Insights from Anti-Retroviral Treatment Centres in Kadapa District
When Anjali (name changed) first walked into the Anti-Retroviral Treatment (ART) Centre in Kadapa District in 2008, she was frail, with persistent fever and a CD4 count of 180 cells/μL—well below the healthy range of 500-1500 cells/μL. Today, at 52, she manages her household, tends to her small farm, and attends quarterly check-ups where her undetectable viral load confirms what modern medicine has made possible: HIV is now a manageable chronic condition for millions. Her journey mirrors the revolution in HIV care over the past two decades, a transformation documented in the health profiles of patients accessing ART centres across India.
This article explores the evolving health landscape of HIV-positive individuals through the lens of ART centres like the one in Kadapa District, examining how antiretroviral therapy has reshaped patient outcomes, what key health indicators reveal about disease progression, and what cutting-edge research promises for the future. The data from these centres doesn't just represent numbers—it tells the story of how a once-devastating diagnosis has been transformed into a manageable health condition through scientific progress and dedicated healthcare infrastructure.
HIV has shifted from a fatal diagnosis to a manageable chronic condition thanks to advances in ART.
HIV is a retrovirus that specifically targets the body's immune system, particularly CD4 T-cells 1 . Unlike common cold viruses that the body can clear, HIV establishes permanent infection by integrating its genetic material into the host's DNA, creating what scientists call a "latent reservoir" of infected cells 2 .
Without treatment, HIV gradually depletes CD4 cells over several years, eventually leading to AIDS, the advanced stage where the immune system becomes too weak to fight off infections and certain cancers 6 . The distinction is crucial: HIV is the virus; AIDS is the condition that develops when HIV is left untreated.
| Feature | HIV (Virus) | AIDS (Condition) |
|---|---|---|
| Definition | Virus that attacks immune cells | Advanced stage of HIV infection |
| Diagnostic Criteria | Presence of virus confirmed by testing | CD4 count <200 cells/μL or specific opportunistic infections |
| Treatment | Antiretroviral therapy (ART) | ART plus medications for opportunistic infections |
| Prognosis | Excellent with proper treatment | Requires immediate medical intervention |
One challenge in HIV control is the "window period"—the time between initial infection and when tests can reliably detect the virus. During this period, which can last several weeks to months, an infected person may test negative despite being able to transmit the virus 6 . Modern fourth-generation tests that detect both HIV antibodies and antigens (viral proteins) have shortened this window to approximately four weeks in most cases 6 .
Early symptoms, when present, typically appear two to six weeks after infection and may include 1 6 :
At ART centres like the one in Kadapa District, healthcare professionals regularly monitor specific biomarkers to assess patients' health status and treatment effectiveness:
This critical measure indicates immune system strength. A healthy immune system typically has CD4 counts between 500-1500 cells/μL.
This test quantifies the amount of HIV virus in a milliliter of blood. The goal of treatment is to achieve an "undetectable viral load".
These are infections that take advantage of weakened immune systems. Their presence often indicates advanced disease or treatment failure 1 .
| Disease Stage | CD4 Count Range | Clinical Features |
|---|---|---|
| Early Infection | >500 cells/μL | Often asymptomatic or flu-like illness |
| Intermediate Stage | 200-500 cells/μL | Mild infections, swollen lymph nodes |
| Advanced HIV (AIDS) | <200 cells/μL | Serious opportunistic infections, weight loss, certain cancers |
Data from HIV surveillance systems reveals important patterns in diagnosis and treatment outcomes:
Despite progress, a significant challenge remains late diagnosis. In 2024, 42% of new HIV diagnoses in England were made at a late stage (CD4 count <350 cells/μL) . Late diagnosis is associated with a tenfold higher risk of death within a year of diagnosis compared to prompt diagnosis .
With effective treatment, people with HIV are living longer. In 2024, over half (52%) of people receiving HIV care in England were aged 50 years and over, compared to just 26% in 2015 . This success brings new challenges, including managing age-related conditions alongside HIV.
The UNAIDS 95-95-95 targets (95% of people with HIV know their status, 95% of those diagnosed receive treatment, and 95% of those on treatment have suppressed viral loads) are being met in several countries. In England, 2024 data shows 95% diagnosed, 99% on treatment, and 98% virally suppressed .
While ART can reduce viral load to undetectable levels, it cannot eliminate HIV entirely because the virus establishes latent reservoirs—dormant HIV genetic material hidden within the DNA of certain immune cells 2 . These reservoirs represent the greatest obstacle to an HIV cure, as they can reactivate if treatment is stopped.
Researchers have developed sophisticated methods to detect and quantify these reservoirs. A 2022 study published in HIV/AIDS journal detailed a flow cytometry protocol for detecting HIV-infected cells by identifying the viral capsid protein p24 inside T-cells 9 .
Blood samples are collected in EDTA tubes to prevent clotting and preserve cells.
The study found that the percentage of p24-positive CD4 T-cells directly correlated with HIV viral load measured by standard PCR methods 9 . Specifically:
The detection method showed 64% sensitivity and 82% specificity for diagnosing HIV infection.
| Application | Sensitivity | Specificity | Positive Predictive Value | Negative Predictive Value |
|---|---|---|---|---|
| HIV Diagnosis | 64% | 82% | 78% | 69% |
| Treatment Monitoring | 55% | 73% | 40% | 83% |
HIV research relies on specialized reagents and tools. Here are some essential components used in the detection and study of HIV:
| Reagent/Tool | Function | Example |
|---|---|---|
| p24 Antibodies | Detect HIV capsid protein; different clones recognize various HIV strains | Clones KC57 and 28B7 9 |
| Flow Cytometry Antibodies | Identify specific immune cell types by surface markers | CD3, CD4, CD8 antibodies 9 |
| Permeabilization Buffers | Enable antibodies to enter cells by creating membrane pores | Perm Buffer III 9 |
| ELISA Kits | Detect and quantify p24 antigen in research samples | In-house protocols developed to reduce costs 4 |
| Broadly Neutralizing Antibodies (bNAbs) | Research tools to understand immune response; potential therapeutic agents | VRC07-523LS, CAP256V2LS used in cure research 5 |
The landscape of HIV treatment is evolving from daily pills to long-acting formulations. Recent research presented at CROI 2025 highlighted an investigational twice-yearly treatment regimen combining lenacapavir with broadly neutralizing antibodies 5 . This approach could transform HIV management by reducing the treatment burden from 365 daily doses to just two injections per year.
Daily pills per year with traditional ART
Injections per year with new long-acting therapy
"Our dedication to scientific discovery [and] our commitment to addressing the diverse treatment needs and preferences of communities affected by HIV"
While complete eradication of HIV remains challenging, several approaches show promise:
To date, at least ten individuals have potentially been cured of HIV through stem cell transplants received for cancer treatment, using cells from donors with natural HIV resistance 8 . While not scalable to millions, these cases provide crucial insights.
CRISPR-based approaches like EBT-101 represent a promising frontier, with the FDA granting Fast Track designation in 2023 2 . This therapy aims to cut HIV DNA out of infected cells, potentially offering a functional cure.
Despite scientific progress, accessibility remains a concern. While research suggests lenacapavir could be mass-produced for as low as $25-46 per patient annually, its current U.S. list price exceeds $28,000 per year 7 . This disparity highlights the need for policies that ensure groundbreaking treatments reach all who need them, not just those in wealthy nations.
Potential annual production cost
Current U.S. list price per year
The health profile of HIV-positive individuals at ART centres like the one in Kadapa District tells a remarkable story of scientific progress. What was once a uniformly fatal diagnosis has become a manageable chronic condition, thanks to decades of research, drug development, and healthcare infrastructure building.
The journey from Anjali's first visit with a CD4 count of 180 to her current life with an undetectable viral load mirrors the broader arc of HIV treatment—from crisis to control. While challenges remain—including latent reservoirs, late diagnosis, and access inequities—the scientific toolkit continues to expand with long-acting treatments, cure research, and innovative detection methods.
As we look to the future, the evolving health profile of people living with HIV serves as both a testament to what science can achieve and a reminder that the work continues until HIV is no longer a global health threat. The data from ART centres worldwide doesn't just track viral loads and CD4 counts—it documents one of modern medicine's most successful transformations, offering hope for the next chapters in this scientific journey.
HIV identified as cause of AIDS
Introduction of ART
"Undetectable = Untransmittable" concept
Long-acting therapies and cure research
References will be added here manually.