Human Immunodeficiency Virus (HIV)

HIV stands for Human Immunodeficiency Virus, which is a virus (see Differences Among Germs).  It destroys one aspect of our immune system, specifically a type of white blood cell called “CD4 Lymphocyte” or “T-helper cell” (old name was “T4 Cell,” we often just say “CD4 Cell” or “T-Cell” for short).  The CD4 cell protects us from strange germs and cancers that never affect people with a normal immune system.

AIDS stands for “Acquired Immuno-Deficiency Syndrome,” which is when enough CD4 Cells have been lost, that those strange germs and cancers are free to hurt us.  It was called a “syndrome,” meaning a group of conditions, because when AIDS was first discovered in 1981, nobody knew what it was.  All we knew were that healthy gay men, drug users, and people who’d gotten blood transfusions were suddenly starting to get strange diseases we’d never seen before.  Something was clearly wrong with their immune systems, nobody knew what.  The word “Acquired” meant not congenital (from birth), since we knew the various rare immunodeficiency diseases which affect young babies.

Now we understand that AIDS is simply the last stage of untreated HIV infection.  On the average, it takes about 8 years from when HIV first enters the body, until a person develops AIDS (lots of variation in this time frame).

History:  The first medical articles about AIDS were published in 1981.  The name was given in 1982.  In 1984 HIV was identified as the cause, a blood test came out in 1985.  Since 1987, nobody has gotten HIV from blood transfusions.  But there was no treatment that really worked, so everyone got infection after infection and eventually died.  A 30-year-old may have attended 100 friends’ funerals. 

Effective treatment became available in 1996; since then, almost nobody dies from AIDS anymore.ย  Patients who begin treatment when they first become infected may have practically a normal life span.ย  Patients who always maintain their HIV treatment, without missing doses, wonโ€™t be able to transmit the virus.

HIV is spread by sex and injecting drugs.  In the US and developed countries it usually infects men who have sex with men; in poor countries it’s men and women equally (Haiti was the first poor country where it was common, back in 1981).  Condoms prevent transmission; however, theyโ€™re not necessary for a patient who never misses treatment doses (but if you donโ€™t have HIV, and donโ€™t know your partner well, please do use condoms).

There are 3 phases of HIV Disease — click links for more explanation

Diagnosis is by a blood test for HIV antibody.  The newest version can sometimes find it by 3 weeks after getting infected, certainly by 3-6 months.  Anyone who’s ever had sex or injected drugs should get one; then repeat it every 6 months if you have new partners.

HIV Treatment is both easy and hard.ย  It’s easy, because today you can take a few pills, sometimes just one pill, once a day, without side effects.ย  Medication is very effective.ย  But it’s hard, because you always have to remember to take the medication.ย  If you miss doses, the virus can become resistant to the drugs, requiring changes to more meds more times a day, maybe with side effects.ย  HIV is the one of the only diseases where if you mess up the medications, they may never work again.

In the mid-2000’s, we used to hold off on giving treatment until the CD4 count dropped to near 350, because there wasn’t risk of getting sick before that.  But now we realize that just having HIV inside you isn’t good for the body.  The immune system actively tries to fight it, and the chemicals that pour out during this are bad for the heart, the kidneys, and may contribute to causing cancer.  Studies suggest that simply living with untreated HIV may be as dangerous as cigarette smoking.

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