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The current approach to an individual just discovered to have HIV is: 1. Counsel them about their disease. 2. To obtain another test called a genotype. This is a blood test where the virus is plucked out and we can determine what drugs this viruses susceptible to. And then: 3. As soon as possible, start effective antiretroviral therapy. And the current use of drugs employs three drugs (minimum) – two different classes of action of these drugs on the virus. This is highly effective with the so-called Integrase Inhibitors and Nucleoside drugs (two different classes of drugs.) You can rapidly bring the viral load in the blood in patients with HIV to undetectable levels and simultaneously, the CD4 cell counts (which are a measure of the immunity) begin to restore themselves.
In the absence of any therapy, if patients are individuals acquire HIV (perhaps 10 years later and no medications or no diagnosis) they may end up with a syndrome known as Acquired Immunodeficiency Syndrome. In this circumstance, these are individuals who are known to have infection with HIV, but their immunity has been destroyed over the intervening years to the point where they’re subject to infections with very uncommon and weak diseases, bacteria, parasites, and other viruses.
You have been diagnosed with AIDS (the Acquired Immunodeficiency Syndrome), which is kind of the end product of years of not addressing or not knowing that you have HIV infection. But all of this is not a death sentence. All we need to do now is to focus on starting you on the appropriate medications. It will be as simple as one pill, once a day. Your CD4 cell numbers will come back up, approaching normal. Your viral load of that virus in your bloodstream will go to undetectable. You just need to remain on this drug and not miss a dose and slowly, as we get better (because you have lost so much of your immunity) we’re going to take two steps forward and then it’ll always be one back or three forward, two back. This will go on for months but by the end of the year, you’re going to be absolutely amazed. You will have gained weight. You will probably be back at work and from there on out for the rest of your life, you’re just going to maintain your life by taking a pill once a day.
By the end of 2014, it was estimated that there were 1.2 million individuals living with HIV infection in the United States. It’s also estimated that about 50,000-55,000 new cases of HIV occur in the United States each year. Worldwide, there are an estimated 35-37 million individuals with HIV. The unfortunate part dealing with the history of this epidemic is that there are now at least 35 million people who have died from this viral illness – similar to the magnitude of death and destruction caused by the 1918 flu epidemic and the bubonic plague in the medieval times.
This disease still remains incurable. However, if patients take antiretroviral drugs, they totally control this viral illness. In a recent study that we’ve just completed, matching individuals with HIV with age-match controls without HIV, and then looking at all the numbers, different lymphocytes and so forth. We have now determined that most of the patients have restored their numbers equal to or greater than uninfected patients of the same age. So both the function and numbers have been completely restored with this chronic use of antiretroviral therapy.
HIV is a virus that enters lymphocytes within the bloodstream. They get in this position by either a direct inoculation into the bloodstream (perhaps from a blood transfusion or sharing needles with people who are doing intravenous drugs) but the most common event is inoculation into a mucosal area – either the rectum or the vaginal cervical tissue. They enter into cells that are in the mucosal areas and then trafficked into the bloodstream, entering millions and millions of lymphocytes. So most of the HIV in the world is transmitted sexually. This is why there is so much emphasis worldwide on reducing sexually transmitted diseases. Those that cause ulcerations on the genitalia are particularly conducive for transmitting HIV from one individual to another.
HIV and tuberculosis co-infection is very common in Sub-Saharan Africa. On the other hand, when I opened the first clinic for HIV in Saigon (or Ho Chi Minh City), we had a lot of interesting illnesses that we don’t encounter here in the United States like penicilliosis, which is a fungal infection that behaves like histoplasmosis – a fungus we do have here in the United States and can co-infect people with HIV – particularly in the Midwest.
I think everyone (every adult) in the United States should receive a HIV test at least once in their life. Those who have risk factors for HIV (for example: gay men who are practicing sex without condoms, intravenous drug users) should have it more often. This extends to people even to the age of 13, where they become sexually active. These individuals should be tested. People should not wait until they feel sick to get this test because the sooner we can intervene with antiretroviral drugs, the better it is for the patient and the better for our community because we reduce the ability of these individuals to transmit it to others.
My name is Steven Klotz. I’m a physician at the University of Arizona. My specialty is infectious diseases and I’ve spent almost 40 years focusing on HIV.
HIV is an acronym that stands for Human Immunodeficiency Virus. These are viruses that cause the disease known as HIV, as well as (in the untreated state, if patients have this disease) eventually they may end up with a syndrome known as AIDS (Acquired Immunodeficiency Syndrome.) In the absence of any therapy, if patients or individuals acquire HIV, perhaps 10 years later and no medications or no diagnosis, they may end up with a syndrome known as Acquired Immunodeficiency Syndrome. In this circumstance, these are individuals who are known to have infection with HIV, but their immunity has been destroyed over the intervening years to the point where they’re subject to infections with very uncommon and weak diseases, bacteria, parasites and other viruses.
HIV infection (once it occurs) is lifelong. We do not have a cure at the present time. About 60% of the people (or less) when they acquire HIV may have some symptoms. An equal number have no symptoms whatsoever. But early symptoms after acquiring it include: fever, swollen throat or sore throat, lymph nodes in the neck and the back of the neck and under the arms are swollen. Occasionally, about 50% of these individuals who actually appear ill will have a rash that looks much like mononucleosis. In other words, it’s a flat red rash found on the torso and the arms and legs of the individual. Virtually 100 percent of these people will have a fever.
I think the first step is diagnosis and as we talked about, this is performed by doing a blood test. These are available at virtually every hospital. Every physician can order this test on any individual. Then secondly: if you have HIV, there are a number of avenues which you can pursue. You may have a very knowledgeable primary care physician you want to stay with but I would recommend that at some point you see someone who’s specializing in HIV care for the simple reason that the drugs are now so powerful that there also can be problems in implementing them and keeping them going, that at least a visit with a specialist in HIV care once would be important. The economics (if you will) of having an HIV infection may appear daunting, but anyone in the United States should be able to obtain drugs for the treatment of HIV. Those who have no work, no insurance, they can go to a local Ryan White clinic and obtain all of this help. These clinics are available in most big cities.
The current prevailing philosophy (if you will) in dealing with HIV-infected individuals is to get them on antiretroviral therapy (or drugs directed against this virus) as soon as possible – on the same day as blood tests turn positive. This accomplishes two goals. One, the patient who is taking the drugs soon becomes unable to transmit it to other individuals, thus stopping this epidemic at least at the level of one person. It also helps that individual specifically in keeping the reservoir of HIV at low levels and restoring the immune cells, which (as I had mentioned before) are lost when you do not treat this illness.
One very important development in the last couple of years has been the rollout of a program we call PrEP or Pre-Exposure HIV Prophylaxis. Individuals who are at risk through sexual contact of HIV can take a daily medication and prevent this from occurring. We are currently giving this medication by prescription and it’s paid for by insurance companies to partners of patients who do not have HIV, but their partners do. So to protect them from acquiring it, they take a tablet every day. Individuals who are practicing high-risk sex without condoms in the community also are eligible for this therapy. The whole point is to prevent the transmission of HIV from one individual to another. This PrEP is very effective.
Some people (perhaps 10%) and many with a Scandinavian background may have a mutation in one of the receptors for HIV which protects them. They become infected, but it does not become a productive infection with consequent loss of CD4 cell numbers and immunity, as occurs in other individuals without this mutation.
Individuals who are infected with HIV are most contagious (able to pass it onto other individuals) early on in the disease, either before they’ve been diagnosed with HIV or even have any symptoms whatsoever because in their blood, they have high viral counts that can be passed on to a sexual partner or someone sharing needles with them. Then after about 6 months or so, their virus goes down in amount and is almost impossible to culture until the end product (which would be Acquired Immunodeficiency Syndrome – people who aren’t taking medications) – in the terminal phases of this illness, they are also very contagious then.
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