Published on November 27, 2017

Q&A: What You Need to Know About HIV

What You Need to Know About HIV

What is the difference between HIV and AIDS?

HIV is human immunodeficiency virus, which is the virus that causes the syndrome known as AIDS, which stands for acquired immunodeficiency syndrome.

If a person becomes infected with the HIV virus, over time this virus depletes a critical part of a human’s immune system known as a CD4 cell. When the CD4 cell level count drops below 200 copies, a person is on the threshold of having AIDS. This means they have now acquired immune deficiency syndrome and are highly susceptible to unusual infections, malignancies and other conditions.

In the past, it was thought that it would take a person roughly 10 years to progress from HIV infection to AIDS, but this time frame is variable with some individuals progressing from HIV to AIDS in just five years or even shorter time periods.

How does one contract HIV?

HIV can be contracted through unprotected sexual intercourse, through sharing needles with IV drug use or through exposure to blood products. Exposure can happen in a health care setting where a health care worker is drawing blood from a patient with an uncontrolled HIV and accidentally sticks themselves.

It absolutely cannot be contracted through normal human interactions such as touch. It is also not contracted through inanimate objects. The bottom line is sex without protection and blood exposure are the ways to catch HIV.

Mother-to-child transmission is also a means by which HIV can be transmitted through the mother’s shared blood. Typically, this does not happen anymore in the modern era and countries such as the United States, where when tested and found positive for HIV, pregnant women are placed on antivirals. When a woman who is pregnant has her HIV controlled, she does not transmit the virus to her child and will deliver the baby safely via normal vaginal delivery.

What are the symptoms?

When someone becomes acutely infected with HIV, the symptoms are very similar to influenza, a flu-like illness or mononucleosis. Individuals can have an unexplained fever, sore throat and swollen lymph nodes, fatigue or malaise. Some people have a rash with acute HIV infection and some will become quite sick and can have other abnormalities, such as hepatitis and headaches.

Some people don’t notice any symptoms when they become infected with HIV. They tend to notice them later when their immune system is decimated. At that point, the symptoms they feel are most likely related to the infection that is making them sick. For example, if they have symptoms of PCP pneumonia, they will be coughing and have a fever; whereas, if they have symptoms of cryptococcal meningitis, they will have a headache and a fever. Typically, by the time someone gets to this stage, they are already losing weight.

These days, we try to be very proactive and diagnose patients with HIV early into their HIV infection and promptly get them on medications. This is so they maintain immune health and never go near the stage of illness where they have AIDS. All people who go into the stage of having AIDS are salvageable. In other words, when someone’s immune system becomes decimated by HIV infection, we can reconstitute it by first controlling the HIV infection. When the virus comes under control, the patient’s immune system can then be built back up. Those individuals usually go on to have healthy immune systems and healthy lives.

How is HIV treated?

We treat the virus with highly active antiretrovirals. Medications we have to combat HIV are dramatically different than they were in the past. Back then, people had to take multiple cocktails of pills several times a day. These drugs had lots of side effects, which made taking the medications very difficult.

Nowadays, nearly all of the drugs that we use to treat patients with HIV infection consist of complete regimens in either one pill once a day or two pills once a day. Currently, there are six FDA-approved single tablet regimens where each one of these single tablets is a complete regimen for HIV.

Not only have the number of pills gone down, the side effects of these pills have become less noticeable. Some of the most well-tolerated regimens have hardly any effects on the patient.

I can attest to that fact because I took an HIV regimen. I become exposed to an HIV patient’s blood after cutting a boil. Blood splashed in my face and I was concerned I had been exposed to the virus. I took a full HIV regimen for 20 days to prevent me getting the virus and I had no side effects from the regimen.

Do you have to be treated for the rest of your life?

At this point, an individual does have to take medications for the rest of their life, so it is fortunate that these regimens, which are typically one or two pills once a day, are very potent and highly tolerable.

In our clinic, approximately 89 percent of our patients are able to be highly adherent to their medications and keep the virus under control. This allows them to have a functioning, healthy immune system and will allow them to have a quantitatively and qualitatively normal life expectancy. There are some nuances in life expectancy curves, but the differences are fairly minor.

Are there any medical breakthroughs on the horizon?

There are a lot of breakthroughs coming along right now. One of the biggest breakthroughs in HIV therapy is in the arena of pre-exposure prophylaxis. Individuals who are at risk for HIV can take one pill once a day that is highly efficacious at preventing HIV. Clinical trials have proven that the efficacy approaches the 90 to 100 percent range.

We have an exciting clinical trial at Cone Health comparing this standard of care of the daily pill for high-risk individuals to a long-acting injectable antiviral that can be given every two months.

We also know that if an individual has HIV and maintains suppression of their virus to low or undetectable levels, they have essentially no risk of transmitting the virus to other people sexually.

This idea is supported by two large clinical trials comparing serodiscordant couples where one individual had HIV and her husband did not. In those two trials, there was no transmission from the HIV-positive individuals to their HIV-negative partner as long as proper virologic suppression of their virus was maintained.

We are also exploring:

  • long-acting injectable antiretrovirals for treatment.
  • using monoclonal antibodies both to be used for treatment and for prevention.

I’m excited about the latter use of these compounds because I think they may help lead to a potential vaccine.

We are also trying to make baby steps toward a cure in terms of trying to understand how to attack the HIV reservoir that persists in patients who are on antiviral medications. If we could get HIV out of the reservoir where it persists in infected patients, we could cure it. However, this is a very complicated proposal.

Is HIV always fatal?

HIV is actually never fatal if the patient takes their medications. However, if the patient does not get on medications and adhere to them, then it is usually fatal as the person progresses to HIV and AIDS. Again, all patients’ health can be salvaged if they can be placed on antiretrovirals and have their course reversed.

What are some myths about HIV/AIDS that people need to know?

HIV is not a “death sentence.” It is easily treatable with antiretrovirals. While the medications are expensive if a patient does not have insurance, there are programs that will cover the cost of the medications – namely the AIDS drug assistance program and the Ryan White program.

Another myth is that the medications have a lot of side effects and that the medications are more dangerous than the disease. This is false as the new medications are highly tolerable and easy to take. They are also very potent and rapidly suppress the virus.

While HIV still does typically infect certain individuals more than others, it is not always simple to assess an individual’s risk. Some people who appear to be low risk by traditional standards still have the infection.

  • Currently, the highest risk individuals for HIV infection are African-American men who have sex with men. Their lifetime risk is currently estimated as being 50 percent.
  • Latino men who have sex with men also are very high risk. Their lifetime risk is currently estimated as being 25 percent.
  • Heterosexual black and Latina women are also at a high risk for HIV. In fact, an African-American heterosexual woman will have a 15-times greater risk of acquiring HIV than a Caucasian heterosexual woman.

Individuals don’t always have to be engaging in high-risk behavior. Sometimes, what city or part of the country a person may live in can increase their chances of being exposed to HIV. There are plenty of patients in my clinic that were monogamous individuals who acquired HIV through only having sex with their husband or partner. This behavior is not considered high risk, but these individuals clearly did not know the status of their partner (and often times the partner did not know their own status either).

It is very important for people to get tested for HIV regardless of what their perceived risk is. Anyone being tested for a sexually transmitted infection should always be tested for HIV. All sexually active individuals, particularly young subjective individuals, and men who have sex with men and transgender women, should be tested frequently. These individuals in particular should be considered for pre-exposure prophylaxis.

About the Author

Cornelius Van Dam, MD specializes in infectious disease at the Cone Health Regional Center for Infectious Disease