was introduced, but initially, the mainstay of treatment was to prevent opportunistic infections and to provide palliative care. In the early 90s, HIV infection became the leading cause of death in people aged 25-44 in America. Initial trials of the antiretroviral AZT proved to be unsuccessful, however in 1994 AZT was found to reduce transmission from pregnant women to their babies. 

The late 90s saw the introduction of new medications such as protease inhibitors, triple therapy to target the virus at different points in the replication cycle, and the introduction of viral load testing.  These led to the widespread closure of HIV wards as the need for inpatient treatment decreased. These improvements were often described as a ‘Lazarus phenomena’ as there was now the ability to bring patients back from the edge of death. Viral load is a measurement of viral replication – the lower the better. A low viral load means the virus will not be passed on. 

The 21st century has seen further developments such as an improvement in the tolerability of antiretroviral therapy, improvements in the formulation (so fewer tablets) and a shift towards earlier treatment. Earlier antiretroviral therapies had less tolerable side-effect profiles with some medications causing lipodystrophy – a change in distribution of body fat stores. 

In 2012 the US FDA approved pre-exposure prophylaxis (PrEP). PrEP is a tablet containing tenofovir and emtricitabine, which are two tablets used in the treatment of HIV. PrEP can be taken before exposure to HIV to prevent HIV transmission. PrEP is sometimes called Truvada, which is its brand name patented by the company Gilead Sciences, but in the UK generally a generic version of PrEP is used. PrEP was initially only available as part of the IMPACT trial which ended in July 2020. Now, PrEP is offered on the NHS to patients at high risk of exposure to HIV. 

Today, transmission rates from a pregnant woman to her baby whilst on combination therapy are very low (less than 1%). Antiretroviral treatment now consists of at least three different drugs which attack viral replication in at least two different places in the cycle. In some of these regimes, all medications may be taken in just one tablet each dose. This is an improvement to the complexities of previous medication regimes, chillingly depicted against a backdrop of ‘Running Up That Hill’ in ‘It’s A Sin’. However, treatment remains lifelong and medication must be taken at strict times. Interestingly, there have been two documented cases of cured HIV with patients in Berlin and London successfully stopping antiretroviral treatment. These were following highly intensive treatments and transplants, which were extremely high risk and so not suitable to be scaled for wider use.  

According to the Independent, ‘It’s A Sin’ has broken the record for the most views of any show in one month on Channel 4. Channel 4 has reported a rise in HIV testing due to the reach of the show. If you’re looking to get a test, they are readily available throughout Brighton and Hove. You can use this website to find out how to get a free postal self-test kit for your area: https://test.tht.org.uk/finder  

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