HIV and AIDS

Ryan wanted to return to school, but he faced AIDS-related discrimination in his Indiana community. Ryan and his mother, Jeanne White Ginder, rallied for his right to attend school. Ryan soon became the face of public education about the disease, gaining national attention over his fight to attend school. Ryan surprised his doctors and lived five years longer than expected. He passed away in April 1990, one month shy of his high school graduation.

Modern medicine and the clinical understanding of AIDS have come a long way since the disease was first discovered in the United States in June 1981. During this time, five young homosexual men in Los Angeles developed an opportunistic infection called Pneumocystis carinii pneumonia (PCP). PCP is the most common opportunistic infection in persons infected with HIV, the virus that causes AIDS (Truong & Ashurst, 2021). What, exactly, is an opportunistic infection? An opportunistic infection is one that occurs more often or is more severe in people with weakened immune systems – such as people who are infected with HIV –  than in people with healthy immune systems. Opportunistic infections are not a big deal to people who have functional immune systems, but to someone with a compromised immune system, these ordinarily mild infections can be life-threatening.

In the early years of studying AIDS, it was categorized as a “gay” disease. This, however, is an incorrect and derogatory stereotype of AIDS. While it is true that men who have sex with men (MSM) account for 55% of all HIV infections despite only comprising between 2% and 6.8% of the U.S. population (Boskey, 2022), MSM are at greater risk for contracting HIV due to the type of sex that they have, not because AIDS is a “gay” disease. In fact, the risk of contracting HIV from anal sex may be as much as 18 times greater than that of vaginal sex (Boskey, 2022). There are several reasons for this difference in transmission rate:

1. The makeup of rectal tissues: The vagina is lined with several layers of epithelial cells that provide a barrier against infection. The rectum is lined with only a single layer of these cells.

2. The fragility of rectal tissues: Rectal tissues are fragile and prone to breakage, which provides the virus easier and more direct access into the body.

3. The immune response: Rectal tissues are rich in a type of immune cell called CD4 T cells, which are the very cells that HIV targets for infection.

Because of these factors, HIV can establish an infection quickly. Scientific studies have shown that within one hour of rectal exposure, HIV can breach the body's frontline immune defense, and can spread throughout the body within 24 hours. HIV can also be spread through vaginal sex; perinatal transmission, or mother-to-child transmission; and from sharing needles, syringes, or other drug injection equipment, such as cookers. A person can only contract HIV by coming into direct contact with certain body fluids from a person with HIV who has a detectable viral load. These fluids are:

• Blood

• Semen (cum) and pre-seminal fluid (pre-cum)

• Rectal fluids

• Vaginal fluids

• Breast milk

For transmission to occur, the HIV in these fluids must travel through a mucus membrane (found in the rectum, vagina, mouth, or tip of the penis), through open cuts or sores, or by direct injection (from a needle or syringe) into the bloodstream of an HIV-negative person.

What are the effects of untreated HIV on a person’s body? 

HIV primarily affects the body by targeting and damaging cells in the immune system, which protects the body against viruses, bacteria, and fungi.

When a person contracts HIV and does not receive treatment, the infection will typically progress through the following three stages:

1. Acute infection: Soon after contracting the virus, the person has a large amount of HIV in their blood, and the risk of the virus transmitting to others is high. Some people may experience flu-like symptoms, but others will have no symptoms.

2. Chronic infection: Without treatment, this stage can last for a decade or longer. People may not have any symptoms, but the virus can still transmit to other people.

3. AIDS: At this stage, a person’s immune system is badly damaged, and their CD4 cell count drops below 200 cells per cubic millimeter (cells/mm3) of blood. They will become vulnerable to opportunistic infections, and the risk of viral transmission can be high.

Treatments for HIV Infection

There is currently no cure for HIV; however, with the right treatment and care, people with HIV can live a normal lifespan. Antiretroviral therapy can reduce the amount of virus in the blood to very low levels. This keeps the person healthy and prevents the transmission of the virus to other people. Having a very low, or undetectable, viral load means that the risk of transmission to others is virtually zero. Experts encourage all people with HIV to start taking antiretroviral drugs as soon as possible after their diagnosis. Early treatment is key to a good outcome. Without antiretroviral therapy, HIV progresses to AIDS within 8-10 years, on average (Mayo Clinic, n.d.). People who develop AIDS without taking any kind of HIV treatment typically live about three years after an AIDS diagnosis.

References

Boskey, E. (2022). Why do gay men get HIV? Why men who have sex with men (MSM) have the highest risk of infection. Verywell Health. https://www.verywellhealth.com/why-do-gay-men-have-an-increased-risk-of-hiv-3132782

HIV/AIDS. (n.d.) Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524#:~:text=Untreated%2C%20HIV%20typically%20turns%20into,with%20a%20healthy%20immune%20system.

Truong, J. and Ashurst, J. V. (2021). Pneumocystis jirovecii pneumonia. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK482370/