• What is HIV? What is AIDS?
• How is HIV spread?
• How does HIV progress if left untreated?
• How does treatment work?
• How can I protect myself?

What is HIV? What is AIDS?

HIV (Human Immunodeficiency Virus) is a virus that can infect the human body.

Viruses are not like cells, which have all the biological machinery they need to live and reproduce. Viruses are just packages of genetic instructions – usually DNA, sometimes RNA – that hijack living cells’ machinery to manufacture copies of themselves. HIV specializes in hijacking and destroying the cells of your immune system. When enough of your immune system has been destroyed, you become vulnerable to opportunistic infections (OI’s) – unusual infections and cancers that a healthy immune system could overcome but yours can’t.

AIDS (Acquired Immune Deficiency Syndrome) is a stage of disease caused by HIV infection.

The AIDS disease stage is marked by severe damage to the immune system and proceeds to death if left untreated. The damage can be measured by very low counts of T-cells (one kind of white blood cell in your immune system), with counts below 200 indicating what is often called full-blown AIDS. Even with T-cell counts above 200, you will be considered to have full-blown AIDS if you are having certain OI’s that only occur when the immune system has almost stopped functioning.

People who are infected but have not progressed to full-blown AIDS should not be called “people with AIDS.” They are people living with HIV.

How is HIV spread?

HIV lives in human blood and other body fluids. HIV can infect a new human host when body fluids from someone who is already infected get into the body of someone who is not. Just getting HIV onto someone isn’t going to cause infection; the virus has to get inside. The human body’s outer defenses – skin, mildly antiseptic saliva and tears, and more – make this difficult.

The two major routes past the body’s outer defenses are (1) unsafe sex – vaginal or anal sex without a condom, or oral sex in which semen enters the mouth; and (2) unsafe drug use – sharing injection needles or powder inhaling tubes.

There are other routes, as hemophiliacs and other users of medications derived from human blood discovered to their sorrow in the 1980's. (The blood supply is now screened much more effectively for HIV and other blood-borne viruses, so using insulin or being given blood during surgery is now much safer.) If you are in a relationship where one of you lives with HIV and one doesn’t, never share razors or toothbrushes. But the main routes are the Two Unsafes: unsafe sex and unsafe drug use.

How does HIV progress if left untreated?

 HIV can’t be cured yet – that’s still some years away – but early treatment can keep the virus from reproducing and doing much of its damage. Left untreated,  HIV progresses in four stages.

         The new infection

For a few weeks after you become infected, the virus explodes into activity, making copies of itself in the virgin territory of your body. Some newly infected people experience a mild, flu-like illness. Others have no symptoms at all. Because there is so much virus in your blood and other body fluids during this stage, you run an unusually high risk of infecting others through unsafe sex or unsafe shared drug use.

         The next three to six months

Over the next three to six months, your immune system learns to recognize the virus as an invader and begins to produce antibodies against it. Unfortunately, HIV is one of the few viruses that can protect itself from the antibodies; your immune system cannot stop the virus without help (treatment).

The antibodies are not completely useless, though. They will make you test positive for HIV – which is not news you want to hear, but at least now you know you have the virus. You can get treatment. You can do things to keep yourself healthy and not pass the virus on to others.

In the three to six months before your immune system starts making antibodies, you may test negative for HIV, even though you are infected. If you’re getting yourself tested because you’ve done something you know is risky, a negative test result doesn’t mean you’re home free. Wait a few months and get tested again. And be just as careful with others, while you wait, as you would be if the first result had been positive. You still don’t know for sure.

         “Latency”

For some years – as many as ten, for some people – the virus doesn’t seem to be doing much. Some people will have minor symptoms that make them wonder whether there might be something wrong – unexplained fevers, night sweats, diarrhea, swollen lymph nodes, fatigue, and so forth. Others may not notice anything unusual during this period.

Deep in your body, though, the virus is slowly dismantling your immune system, hijacking white blood cells to make copies of itself faster than your body can replace them. When this has gone on long enough, the immune system is so damaged that it can’t protect you from major opportunistic infections (OI’s) and cancers.

         AIDS

AIDS is the final stage of HIV infection, when your immune system is so damaged that you begin to have major opportunistic infections. Many people who never got themselves tested first learn they have HIV when they go into hospital with a cancer or fungal infection that people with intact immune systems just don’t get. The most common of these disease-stage-marking OI’s are Kaposi’s Sarcoma, a skin cancer, and pneumocystis pneumonia, a fungal respiratory infection.

Left untreated, HIV at this stage of disease will kill, often in a few weeks or months, almost always within a very few years.

Fortunately, even at this stage, starting treatment brings many people back to reasonably normal health and normal lives. Current treatments don’t cure HIV, but they can keep it inactive, so your immune system can function more normally and effectively. The results aren't always as good as they might have been if treatment had started earlier, but even people starting treatment at this late stage often get back to fairly good health with fairly normal life expectancies.

How does treatment work?

HIV treatment today includes drugs to keep HIV from reproducing in the body, and management of inflammatory disorders that HIV causes even when prevented from reproducing.

There is no “cure,” yet, no course of treatment you can follow for ten days or two months and never have to worry about your infection again. Researchers are working on that, but no one expects a true cure this year or next. For the foreseeable future, treatment means using drugs to control – not eliminate – the virus, and managing the inflammations.

         Control: keeping HIV from reproducing

Stop reproduction and you (mostly) stop the damage it does to the immune system. We can do this by taking combinations (“cocktails”) of HIV drugs. The roughly thirty HIV drugs now available work by interfering with one of the three stages of the viral reproduction cycle – entering a cell of your immune system, taking control of its machinery, and using that machinery to assemble new viruses to enter more cells. If the virus can’t reproduce, it can’t infect more immune system cells.

Here’s the science behind the “cocktail” approach to using drugs to control HIV reproduction.

Different HIV drugs may interrupt the same stage of reproduction in different ways. Researchers have used this to solve one of the most serious problems in treating HIV. Before the mid-1990's, doctors usually prescribed one drug at a time. Each drug used would soon lose effectiveness, because HIV mutates rapidly, and with so many new versions of the virus being produced, very soon there will be one that can find a way around the drug.

As more drugs became available, though, researchers experimenting with using them in combination found (1) that they could prevent reproduction almost completely, and (2) that the drugs kept working because no single mutation was likely to hit the bulls-eye and give the virus a way around all the drugs at once. People taking “cocktails” can now stay on the same specific combination of drugs for five years or more.

The “cocktail” is a control, not a cure. It only blocks viral reproduction, so it can’t reach HIV in hiding places where it just lies dormant, waiting to become active and start reproducing another day. Stop taking your “cocktail,” and the HIV will come right back. This means that starting HIV drugs is a lifetime commitment.

         Management: dealing with inflammatory disorders (and more)

If your doctor is any good at HIV medicine (and find a new one, if she or he isn’t!), you will find yourself being tested routinely for blood pressure, cholesterol levels, liver and kidney function, rare cancers, and all sorts of others things you thought only old people had to worry about.

Even treated, HIV overexcites the same immune system that can’t get rid of it, and the resulting chronic inflammation ages organs and arteries early. Your doctor may prescribe anti-inflammatories (aspirin, Ibuprofin, etc) or statins (cholesterol busters) to slow that process down, and suggest changes in lifestyle like quitting smoking and eating more fruits and vegetables. Everyone’s body is a little different, so talk to your doctor about what’s right for you.

How can I protect myself?

Click HERE to find out!