By Anne Lips
Since the first appearance around 1980, there is no region of the world untouched by Human Immunodeficiency Virus (HIV) /Acquired Immune Deficiency Syndrome (AIDS) 1,2. Over the past two decades, due to intense research and community involvement, great progress has been made in the understanding of HIV and AIDS 3,4.
An HIV infection starts without any symptoms or ill-feeling.5 In the beginning, the progress of HIV is often very slow and there are only slight changes in the immune system. Infected individuals may feel healthy, but the virus is replicating inside their bodies. However, after 2 to 4 weeks, some individuals can develop an ill-feeling, often described as “the worst flu ever”. This varies greatly between individuals; not all infected individuals will develop these symptoms. When there are no symptoms, it is called an asymptomatic infection, which can last for weeks or even years. The primary stage of infection - also known as the acute infection - lasts until the seroconversion, which is when the developed HIV antibodies become detectable. This can take up to 3 months after infection.
After this acute infection, there is the second, latent stage. During this stage symptoms usually do not manifest themselves as much as during the first stage. The virus keeps reproducing at low levels and the immune system becomes weaker due to the damage done by the virus to the white blood cells called CD4 cells. The CD4 count indicates the condition of the immune system. When a HIV infection is left untreated, the CD4 count drops. When taking combined Antiretroviral Therapy (cART), a combination of multiple HIV medicine, the progress of HIV is suppressed and individuals will stay in the latent stage.3,6
An untreated HIV infection can lead to AIDS. AIDS is the most advanced phase of an HIV infection. In this stage the body cannot fight off opportunistic infections and diseases anymore. When the number of CD4 cells drops below 200 cells per cubic millimeter of blood (200 cells/mm3), individuals are considered to have progressed to AIDS. AIDS develops as a result of the damage caused by HIV to the immune system and describes the stage when the immune system cannot protect the body against specific opportunistic infections and tumors. An individual is also considered in the AIDS stage, if they developed one or more opportunistic infections or HIV-related cancer.
Keeping this in mind we need to acknowledge that HIV is the name of the virus and therefore it is HIV that is transmittable.
In 1987 the first ARV (antiretroviral) drug was approved to treat HIV. Before that, since there was insufficient treatment available for patients, progress of HIV and the damage it caused to the immune system were unpreventable. When an individual's CD4 count was lower than 200 cells/mm3, they progressed to AIDS. Without efficient treatment CD4 counts would not increase over 200 cells/mm3 and as a result of that, the immune system could not fight the infections effectively anymore. That is why AIDS was considered to be a death sentence. As research has made great progress in treatment innovation and provided that patients are given proper treatment, HIV no longer is an infection with fatal consequences when suppressed adequately.4,7
With modern treatment, replication of HIV in the body can be suppressed and the immune system can be strengthened to prevent individuals from developing AIDS. Thanks to these improvements in understanding and treatment of HIV, life expectancy of someone living with HIV, who is on and responding well to cART, is no different than that of the general population.
References:
1. Levy JA. HIV Pathogenesis: Knowledge Gained after Two Decades of Research. Adv Dent Rest 2006; 19. P10-16.
2. World Health Organization. HIV/AIDS and other sexual transmitted infections. N.d. [Available from: http://www.who.int/ith/diseases/hivaids/en/]
3. RIVM. Hivinfectie. Richtlijnen. [Available from:https://lci.rivm.nl/richtlijnen/hivinfectie 16/02/2017.]
4. Fauci AS. HIV and AIDS: 20 years of science. Nature Medicine. 2009; 3. 839-843.
5. Hassan MN. Pathogenesis of HIV Infection. Infect Dis Rep 2013; 5(suppl 1): e6
6. Antinori A, et al. Late presentation of HIV infection: a consensus definition. HIV medicine. 2010; 12(1): 61-64
7. U.S. Food and Drug Administration. HIV/AIDS Historical Timeline 1981-1990. 2014. [Available from: https://www.fda.gov/forpatients/illness/hivaids/history/ucm151074.htm]