The Basics: HIV, AIDS and related co-infections

I dedicate this to all those who suffered needlessly, died prematurely, were born free but sick; and felt the pain of not only disease but also isolation and stigmatization.

 

I started this blog with the objective of writing about what I know, and love: global health. I want to write about serious issues in a way that is accessible and relevant. I also want to share my opinions.

 I’m pissed off. I have noticed a trend of reporting on HIV & AIDS in terms of morbidity and mortality that seems not to draw a distinction between these two related but independent conditions.

HIV: Human Immunodeficiency Virus

AIDS: Acquired Immunodeficiency Syndrome

The attention on HIV and AIDS has simmered down in mainstream media. Indeed, major progress was made in slowing the rate of new infections, AIDS deaths and treating the co-infections with which HIV is associated. But it still irks me every time I see HIV and AIDS used interchangeably. I am equally annoyed by the frequent misinterpretation of HIV & AIDS data that leads not only to misunderstanding of disease process but also an underestimation of the progress made by governments, NGOs and major international governing bodies, notably the World Health Organisation.

Human Immunodeficiency Virus (HIV) is a virus that can be spread by a number of infection modes. The epithelial linings of the vaginal and anal cavities make them particularly vulnerable to exploitation by the virus. Intravenous infection by the sharing of needles is another way that the HI virus can gain access to the host by the circulatory system. Mother to child transmission also persists as a concern in many regions.

HIV can remain latent, showing no symptoms for up to 10 years before progressing to AIDS (in the absence of treatment). Some people progress rapidly from HIV to AIDS. These individuals are called fast progressors. A small percentage of individuals never progress to AIDS, but I will not focus on this in this article, as this is a small minority of patients.

HIV currently has no vaccine; and its ability to change its surface proteins and integrate itself within the DNA of the host makes it very hard to develop one.

Nonetheless, with antiretroviral treatment (ART) an individual can live a relatively normal, long and healthy life. In fact, some studies have shown that HIV positive patients on antiretroviral treatment tend to live up to two years longer than the average national life expectancy. This may be due to their constant medical monitoring.

Once an individual has progressed to AIDS, however, in the absence of any form of ART, their prognosis is poor and death is virtually inevitable.

This brings me to the interpretation of HIV & AIDS data. People die of AIDS. People do not die of HIV. HIV deaths are always associated with comorbidities. The suppression of the immune system caused by HIV makes HIV positive individuals far more susceptible to a range of infections: from cryptococcal meningitis to Tuberculosis and pneumonia.

Some of these are particularly difficult to treat in HIV positive patients.

Moreover, due to the characteristic of latency in HIV, it is common that patients present at clinic and hospital with the confection, unaware of their HIV positive status. This produces new challenges, particularly in the case of Tuberculosis, especially multi-drug resistant tuberculosis. Often the drugs associated with treating these infections, with their long and complicated treatment courses, have a negative interaction with the initiation of ART. There is much debate about when and how to start treatment for HIV and TB in such a way that minimises risk of mortality to patients. Most recent research has shown that the time to start ART after MDR treatment is dependent on how poorly the individuals immune functioning is at the time of presentation; measured by CD4 T-lympocyte count.

This is a topic that will be explored in a later article in detail however I hope that this article has made the distinction between HIV and AIDS clear. I also hope it explains what are sometimes referred to as ‘HIV deaths’ and that even nations with a high population of HIV positive individuals, through the utilization of ART, heavy monitoring and treatment of coinfections in HIV positive individuals, informed by current research, can still achieve a high life expectancy and reasonably high quality of life for its citizens.

 

Cheers, Happy Friday!

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