HIV is not a death sentence, before we dig into the nitty gritty, there are a few concepts that I think would be worth reviewing so that we're all on the same page.
The first concept is that HIV is a virus, sometimes it's referred to as a retrovirus, and the most common way that HIV is transmitted is through sexual exposure. However, we also know HIV is easily transmitted through blood, and that could mean through sharing of needles, or it can even mean from mom to developing baby.
What's really interesting, and I think new news to a lot of people, is that every time somebody is exposed to HIV, it doesn't necessarily mean that you get infected. In fact, not that we ever want to be exposed to HIV, but the likelihood of getting infected from a single exposure is actually relatively low. However, it's sorta like playing Russian roulette. You don't wanna take your chances.
HIV targets the CD4 molecule on the T cell, and as HIV infects that T cell, it will ultimately result in the death of that cell. The CD4 T cell is a critical component of the immune system. And the way that I like to think of the CD4 T cell is that it's like the general of the immune system, or general of the army.
The role of the CD4 T cell is to orchestrate, or organize, or coordinate the rest of the immune system so that it can fight the good fight if it sees an invading microbe. Over the course of time, as the HIV virus is replicating, it's constantly infecting CD4 cells and causing them to die. If that becomes severe enough, somebody actually has acquired immunodeficiency syndrome, or AIDS.
So let's look at the timeline from what happens the moment HIV enters your body until it then widely disseminates and causes widespread HIV infection.
Once virus enters the body, it hitches a ride to a nearby lymph node where it can start infecting its target and reproducing itself over and over again in such high level that it will then spill out into the bloodstream and widely disseminate throughout the body. That is the earliest stage of HIV infection.
During this time, when HIV leaves the lymph node and spreads throughout the body, it reaches numbers that are sky high. And in fact, if you measured HIV in the bloodstream, it would be at the highest level during that period of time than at any other time during the natural history of HIV infection. There's one major implication of having that high level of virus in your body. And that means, at that time you are super infectious to another.
And the problem is that when people have such high level of virus early on, they most likely have no idea that they're even infected. And so it's sort of the perfect storm because at the very time that you're most infectious to somebody else, you may not even know that you're infected yourself.
Prevention of HIV Infection Before Exposure
We know that there's a highly effective strategy for people who are at extremely high risk of acquiring HIV through sex, in which we call that strategy pre-exposure prophylaxis, or PrEP. And all PrEP is, is taking two HIV medications in one pill, that's the most common strategy for PrEP, to take medications every day in case you find yourself at risk or exposed to HIV. And having that medication on board can prevent infection in the vast majority of cases.
This isn't a strategy for everybody, but it's a really good strategy for people who find themselves frequently at high risk for being exposed or infected with HIV.
Prevention of HIV Infection After Exposure
I often get called from patients who said, Doctor, I think I may have just been exposed to HIV, what do I do? And fortunately, there is another strategy called post-exposure prophylaxis, which involves taking HIV medication for several weeks in order to prevent infection from taking hold.
If we think about a sexual exposure, the most common way virus enters the body, once HIV is in contact with the surface that it's going to infect, over the course of approximately 72 hours before the virus actually reaches the lymph node, provides us with an opportunity to treat people with a high risk exposure with HIV medicines in order to abort virus from causing infection.
Although this is little known, most people who have early HIV, within two to three weeks after virus entering their body, develop what we call acute HIV infection or the acute retroviral syndrome (ARS), and that is a flu-like or a mononucleosis-like illness. And so for anyone who's ever had mononucleosis, you'll certainly be able to identify with these symptoms.
Most people have fever, very bad sore throat, swollen glands, rash, poor appetite, nausea, unintentional weight loss. And if that's you, if you have those symptoms, does it mean you have HIV? Definitely not.
But if you think you had an exposure within the past several weeks and you develop these symptoms, that means you should be calling your doctor right away and saying, I have these symptoms and I have a potential recent exposure, what do I do? So the bad news is that untreated HIV infection will progress towards AIDS.
The good news is that with treatment, we can virtually halt HIV in its tracks. So don't wait, 72 hours is a very short period of time, but it can be critically important and be the difference between becoming infected and staying uninfected.
It's important to remember that being diagnosed with HIV is not a death sentence. And we know that in 2021, most people are going to do great. It's just a matter of seeking medical attention, getting started on the most appropriate therapy and sticking to the regimen.
HIV is a chronic disease now, just like high blood pressure and diabetes. And what we know is that the earlier you treat it, the better you're probably going to do.
HIV Testing
How frequently a person should get tested for HIV deaths, the infection or for AIDS?
According to the CDC (Center for Disease Control and Prevention), what they recommend is, any person between the age 13 years and 64 years, they have to get tested for this virus, that is HIV virus, at least once in a lifetime. This is what is recommended.
When do we go ahead and test ourselves frequently without the recommendation? For example, healthcare professionals. We are at the high risk of any kind of infection transmission, be it HIV, HBsAg, that's hepatitis B or hepatitis C. So people who are in healthcare professions and who are exposed to HIV virus, these are the kind of people who have to go for screening frequently.
Now what about the general public? When are they supposed to go ahead and get themselves tested for HIV?
First and most important reason is whenever they have had an encounter with a person who is unknown or whose status of HIV is unknown and this is the most important indication where they have to go and get themselves tested for HIV.
Another scenario where a person is having multiple sexual partners, even them, they have to go and get themselves tested for HIV, especially men. Men are more prone for HIV transmission. So people who have had multiple sexual partners or an unnatural intercourse like an anal intercourse, which happens very frequently in homosexual men, so they also have to get themselves tested very frequently.
In a very common scenario, what happens is if people have shared needles during drug abuse. These are certain things which they are not forthcoming, but in case if there's any needle sharing during any drug abuse, even then they have to go and get themselves checked for HIV infection. These are the very common indications where you have to go and get it checked.
Now how do you check for the HIV infection?
So you have home tests, the rapid tests. These actually use the presence of antibodies in the blood and which says whether you know you are exposed to the infection or you are HIV positive. Another method of doing is by doing an antigen testing.
Antigen testing is nothing but the presence of the antigen, that's the viral antigen in your blood. So this is done in specific laboratories. Suppose if the exposure has happened very recently, then you actually have to get the test for viral load in the blood.
If you're doing an antibody test, there's something called window period where after the exposure of the HIV infection, it will not be detected in your blood because there won't be presence of antibodies. Antibodies take a while for it to get present.
So if antibody test is performed in a window period, it'll turn negative. So you need to have series of at least three of antibody testing in a period of six months for you to be completely declared as HIV free. HIV was considered to be a taboo earlier, but not now.
There's so many advanced medications that are available so that you can be as healthy as other people. No one will ever know whether you're infected with HIV unless and until you go ahead and tell people. But the most important thing is early diagnosis and early initiation of treatment.
The earlier you get diagnosed, you can go on medications and you can live a normal life. So there is nothing to feel guilty about it or feel ashamed of it and not taking proper steps at healthcare as soon as you get diagnosed.
So most important is as soon as the diagnosis is made, please go ahead and follow up with your healthcare professional because they are the ones who will help you to the right medication.
While medication will not cure HIV, these medicines are so effective that they can restore your immune system to near-normal levels, and therefore you should live a near-normal life.
FAQS About HIV Infection
Fact Check: HIV and AIDS are pretty much the same thing.
This is false. Being HIV infected just means that the human immunodeficiency virus is living in your body. However, having AIDS or the acquired immunodeficiency syndrome is what happens to somebody after years of having HIV inside their body.
Fact Check: If you have HIV, it's only a matter of time before you have AIDS.
This is false. There are now over 30 drugs that can effectively treat HIV infection. These medications prevent the virus from replicating or reproducing.
So how does this all work? A good analogy that was presented years ago at one of the early AIDS conferences is that the development of AIDS is like a train speeding down a track towards a ravine. We know the speed of the train is similar to the level of virus in the bloodstream or the viral load, and we know the distance the train has to travel to fall over the cliff is the CD4 count.
Medicines will stop the virus from replicating and therefore will lower the viral load in the blood. Hence, it's analogous to stepping on the brakes of the train and stopping it from speeding down the track. In doing so, as the virus is suppressed, the number of T-cells or the CD4 count will slowly increase, and that will serve as similar to adding track back to the train so that the train gets further and further from the cliff.
So although the development of AIDS is like a train speeding down the track, the initiation of AIDS medicines stops the train in its tracks and will actually start to reverse the process altogether.
Fact check: There are no symptoms of HIV until I have AIDS.
True and false. This is a tricky question because many people are unaware of early symptoms of HIV until they develop AIDS. However, many people have a mononucleosis or flu-like illness several weeks after being infected with HIV.
This flu-like illness, also called the acute retroviral syndrome, can make you feel sick for a few days or weeks and then goes away. Most people with the acute retroviral syndrome are unaware that they are HIV infected, and because they get better over time, often don't seek medical attention. However, if you do become sick and have had a possible recent exposure, you should call your doctor and let he or she know.
Fact check: HIV is forever, but AIDS is not.
This is true. While infection with HIV is forever because the virus will always be within your body, the development of AIDS is not. Most infections occur when the CD4 T lymphocyte count falls below 200. So, that level is when we consider people as having the acquired immunodeficiency syndrome or AIDS.
However, with effective therapy, we can build that CD4 lymphocyte count back up, and in fact, we can build it almost to near normal levels. So, once the CD4 lymphocyte count goes above 200, that person is considered as not having AIDS anymore, even though they're still HIV infected.
Fact check: I heard that when you have HIV AIDS, you have to take a handful of pills every day.
False. This used to be true many years ago, but now therapy is easy to take, and many patients may only have to take as little as one pill once a day.
Now there's even a once per month injection that also works well. So, long gone are the days in which HIV infected patients have to take lots and lots of pills.
Fact check: Is it true that if I get treatment, I will have lots of side effects from medication?
Mostly false. While there are common side effects from HIV medications, they are manageable. Some people initially get side effects like headache or gastrointestinal upset, but these side effects tend to be short lived and will likely get better after several days or weeks on treatment.
However, some people do get intolerable side effects, and if that's the case, medications may need to be switched around until a regimen is found that works and is acceptable.
Fact check: People with AIDS can have a close to normal life expectancy.
This is mostly true. The key to having a long and healthy life while living with HIV AIDS is to seek out medical care and take HIV medications seriously. While medication will not cure HIV, these medicines are so effective that they can restore your immune system to near normal levels, and therefore you should live a near normal life.
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