World AIDS day is observed each year on December 1st and is an opportunity for people worldwide to unite in the fight against HIV. Show ing their support for people living with HIV, and remembering those who have gone before us. Starting in 1988, World AIDS Day was the first ever global health day. Since the start of the AIDS crisis in the 1980s, some 70 million people have been infected with HIV, and 35 million of those people have died. Both these numbers are staggering in their own way, and together they tell the story of a disease that has led to an incredible amount of loss, but also one that, if you are lucky enough to have access to the right medicines, it is no longer a death sentence. So, in honor of AIDS day that was on Saturday December 1st, let’s look at how far we’ve come.
HIV or Human Immunodeficiency Virus is a class of virus known as a retrovirus that infects human cells. In every human cell there is a structure called the nucleus in which our genetic makeup is stored called genes in the form of Deoxyribonucleic acid or DNA. A retrovirus gets its name from the fact that it uses its Ribonucleic acid or RNA, DNA’s less stable cousin, as genetic material. Once HIV infects a cell, it makes a DNA version of its own genetic information contained in its RNA, with a special enzyme, and then inserts that viral DNA copy into the hosts cell DNA. If that sounds sneaky, it is, and it is part of why HIV has been so difficult to treat. What gives HIV its deadly reputation is its ability to infect and ultimately kill an essential white blood cell (WBC) that is an integral part of the body’s immune response. This response is launched against dangerous invading microbes that can potentially infect human cells causing disease. These WBCs are known as CD4 T helper cells. They recognize a threat and pump out proteins that help coordinate a number of different pathways which result in a powerful immune response against microbes. You definitely want them around!
HIV is spread by bodily fluids including; blood, semen, vaginal fluid and breast milk. That is why HIV can be transmitted through; sex, dirty needles, breast feeding and any other swapping of fluids. A major exception is saliva, as it is full of other chemicals that prevent HIV from being infectious, like antibodies and other antimicrobial proteins. Based on research in the 1980s after discovering this virus infects humans, the Cut-Hunter hypothesis was developed to explain how HIV was introduced as a virus in the human population and first manifested in the decade of big hair and Michael Jackson. An AIDS like syndrome was noticed in monkeys that were hunted in south western Cameroon, in the forests of the Congo. These monkeys were found to have the Simian Immunodeficiency Virus or SIV. In the course of butchering a monkey, some of the virus-infected monkey’s blood may have entered a small cut on the hunter’s hand, or a bit of blood splattered in his mouth. The virus, close enough to human biology, now would have infected the hunter. Over time, if the hunter passed the virus along to enough people, it evolved into the HIV we know today.
When someone is first infected, they might feel like they have a bout of the flu, with a fever, headache, rash, sore throat and muscle and joint pain. That is because the virus is infecting many cells and the immune system is trying to fight them off. But, within a few weeks, those symptoms pass because by then the person has specific antibodies that can keep the virus from running totally rampant. After that, they usually feel fine for a long time, in many cases a really long time, like several decades (incubation period). Until, one day, they do not, because the virus had gradually killed off too many T Cells, leaving the body unable to properly defend itself against anything that might be dangerous or infectious. That is when someone is said to have AIDS or Acquired Immune Deficiency Syndrome. This diagnosis is made once the person’s T cells are below 200 cells per microliter of blood (normal range is 500-1,500), or they develop an opportunistic infection. These are infections that anyone with a normal immune system would usually be able to fight off usual. But, because HIV has obliterated most of their T cells, AIDS patients get really sick and they can die. Most of the time it is an opportunistic infection that kills them.
Scientists have postulated, based on the long incubation of HIV and the oldest blood samples recorded as HIV positive, that HIV may have first infected human around 1908. It is believed that it continued to spread among humans in and around the Congo through the sex trade and via dirty needles that the colonists used to administer drugs. At a time, using clean needles and proper sterile technique was not practiced as science was not that advanced. With time, infected people, through traveling to other places outside of the Congo, carried the disease with them. Research has identified the first places to have epidemics were Haiti and India, then through several quirks in history, ultimately to the United States (US). Back in the 1980s in the US, when HIV was not heard of, there were strange cases of a pneumonia caused by a fungus, Pneumocystis Carinii, a rare cancer called Kaposi’s sarcoma and oral thrush (a yeast infection in the mouth) affecting healthy young homosexual men. These diseases were only ever recorded in those whose immune system was compromised. On analysis of the blood of these homosexual men, a low CD4 T cell count was found, a characteristic of an impaired immune system. Surveillance then revealed that these men were developing extremely rare infections and cancers that were killing them. At that time, when not much was known about HIV, the association with homosexual men was certainly striking, and early on, many called it GRID for Gay Related Immune Deficiency. One can see how the stigma of HIV started in a time when gay rights was not heard of and it was seen as immoral and certainly not as socially acceptable as it is today. It was even referred to as the ‘Gay Cancer’ or ‘Gay Plague’ at that time. As time went on, it was realized that the disease was not only limited to gay men. It was turning up in those who had regular blood transfusions, intravenous drug users, women, infants and heterosexuals men, in particular recent immigrants from Haiti. This was very reveling, as it hinted to scientists that the disease was infectious and spread through blood. This pattern was seen in other blood brone diseases like Hepatitis B. Further research led to the name AIDS and the discovery that the mode of transmission of the infection was through exchange of bodily fluids.
In the 21st century, now that we know more about HIV and its transmission, many practices have changed in the medical field to prevent HIV transmission. Guidelines have been established internationally so that IV administration and procedures demand the use of new sterile needles with every procedure. However, the current leading causes of spread are by having sex (especially unprotected sex) and sharing needles and other injection equipment with someone infected with HIV. Substance use can contribute to these risks indirectly because alcohol and other drugs can lower people’s inhibitions and make them less likely to use condoms. Also, babies can be infected in the womb, at birth, or through breast feeding. Unlike the common flu virus, HIV cannot be spread from shaking hands, if someone coughs on you or by being in normal contact with them. Thus, factors that puts an individual at risk of contracting HIV are; having unprotected sex, multiple sex partners, other sexually transmitted infections, transfusion of contaminated blood and blood products, contaminated syringes and needles, drug abuse, unsafe piercings, negligence in medical practice and mother to child HIV risk. One of the main reasons why HIV/AIDS is so widespread is the lack of knowledge about these risk factors and transmission of HIV. Also, many infected with HIV do not know their status as they are virtually asymptomatic. This adds to the problem. There have been many health initiatives, both public and private, to promote safe sex by the use of condoms, discouraging promiscuous behavior, getting tested to know one’s status and regular STD screening tests.
Given the history of HIV, we can understand how those with the disease are stigmatized. Because of the lack of knowledge by the general public that still exists today about HIV, many with the disease have lost their loved ones, friends and virtually their entire social network because of the stigma attached to the disease. In terms of reducing stigma, we can do much better in the fight against HIV. With current state of treatments of HIV and its downgrade from a death sentence to a chronic disease like diabetes mellitus or hypertension, it is hoped that this stigmatization and discrimination will change. The major challenge in treating HIV is that, due to its haphazard replication, it mutates quickly and develops resistance to drugs that initially had worked. The current treatment regime is a combination or cocktail of drugs that target the virus at various stages of its lifecycle. Current drugs include Azidothymidine (AZT), an inhibitor of the enzyme it uses to copy its RNA into DNA, and protease inhibitors (PI) that inhibit an enzyme that HIV uses to make a lot of the proteins it needs to infect new cells. These drugs target two different parts of the HIV lifecycle. Thus combining them makes it harder for the virus to mutate to escape both drugs. A cocktail of these drugs are called Antiretroviral Therapy (ART) and is now the standard treatment. This treatment has seen results of patients living longer, reduction of blood virus levels and maintenance of a high CD4 cell counts. This breakthrough has changed HIV infection from a deadly death sentence to a chronic disease. It has also helped in preventing the spread of HIV as the treatment is so effective that, the amount of virus in patients is often undetectable, making them asymptomatic for longer and less likely to infect others. It is hoped that soon, since HIV/AIDS is now deemed a chronic disease, clinics can be at the primary care level much like other chronic disease clinics for diabetes and hypertension. However, that will be determined by our efforts to destigmatize the disease.
More information on HIV can be sought at your local health facility or these websites:
Contact: 1-868-627-1163 ext. 2085
Dr. Visham Bhimull,
Diploma in Family Medicine(UWI)