If you have tested positive for HIV, the first and foremost thing to know is that having this virus is no longer considered a death sentence . If you were diagnosed in the early stages of the infection, odds are good that, with proper treatment, you can live a normal, effectively healthy, full life.
In fact, in developed nations, the average life expectancy of people living with HIV is near that of HIV-negative individuals, and both life expectancy and quality of life in HIV positive people is often higher than in those living with diabetes, dementia, autoimmune disorders, Parkinson's, cancer, and other chronic illnesses.
So, if you are reading this text after finding out that you tested positive — breathe deep and try to focus your mind on what comes next rather than letting it slip into despair over your diagnosis. A positive emotional response is the first and most important step in the process of healing.
Read on to learn more about what to expect from living with HIV — in what ways life will change for you and what you can, over time, expect to mostly, or completely stay unchanged.
First off, we need to draw a line between HIV infection and AIDS. These two are not the same — HIV positive people may develop AIDS, but this is not always the case, especially with the latest advancements in antiretroviral therapy (ART).
HIV is the acronym for the Human Immunodeficiency Virus, and AIDS stands for Acquired Immunodeficiency Syndrome. If HIV progresses to AIDS, the immune system of the carrier becomes severely compromised and susceptible to microbial infections and infection-related cancers, which, at that point, become lethal.
So, HIV itself doesn't kill; nor does AIDS, strictly speaking. The secondary infections, which the AIDS patient's immune system becomes defenseless against, are what ends up overpowering the carrier.
However, HIV doesn’t have to develop into AIDS. As noted, in this day and age, HIV ART has become advanced enough to suppress the viral load, sometimes to levels where the virus can’t even be detected in the blood anymore. This means that, with diligent treatment, an HIV positive status can be reduced to not much more than a label.
However, for this to happen, treatment needs to be started as early on in the infection as possible. This is why preventative testing and early detection are critical for both the effectiveness of an individual’s treatment and for curbing the HIV epidemic itself.
There are two general stages of the HIV infection: acute HIV and chronic HIV. The acute stage may last for a few months and is followed by the chronic stage, which can last for many years before evolving into AIDS.
Acute HIV infection is the initial stage of HIV. It usually starts 2 to 4 weeks after the infection onset. Some people experience flu-like symptoms during this period, such as fever, chills, night sweats, body rashes, fatigue, muscle pain, swollen lymph nodes, mouth ulcers, and others. This symptomatology is often characterized as ‘the worst flu ever.’
At this stage, HIV multiplies swiftly and spreads throughout the body. The virus attacks and kills the immune system's infection-fighting CD4 cells (CD4 T lymphocytes) before antibodies can be created to suppress the attack.
The amount of HIV in the blood rises to high levels during the acute HIV infection stage, which dramatically increases the risk of HIV transmission; many people who don’t experience heavy symptoms and don’t get diagnosed go on to infect others without knowing that they themselves are infected. This is why regular testing, such as can be done with at home HIV test kits, is crucial for limiting early-stage transmission.
If a person starts on antiretroviral therapy (ART) during this time, they may have a major advantage in gaining control over the infection.
As time passes, the body initiates an immune response, and the carrier starts to feel better. As a result, some HIV positive people may not show any symptoms once the infection becomes a chronic condition, while others may experience swollen lymph nodes, episodes of fever and diarrhea, and other relatively manageable symptoms.
During this stage of HIV infection, which is also referred to as an ‘asymptomatic HIV infection’ or ‘clinical latency,’ HIV continues to proliferate in the body, although at a much slower pace.
Without ART, chronic HIV infection can take about 8 to 10 years or longer to defeat the immune system and progress to AIDS, but this process may go faster in certain individuals. Those who are on ART may be in this stage for several decades.
While it is still possible to infect others at this point, those who take ART exactly as prescribed and see their viral load drop to undetectable levels have practically no chance of transmitting HIV through intercourse to an HIV-negative partner.
While doctors will typically routinely run a variety of tests on HIV positive patients, two important indicators need to be kept in check at all times: CD4 count and viral load.
Viruses cannot replicate outside the living cells — they need to hijack living cells in the host’s body to be able to create copies of themselves in those cells. Once a sufficient number of copies have been created, they break out, killing the host cell in the process.
While HIV has been reported to infect a wide range of cells, it primarily targets white blood cells called CD4+ T cells and monocytes. These scout cells are essential in initiating immune responses in the body; once the HIV infection begins, their numbers start falling rapidly.
Still, the human body can produce these cells in large numbers, so it can take years for HIV to reduce the CD4 cell count below the critical level. Generally, a CD4 count of 500-1400 per cubic ml of blood is average. A value below 400 is problematic, and, if it falls below 200, there is a severe risk of secondary infections.
This is why doctors regularly monitor CD4 levels in HIV positive patients to know how effective the drug therapy is and to assess the person's level of immunity.
Doctors also routinely take Real-time PCR (RT-PCR) measurements of the number of viral copies per milliliter of blood — this is referred to as the ‘viral load.’
In those who do not take ART, viral copies can number in several thousands or several hundreds of thousands of copies per ml. Those who take ART regularly as prescribed, on the other hand, have a realistic chance to get this number down to below 200 (this is known as “viral suppression” status), and even to a level that’s undetectable by the PT-PCR test.
It’s important to note that undetectable does not mean that the virus is absent from the body; it simply means that it is suppressed so effectively by the treatment that the test is not able to detect any viral copies.
With regular ART, it normally takes anywhere from 1 to 6 months to reach an undetectable viral load. If this status can be maintained for 6 months from the first undetectable result, the viral load is considered “durably undetectable” and the virus is then, provided that ART is regularly taken, effectively impossible to transmit to an HIV negative person in unprotected sexual intercourse.
It’s incredibly important to take ART regularly. If therapy is discontinued, the viral load quickly rebounds, and infecting others again becomes a risk. Stopping and restarting therapy can lead to the development of drug resistance, rendering the treatment regimen ineffective and limiting future treatment options.
Over 50 different medications are available to treat HIV; they are grouped into seven drug classes according to how they fight the virus and are prescribed based on individual needs and factors such as potential interactions with other medications.
Drugs that can reduce HIV replication were discovered within a few years after discovering HIV in 1983. However, only in the early 2000s, when it was understood that combination therapy with three drugs could suppress HIV growth indefinitely, was when we were able to assume effective control over the infection.
Further studies have led to the introduction of the first once-a-day pill for HIV, Atripla. For many HIV positive individuals, managing the infection will be as simple as taking this one combination pill each day. Others may need to take more, but typically 4 pills per day is the maximum.
People who have had an undetectable viral load (or who have been virally suppressed) for at least three months may be eligible for a monthly or bimonthly shot instead. HIV therapy shots are long-acting injections that are used to treat HIV patients according to the treatment strategy
Many pharmaceutical companies are also developing even longer-lasting injections . Many of these are in an advanced stage of testing, and, when produced, will allow HIV positive individuals to manage their infection with a single injection every two to six months.
To summarize, HIV is no longer a life-threatening infection — if treatment is started early, ideally in the acute stage, the condition can be managed effectively with just 1-4 pills a day or, later on, with a shot each month or two months.
If ART is taken regularly, HIV positive individuals can have a comparable life expectancy and quality to HIV negative people. While, at present, medications cannot completely eradicate the virus from the body, they can effectively suppress it to undetectable and untransmittable levels.
Finally, scientific research into HIV abolition never has and never will stop, and hopes are high that an actual cure may be found for this virus soon.
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