December 1 is observed as World AIDS Day, which is dedicated to increasing awareness about AIDS and HIV. AIDS is a global pandemic that began in 1981 and has persisted as an international public health issue.

Since the pandemic began, an estimated 40 million people worldwide have died from AIDS. In addition, an estimated 37.7 million people are currently living with HIV. In the United States, an estimated 1.2 million people 13 and older are infected with HIV. About 13 percent — one out of seven— don’t know they’re infected and need to be tested.

HIV, or human immunodeficiency virus, is an infectious germ that attacks the body’s infection-fighting immune system. Specifically, it attacks and destroys a type of white blood cell called CD4 cells. These cells help coordinate the immune response to bacteria and viruses by stimulating other immune system cells to fight the germs.

When CD4 cells are compromised, the immune system doesn’t work properly. As a result, the person become susceptible to other illnesses called opportunistic infections. Without treatment, HIV gradually destroys the immune system and will progress to AIDS, acquired immunodeficiency syndrome.

HIV is spread through contact with certain body fluids of people infected with the virus. These body fluids include blood, semen, preseminal fluid, rectal fluids, vaginal fluids and breast milk. In most cases, HIV is spread by having unprotected anal or vaginal sex or by sharing drug equipment, such as syringes and needles, with an infected person.

The body can’t rid itself of HIV, and there’s cure for the infection. Once infected with HIV, a person has it for life.

Many people feel no symptoms during the first few months after infection and may not know that they’ve been infected. Others experience flu-like symptoms within two to four weeks after becoming infected with HIV. This time frame is considered Stage 1, or acute HIV infection.

Possible symptoms include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes and mouth sores. Some people experience no symptoms and do not feel sick during this stage. As the disease progresses, symptoms may expand to include weight loss, diarrhea and cough.

Even with symptoms, the only way to know for sure if someone been infected with HIV is to get tested. There are several types of tests available from a doctor’s office, hospital or community health center. There are even HIV tests you can take at home.

If you suspect that you’ve been exposed, get tested.

Stage 2 is chronic, or asymptomatic. During this stage, the virus is still active but not reproducing as quickly. A person often has no symptoms during this stage but can still spread HIV to others. Without treatment, this stage can last for 10 years or more before progress to Stage 3, which is AIDS.

A diagnosis of AIDS is made if the CD4 count drops to less than 200 cells per cubic millimeter of blood. (A normal count ranges from 500 to 1,500.) AIDs may also be diagnosed if certain opportunistic infections develop. These include pneumocystis pneumonia, a lung infection; Kaposi sarcoma, a skin cancer; cytomegalovirus, which typically affects the eyes; tuberculosis, which mainly infects the lungs; and candidiasis, a fungal infection.

HIV is treated with a combination of medications known as antiretroviral therapy (ART). In most cases, ART suppresses the HIV so that it is undetectable in the blood. The amount of the virus in the blood is called the viral load. People with HIV that take ART as prescribed and get and keep an undetectable viral load can live long, healthy lives and will not spread HIV to uninfected partners through sex.

In the US, most people with HIV don’t develop AIDS because ART stops the progression of the disease. Although an AIDS diagnosis indicates severe damage to the immune system, ART can still help. Without treatment, however, people with AIDS typically survive about three years.

To help prevent HIV and AIDS, use a latex condom during vaginal, anal or oral sex, and never share needles to inject drugs.

There are other ways to prevent HIV, including preexposure prophylaxis (PrEP), a medication taken daily if at risk for infection. Postexposure prophylaxis (PEP) is medication taken within 72 hours of possible exposure to prevent the virus from taking hold.

If you do become infected with HIV, take your ART and visit your doctor as recommended. Remember; ART enables people with HIV to live healthy, productive lives. It also serves to prevent further spread, reducing the risk of onward transmission by 96 percent.

Patti DiPanfilo

World AIDS Day, which is observed on December 1^st, was created to unite people worldwide in the battle against HIV and AIDS. It’s also a time to show support for people who have the virus and commemorate those who have died from it. World AIDS Day serves as a perfect opportunity to review what we know about HIV and AIDS.

HIV, which stands for human immunodeficiency virus, is a virus that attacks your body’s immune system, specifically its infection-fighting CD4 cells. If your CD4 cells are depleted, you become more susceptible to other infections and diseases. Your body cannot eliminate HIV and there is no cure for its infection, so once you get the virus, you have it for life.

HIV is spread through contact with the body fluids of someone who is infected with HIV. These body fluids include blood, semen, pre-seminal fluid, vaginal fluids, rectal fluids and breast milk. In the US, HIV is spread mainly by having anal or vaginal sex without a condom, or sharing needles or other equipment to inject drugs with someone who has HIV.

Some people develop flu-like symptoms within two to four weeks after HIV infection, which is considered stage 1, or the acute infection stage. The common symptoms during this stage, which include fever, chills, skin rashes, night sweats, muscle aches, sore throat, nausea, vomiting, diarrhea, swollen lymph nodes and mouth sores, may last a few days or several weeks.

If you experience any of these symptoms and suspect that you’ve been exposed to HIV, see your health care provider and get an HIV test to determine for sure if you’ve been infected.

If you have HIV and don’t begin treatment right away, your condition can progress into stage 2: the chronic, or clinical latency, stage. During this stage, your HIV is still active, but is reproducing at a slower rate, so you may not experience any symptoms. Without treatment, this stage can last for a decade or longer. But in some people, it progresses more rapidly.

The third and most serious stage of HIV is acquired immunodeficiency syndrome, or AIDS. You are considered to have AIDS when your number of CD4 cells falls below 200 cells per cubic millimeter of blood  (a healthy count is between 500 and 1,500 cells/mm³) or when you develop one or more severe illnesses called opportunistic infections even if your CD4 count is above 200.

These opportunist infections, which include recurrent pneumonia, tuberculosis, brain and spinal cord disease, various lung infections, chronic intestinal infection, cytomegalovirus, salmonella and toxoplasmosis, remain a major cause of death in people with AIDS.

Without treatment, people with AIDS typically survive about three years. But if they contract a dangerous opportunistic infection, their life expectancy without treatment drops to about one year. Treatment with HIV medication at this point can still help and may even be life-saving, but beginning treatment as soon as you learn you have HIV gives you the best possible outcome.

There’s only one way to know for sure if you have HIV and that’s to get tested. There are several  types of tests, such as tests that look for antibodies and antigens in your blood, that you can get through your health care provider. Tests are also available at most medical clinics, community health centers and hospitals. Further, home testing kits are available at your pharmacy or online.

Home HIV testing is an especially valuable tool today, as many people are unable to visit their providers or an outpatient clinic due to the COVID-19 pandemic.

Treatment for HIV is a combination of medications called antiretroviral therapy, or ART. People on ART follow a regimen of certain medications every day. ART works by preventing HIV from multiplying, which reduces the amount of the virus in your body, which is called a virus load. A lowered virus load protects your immune system and prevents the progression of HIV into AIDS.

A main goal of ART is to reduce your viral load to an undetectable level, meaning the amount of HIV in your blood is too low to be detected on a viral load test. If you maintain an undetectable virus load, you will have virtually no risk of transmitting HIV to an uninfected partner.

The US Centers for Disease Control and Prevention estimated that there were 1.2 million people in the United States with HIV in 2018, the most recent year with available statistics. Of those people, the CDC estimated that about 14 percent, or 1 in 7, did not know they had the infection. Fortunately, the outlook for people with HIV has continued to improve over the decades.

In the 1990s, a 20-year-old individual with HIV had a life expectancy of 19 years. By 2011, it had improved to 53 years. Today, life expectancy is near normal if ART is started soon after contracting HIV.

If you don’t have HIV, there are a few things you can do to protect yourself against it. Practice safe sex. Use a condom each time you have anal, vaginal or oral sex. Don’t share needles or other equipment to inject drugs. If you think you’re at risk for HIV, consider pre-exposure prophylaxis, or PrEP. That involves taking certain HIV medications every day.

If you’re HIV-negative and are exposed to HIV, post-exposure prophylaxis, or PEP, is an emergency medication you take after exposure that can stop HIV before it infects your body. PEP consists of three antiretroviral medications given for 28 days. It should be started as soon as possible after exposure, but before 36 to 72 hours have passed.

 

Anyone who remembers the emergence of AIDS in the early 1980s might be astonished at how much has changed in 35 years.

In the beginning, doctors didn’t know much about a strange disease that seemed to affect gay men. One of the first alerts appeared to be an outbreak of a rare cancer. Scientists eventually discovered the virus called HIV, the cause of AIDS, and how AIDS attacks the immune system.

At one time, an HIV infection was a virtual death sentence. There were no effective treatments to stop progression to full-blown AIDS. A timeline of the epidemic shows that by 1992, AIDS was the leading cause of death for men ages 25-44 in the US.

Today, it’s a much different story.

A new British medical study shows that a young adult with HIV in North America and Europe, who is being treated with antiretroviral drugs, can expect to live a near-normal lifespan.

Specifically, the study indicates that a 20-year-old with HIV who began antiretroviral treatment between 2008 and 2010, and had a low viral load after a year of treatment, has a life expectancy of around 78 years old. That’s lower than the general population, but far higher than for people who lived with HIV before antiretroviral drugs were available. It’s a decade more than the life expectancy of people treated with early antiretroviral medications.

Antiretroviral drugs to fight HIV were introduced in mid-1990s. They were game-changing at the time, and have since improved. Today’s versions work better, are less toxic and require fewer pills. The improvements in care are why people with HIV are living longer, according to researchers.

So where are we now? US health guidelines recommend routine HIV screening tests for teens and adults between 13 and 64. Even if you aren’t in a high-risk category, the Centers for Disease Control and Prevention says that you should get an HIV test at least once to know your status.

And, of course, people who fall into higher risk categories should be tested more often. Sexually active gay and bisexual men might consider testing every three to six months, in fact, says the CDC. Heterosexuals with multiple sex partners also should seek routine HIV screening. (The CDC offers an online HIV risk reduction tool that can be customized for information specific to gender, sexual orientation and more).

Remarkably, a large percentage of people with HIV don’t know they have the virus. In 2015, the CDC estimated that one in eight Americans with HIV were unaware they had it. They accounted for about one-third of HIV transmissions in the US.

In the US, Southern states have become the epicenter of HIV and AIDS. By 2014, they accounted for 50 percent of new HIV cases in the entire country. According to news reports, poor rural areas and ethnic minorities have been disproportionately affected. These are places with fewer resources to treat HIV and where many with the virus don’t know they have it.

Yet, if all people with HIV infections were diagnosed and treated promptly, 90 percent of new cases could be prevented, according to the CDC.

Tremendous strides against HIV and AIDS have been made since those first reports of a strange sickness appeared in the early 1980s. Hopefully, the progress can continue until HIV is controlled – or gone entirely – in the US and around the world.