As we move into the fourth generation of HIV, I often ask myself if the other half of that infamous acronym should still be part of the HIV/AIDS pair. AIDS, even 30 plus years later, conjures images of the archetypal AIDS ‘victim’ of the 80s dying alone and suffering in shame. We know that the more than 30 Million people whom have died from AIDS or HIV-related deaths since the early days were not victims nor did they need to carry any shame of the disease even though society insisted otherwise. Unfortunately, many did die alone and suffered unnecessarily. Such images are not today’s images of people surviving with HIV, and an AIDS diagnosis today does not elicit an automatic downward spiral to death.
--HIV
disease continues to be a serious health issue for parts of the world.
Worldwide, there were about 2.1 million new cases of HIV in 2013. About 35
million people are living with HIV around the world, and in 2013, around 12.9
million people living with HIV were receiving antiretroviral therapy (ART)
--To
date, an estimated 658,507 people diagnosed with AIDS in the United States have
died
--An
estimated 1.5 million people died from AIDS-related illnesses in 2013, and an
estimated 39 million people with AIDS have died worldwide since the epidemic
began
By no means am I
denying the fact that people continue to die from HIV related illnesses or
AIDS; however, with today’s treatment and ART options people are dying due to
inability to access HIV medications/treatment and the large percentage of people with HIV (including the 1:5
people who do not know they are HIV positive) who are not adherent to
medication or undetectable (viral suppression), making them more susceptible to
HIV related illnesses. This speaks to the need for universal HIV testing, the
importance of knowing you and your partner’s status, and equal access to life
saving medications and treatment.
In the beginning
of the HIV/AIDS pandemonium, AIDS diagnoses were common and held inherent dire
consequences. The HIV disease progression moved rather quickly from
Asymptomatic to AIDS. Over the years, the progression from HIV to AIDS without
medication or treatment can still take up to 10 years (more or less for a
percentage); however, with correct medication and treatment a person surviving
with HIV may never progress to AIDS. Also, once an individual is diagnosed with
AIDS, presently, and they become undetectable and their CD4s climb to a healthy
range that AIDS diagnosis does not go away: from that point on the individual
is labeled as having an AIDS diagnosis.
So,
what is the difference between HIV and AIDS?
Historically,
the acronyms of HIV and AIDS have been used interchangeably and, unfortunately,
too many people think HIV and AIDS are either the same illness or completely
different illnesses. This has contributed to the overall social mis-education and
stigma regarding the HIV disease progression to AIDS. So, how does HIV progress
to AIDS and is this progression inevitable?
HIV Stage 1: AKA Primary HIV infection or Acute Retroviral Syndrome (ARS). ARS
develops within 2
to 4 weeks after infection with HIV; one may feel sick with
flu-like symptoms or display no symptoms of ARS. At this time, there is a high
production of HIV in the body, which creates the need for more CD4s to fight
off the virus creating an overall decrease in CD4s. It is important to know
that an individual is most infectious at this time and capable of transmitting
HIV to others due to the high replication of HIV in the body. Formation of
antibodies takes place at this time (integral in HIV testing) and seroconversion
(converting from HIV negative to HIV positive) takes place as well.
HIV Stage 2: Clinical latency (inactivity
or dormancy) is the period that is often called asymptomatic HIV
infection or chronic HIV infection. The virus still exists and is developing in
an individual at this time without producing any symptoms. It is important to
remember that a symptom-free person is still highly capable of transmitting HIV
to others. This reflects the need for early and routine HIV testing. If one is
unaware of their HIV status, then they are just as unaware of unintentional
transmission. If not on ART at this point, a person with HIV viral load will
increase and CD4 count will decrease ushering in the AIDS diagnosis. Without treatment,
a person lives in the clinical latency stage on average 10 years. With
treatment, a person can live in the clinical latency stage for decades and may
never progress to an AIDS diagnosis.
HIV Stage 3: AIDS: This is the
stage of infection that occurs when your immune system is badly damaged and you
become vulnerable to infections and infection-related cancers called
opportunistic illnesses. When the number of your CD4 cells falls below 200
cells per cubic millimeter of blood you are considered to have progressed to
AIDS. (Normal CD4 counts are between 500 and 1,600 cells/mm3.) You can also be
diagnosed with AIDS if you develop one or more opportunistic illnesses,
regardless of your CD4 count. Without treatment, people who are diagnosed with
AIDS typically survive about 3 years. Life expectancy once someone has a dangerous
opportunistic illness falls to about 1 year. People with AIDS need medical
treatment to prevent death. Without ART, a person with AIDS plus an
opportunistic infection has an average one year life expectancy.
Is
it sill necessary to distinguish between HIV and AIDS diagnoses?
This is where
the dilemma of the HIV related illnesses and deaths versus AIDS deaths come to
a head. Today, once an individual is diagnosed with AIDS (either newly
diagnosed or due to lack of ART) death is not the only possible outcome. The
advent of having over 30 HIV medications in five different medical classes is
how one can easily move from an AIDS diagnosis back to surviving with HIV and
returning to a healthy status. Following this line of medical ‘logic’, then
what is the significance of distinguishing between HIV and AIDS? At this point
and in today’s HIV culture, AIDS-related deaths today may actually be
HIV-related deaths. I urge the medical
community to move from AIDS diagnoses to diagnosing individuals among an HIV
Illness Continuum.
Not only does
the AIDS diagnosis never go away neither does the AIDS-associated stigma. Just
as AIDS conjures up the gloomy images of early AIDS sufferers, AIDS also implies
death without exception. We have learned that this does not have to be the case
at this point in the HIV realm. Thus, the medical community needs to realize
the irrelevance of distinguishing HIV and AIDS. This only creates a culture of
have and have nots where it is better to be HIV positive than to have AIDS or
any other mutation of this form of skewed thinking.
Perhaps, a
shift in the HIV/AIDS paradigm may be the shift in social stigma associated
with HIV and AIDS. Part of the HIV-related stigma is due to the AIDS era when
one became HIV positive and transitioned to AIDS quickly ending in an untimely
death. The fear of the disease and death are real and has far-reaching
consequences.
In closing, the
landscape of HIV is forever changing and AIDS may no longer need to be such an
influential diagnosis. Moving away from AIDS is by no means denying AIDS or forgetting the millions whom have suffered
from and succumbed to AIDS since the ominous plague of the early 80s. It is
imperative to remember and preserve the legion who have died and revere them by
distinguishing their plight as AIDS and honoring them as warriors. This fourth
generation of HIV may be the watershed where we move into a post-AIDS (possible
AIDS-free) society.
Bryan Heitz
Risk Reduction Specialist
