The Changing Face of HIV

Formerly a death sentence and a disease that at one time attracted as much political attention as scientific, HIV/AIDS confounded the medical establishment when it was first diagnosed in the early 1980s — and fanned fears of a new plague that modern medicine would be unable to halt. However, advances in treatment over the past decade and a half have changed a diagnosis of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) from a death sentence to a manageable condition — much like other chronic diseases such as hepatitis A or diabetes. And, public education campaigns, as well as changing public attitudes toward sexual behavior, have softened most of the opprobrium once directed at those who contract the virus.

What Is HIV?

HIV is the name of both the disease (sometimes referred to as HIV/AIDS) and the virus that causes it.¹

It was 33 years ago that public health agencies first began to notice a class of symptoms that indicated a spreading type of immunological disease. In 1981, the Centers for Disease Control and Prevention (CDC) in its weekly newsletter reported on a high incidence of a rare form of pneumonia among gay men in Los Angeles. Within 12 months, public health agencies had tracked similar outbreaks of unusual diseases associated with compromised immune systems in other parts of the United States, and for the first time, researchers began tying these together and searching for a cause.²

By late summer of 1982, the term AIDS was in use by CDC. But, it wasn’t until 1983 that the cause of this new disease was first isolated. Originally called the lymphadenopathyassociated virus (after its location in an infected patient’s lymph nodes), by 1985 independent research had confirmed a virus as the cause of AIDS and, thus, coined it HIV.²

HIV weakens the body’s immune system by attacking and killing a type of white blood cell critical to the body’s defenses — a cell called CD4. Too few CD4 cells, and the body is unable to fight off infections or defend itself against otherwise rare forms of cancer that normally would be disposed of before they formed tumors.³

But, while health officials didn’t recognize the pattern of infections caused by the HIV virus until 1981, and didn’t discover the cause until 1983, researchers since have determined that the virus likely was present in the United States since the mid-1970s (at the latest). After studying the genetic makeup of HIV and other viruses that target our closest animal relations, researchers now believe that modern HIV is descended from a virus that infected African chimpanzees in the 19th century. Human beings who hunted and ate the chimps likely contracted this simian immunodeficiency virus, or SIV, which mutated in the following decades into the form that today causes HIV.⁴

As with SIV, the HIV virus is not very robust and cannot survive outside the host. It can be contracted only from bodily fluids — blood, semen or vaginal fluid — from someone who is infected. The main methods of transmission are unprotected sexual contact, blood transfusions and sharing of unsterilized hypodermic needles among illicit drug users.⁵

Symptoms of HIV

The symptoms of HIV vary, depending on the individual and the stage of the disease. Many, but not all, people infected experience flu-like symptoms that are often described as the “worst flu ever” within two to four weeks after HIV infection. This is the first stage, known as “acute. retroviral syndrome” (ARS), or “primary HIV infection,” which is the body’s natural response to the HIV infection and causes symptoms such as fever (the most common symptom), swollen glands, sore throat, rash, fatigue, muscle and joint aches and pains, and headache that can last anywhere from a few days to several weeks. On the other hand, not everyone who is infected with HIV develops ARS. Many people who are infected with HIV do not have any symptoms at all for 10 years or more.⁶

Then, the disease moves into the clinical stage, the second stage, sometimes called “asymptomatic HIV infection.” Depending on treatment, people can live with clinical latency between 10 years and several decades.

AIDS is the third stage of infection when the body’s immune system is weakened. AIDS symptoms can include rapid weight loss; recurring fever or profuse night sweats; extreme and unexplained tiredness; prolonged swelling of the lymph glands in the armpits, groin, or neck; diarrhea that lasts for more than a week; sores of the mouth, anus or genitals; pneumonia; red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids; and memory loss, depression and other neurologic disorders. Many of the severe symptoms and illnesses of AIDS come from the opportunistic infections that occur because the body’s immune system has been damaged.⁶

Diagnosing HIV

HIV is diagnosed through blood or oral fluid tests that look for antibodies the immune system makes in response to the presence of the HIV virus.⁷ If this test is positive, a second test to confirm the results is ordered before a diagnosis is made. The second test may use a different method to look for the antibodies, or it may be designed to detect HIV antigens or genetic material (RNA).⁸ However, as the HIV virus is slow to replicate, the infection is also slow to develop. It generally takes weeks to months before newly infected patients will have enough HIV virus in their bloodstream to generate a positive test. Yet, they are already contagious during this period.⁷

Treating HIV

CDC estimates that 1.1 million Americans currently have HIV.⁹ Unfortunately, there is presently no cure for HIV. Once it is contracted, patients will have it for the rest of their lives. There is also no vaccine to protect against HIV at this time.

The maintenance use of antiretroviral drugs has proven effective at suppressing the virus — slowing its development to allow patients’ immune systems to continue to fight the secondary infections that can make HIV/AIDS deadly if left untreated.¹⁰ However, these drugs are merely treatments, and patients on maintenance regimens remain contagious and capable of spreading the virus.

Most physicians prescribe a mixture of up to three antiretroviral drugs in a combination known as a “cocktail.” There are five different types of these drugs, classified by the method they use to fight the HIV virus:¹¹

• Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) that mimic DNA building blocks the virus needs to replicate itself, but don’t work properly for that process
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) that interfere with an enzyme needed by the virus to replicate itself
• Protease inhibitors (PIs) that interfere with another enzyme that allows the virus to cut up its genes into smaller pieces during replication
• Entry/fusion inhibitors that make it more difficult for the HIV virus to penetrate the membrane of the CD4 white blood cells, preventing individual cells from being infected
• Integrase inhibitors that interfere with an enzyme necessary to the virus’s ability to reproduce itself

By crafting a strict schedule of multiple combinations of these drugs, physicians are able to help their patients continue to live full, active lives. While there are side effects to these drugs, with more than 30 individual drugs spanning these five classes, doctors are often able to minimize the side effects suffered by their patients by changing the combinations.

Ongoing Research

The top priority of medical researchers is to develop a fully effective vaccine to prevent HIV. However, because the body never fully rids itself of the HIV virus the way it does with other dangerous viruses, the traditional approach of introducing weakened or dead viruses to stimulate the body’s production of antibodies tailored to that specific virus has not been successful.¹²

Still, research continues for a potential HIV vaccine that will prevent HIV’s spread and lead to its ultimate demise. There is also ongoing research into vaccines that might alter the disease’s development in ways that lower the rate of its transmission.¹³

Short of eradicating HIV via inoculation, researchers are also exploring new leads on various forms of prevention — from creams and gels that would create an HIV-proof barrier during sexual activity, to drugs to reduce the risk of contracting HIV. CDC is now promoting use of PrEP, or pre-exposure prophylaxis, to reduce the risk of contracting HIV by those engaged in ongoing high-risk behavior.¹⁴

Additional research continues, of course, into finding yet more drugs to join the 30 or so antiretroviral drugs already being used to further slow the development of HIV in infected patients. It is hoped a future antiretroviral drug, or a combination of them, will be successful in ridding the body of the virus completely — providing a true cure for HIV.¹⁵