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Introduction
HIV continues to be a major public health problem both nationally and globally. When asked, many people think HIV has a cure since they rarely hear about it any more. Unfortunately this is not true, and the lack of HIV awareness may lead to risky behaviors and infection. There are about 56,000 new cases of HIV/AIDS reported each year in the US. Increasing HIV awareness and prevention messages are an important component to any strategy focused on decreasing this number.
HIV: The Basics
HIV was first identified in the US in 1981. Five cases of young gay men with unusual symptoms including weight loss and wasting, pneumonia, fevers, and diarrhea were reported in the MMWR (1981). Once identified, the men died within a short period of days or weeks. Fear grew because no clear route of infection or cure was known.
Eventually, scientists discovered that this disease is caused by an unidentified organism later named Human Immunodeficiency virus or HIV. The virus had originated as Simian Immunodeficiency virus (SIV) among primates in Africa. As can happen with zoonosis, the virus mutated when it jumped species. SIV does not cause a terminal illness in its hosts as HIV does. African natives were infected while using primitive hunting techniques and as they began to migrate to larger cities the disease spread.
Without treatment, HIV attacks the CD4 helper cells of the immune system limiting the body’s natural defense against invasion by pathogens. Unable to defend themselves, patients develop severe immune suppression and opportunistic infections. As the disease progresses, Acquired Immune Deficiency Syndrome (AIDS) develops, followed by death.
The Centers for Disease Control and Prevention (CDC) set the criteria for an AIDS diagnoses as a CD4 count of 200 cells/ul or less and/or the diagnosis of an AIDS defining illness (MMWR, 2008). A partial list of these illnesses includes:
- Candidiasis of bronchi, trachea, esophagus or lungs
- Cervical cancer, invasive
- Cryptococcosis, extrapulmonary
- Kaposi sarcoma
- Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
- Mycobacterium tuberculosis of any site, pulmonary, disseminated, or extrapulmonary
- Pneumocystis jirovecii pneumonia
- Pneumonia, recurrent
- Progressive multifocal leukoencephalopathy
- Wasting syndrome attributed to HIV
The development of antiretroviral medications (ART) has had a significant impact on the prognosis of HIV/AIDS. Five classes of ART are commercially available in 2012 with several other novel classes in different stages of development and clinical trials. Today, a person with HIV on an efficacious medication regimen has the possibility of living to the normal life expectancy of someone who does not have HIV. Medication adherence is paramount to successful treatment since studies have shown than less than 95% adherence can lead to drug resistance and treatment failure.
There is still no cure for HIV. ART is designed to interrupt viral replication at one or more points of the replication cycle. Adherence with a resulting undetectable viral load (the number of copies of virus circulating in the blood) can reduce complications of HIV and infection with opportunistic infections by preventing immune depletion. Having an undetectable viral load also decreases the risk of transmission with exposure.
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