Category Archives: HIV

Testing for HIV is quick and simple

At the end of 2019, an estimated 1,189,700 people in the United States were predicted to have HIV. However, it’s not possible to determine an exact figure as about 13% of HIV-positive people in the U.S. are unaware of their HIV status (1).

This lack of knowledge is because many people infected with HIV are unaware of the infection in the early stage (acute, stage 1), as they may not experience any symptoms or only mild symptoms (e.g. headache and sore throat) that can be easily confused with other illnesses (1).

Have you been at risk of catching HIV?
Maybe you have had unprotected sex recently or you have shared injectable drug equipment with someone else. You could unknowingly be carrying HIV and at risk of transmitting it to others too.

Get peace of mind and take an HIV test today. Testing is quick, relatively painless, and simple.
We offer a 4th generation HIV test that detects both the HIV p24 antigen and HIV antibodies. The HIV p24 antigen is a structural component of the viral particle and can usually be detected in the blood of an infected individual from 2-3 weeks after infection. However, p24 antigen levels in the blood begin to decrease 3-4 weeks post-exposure until no longer detectable. HIV antibodies are produced by an infected individual in response to the viral infection. They are usually not detectable until 4-6 weeks after exposure or up to 3-6 months in some cases, but then generally remain detectable (2).

Our test just requires a tiny blood sample self-collected from a finger-prick. This blood sample is then sent to our laboratory for analysis by a fully automated immunoassay–the same very accurate assay type that is used by doctors, clinics, and hospitals all over North America. But our test has one distinct advantage–there is no need to make a doctor’s appointment to get your sample collected. Collect the sample in privacy at home and receive your results online as soon as testing is complete.

HIV testing window period
It is important to note that there is a window period of 45-90 days, during which HIV diagnostic tests may produce a negative result, although infected individuals can still transmit the virus to others. This is because there are just not enough of the tested molecules (antigen and antibodies) present to be detected by laboratory assays. Follow-up testing is recommended for any individuals with a negative result who may have been exposed to HIV. An alternative test type that detects HIV nucleic acid in the very early stages of an infection is also an option (3).

What if I test positive?
Although an HIV diagnosis is still very unpleasant news, it is no longer the death sentence it once was. Even though there is no cure for HIV, antiretroviral therapy (ART) is a very effective treatment to prevent the progression of HIV and to prevent the transmission of HIV to others. It enables HIV-positive individuals to live relatively normal, healthy lives (3).

For more information about HIV treatment, please see our previous article “How is HIV treated?

References:
1. HIV Basics. CDC.
2. Busch MP, et al. (1995) Time course of detection of viral and serologic markers preceding human immunodeficiency virus type 1 seroconversion: implications for screening of blood and tissue donors. Transfusion, 35 (2), 91-97.
3. HIV/AIDS. World Health Organization.

Posted in HIV

Is there a link between HIV and cancer?

Human immunodeficiency virus (HIV) is a sexually transmitted disease (STD), which targets the cells of the immune system, in particular, a type of white blood cell called a helper T cell (or CD4+ T cell) (1).

Helper T cells are probably the most important cell type in adaptive immunity. They release cytokines (messenger molecules) to activate B cells (antibody-producing immune cells) and activate cytotoxic T cells (white blood cells that kill infected target cells) (2). So, when there are not enough helper T cells, the whole immune system is affected, and this is exactly what happens in people with HIV, particularly untreated HIV that develops into AIDS.

HIV patients suffer from a range of symptoms, including very high susceptibility to various microbes, some of which are normally harmless in healthy people. HIV patients also have an increased risk of developing specific cancers, known as “HIV-associated cancers”. Three cancers, in particular, are termed “AIDS-defining cancers” or “AIDS-defining malignancies” (3).

What are the three “AIDS-defining cancers”?

  • Kaposi sarcoma (500x increased risk in HIV patients)
  • Aggressive B-cell non-Hodgkin lymphoma (12x increased risk)
  • Cervical cancer (3x increased risk)

If someone with HIV is diagnosed with one of these cancers, it confirms a diagnosis of AIDS (3).

What other cancers are most common in HIV patients?
Other cancers that are more common in HIV patients are collectively termed “non-AIDS-defining cancers” (3) and include:

  • Hodgkin lymphoma (8x increased risk)
  • Anal cancer (19x increased risk)
  • Liver cancer (3x increased risk)
  • Oral cavity/pharynx cancers (2x increased risk)
  • Lung cancer (2x increased risk)

HIV patients are not only at a greatly increased risk of developing one of these cancers, but they also are at a much higher likelihood of dying from cancer too (3).

Why are these cancers more common in HIV patients?
HIV severely weakens the immune system by killing off helper T cells that are so vital for a good immune response. This means HIV patients are a lot more susceptible to viral infections, including viruses that can lead to cancer (3). Examples of these viruses include:

  • Kaposi sarcoma-associated herpesvirus (KSHV) aka human herpesvirus 8 (HHV-8) – causes Kaposi sarcoma and some lymphoma subtypes
  • Epstein-Barr virus (EBV) – causes some non-Hodgkin and Hodgkin lymphoma subtypes
  • Human papillomavirus (HPV) – high-risk types can cause cervical, vaginal, and vulvar cancers, anal cancer, penile cancer, as well as mouth and throat cancer
  • Hepatitis B and hepatitis C viruses – cause liver cancer

There are also other reasons that cancer is more common in HIV patients, including:

  • Increased likelihood of other risk factors (e.g., smoking, heavy alcohol consumption)
  • Immunosuppression and inflammation may increase cancer risk

Does antiretroviral therapy decrease the cancer risk in treated HIV patients?
Antiretroviral therapy (ART) has reduced the number of people affected by certain cancers (e.g., Kaposi sarcoma) but the risk in HIV patients is still higher than in people not infected with HIV (3). In addition, effective ART significantly increases the lifespan of HIV patients, but this also means there are now more older people living with HIV (that prior to ART would have succumbed at a much younger age). This means that there is now an increased incidence of cancers common in older age in people with HIV (3).

What are ways for HIV patients to reduce their cancer risk?

  • Start on ART as early as possible and continue to take ART medications as instructed
  • Abstain from smoking
  • Limit alcohol intake
  • Get tested for Hepatitis B and Hepatitis C and obtain treatment if required
  • Regular screening for cervical cancer (HPV high-risk test available here)
  • Get the HPV vaccine (if less than 26 years of age)

 References:
1. Al-Jabri AA. (2003) How does HIV-1 infect a susceptible human cell? J Sci Res Med Sci. 5(1-2): 31-44.
2. Alberts B, et al. (2002) Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Helper T Cells and Lymphocyte Activation.
3. HIV Infection and Cancer Risk. NIH, National Cancer Institute. Reviewed Sept 2017.

Posted in HIV

HIV and AIDS: Debunking the myths

At the end of 2020, there were an estimated 37.7 million people living with HIV around the world, with over two-thirds of the cases occurring in the WHO African Region (1). In the United States, 36,801 new cases of HIV were diagnosed in 2019, with an estimated 1,189,700 people predicted to have HIV at the end of 2019. Yet, about 13% of HIV-positive people in the U.S. are unaware of their HIV status (2).

Major medical advances have drastically improved life for people with HIV, but there is still a lot of misinformation about HIV and AIDS. In this article, we debunk 10 common myths about HIV and provide you with the facts instead.

#1 Touching someone with HIV puts me at risk of catching HIV
This is one of the biggest misconceptions about HIV. HIV can only be passed from one person to another via specific bodily fluids:

  • Blood
  • Semen (including pre-cum)
  • Vaginal fluid
  • Rectal fluid
  • Breastmilk

And it is necessary for the infected bodily fluid to enter the blood of another person for transmission to occur. This can be through:

  • Unprotected sex (both rectal and vaginal, but only very rarely through oral sex)
  • From mother to child during pregnancy, childbirth, or breastfeeding
  • Sharing needles, syringes, or other drug-injection equipment

This means that it is usually not possible to catch HIV from kissing and hugging, sharing food, insect bites, toilet seats and bathing, sneezes and coughs, or sweat.

Nowadays with thorough testing of donated organs and tissues, it is also very unlikely that HIV will be transmitted from blood transfusions, blood products, or organ and tissue transplants.

#2 Washing after sex will prevent me from catching HIV
No, washing immediately after sex will not prevent the transmission of HIV if bodily fluids have already been exchanged. Other common myths about HIV prevention include a belief that pulling out prior to ejaculation or being on the contraceptive pill will prevent HIV transmission. Pre-ejaculate (pre-cum) can also contain the HIV virus so transmission can still occur. The contraceptive pill in no way protects against HIV (or any other STD for that matter!). It is for preventing pregnancy, but not for preventing infectious disease transmission.

The only ways to really protect yourself from catching HIV through sex are by using condoms or taking pre-exposure prophylaxis (PrEP). PrEP is a prescription medication that is very effective at preventing HIV when taken exactly as prescribed. It is also important to get tested and treated for other STDs, as if you have another STD it can increase your chance of catching HIV.

#3 HIV has very distinct symptoms
Some people believe that it is easy to spot those with HIV as they have distinct disease symptoms. Or they think that they will know if they have caught HIV by experiencing the symptoms themselves.

However, the early symptoms of HIV are actually not at all easy to spot. Some people may not even show any symptoms at all in the early stages. While others just display general symptoms typical of many other types of infections, e.g., fever, fatigue, general malaise.

The only way to accurately determine if you have caught HIV is to get tested. Saliva testing is an option but testing of blood is more accurate and detects an HIV infection at a much earlier time point post-exposure. We offer a 4th generation HIV test that detects both HIV antigen and HIV antibodies from just a simple finger-prick blood sample.

#4 I will definitely catch HIV if I have sex with someone with HIV
This is another false belief. Correct condom use and PrEP prevent HIV transmission. In addition, antiretroviral (ART) medication is very effective at controlling the viral replication of HIV. Although ART does not cure HIV, it can ensure that the amount of virus in the blood (viral load) is very low. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood and ensures that HIV transmission through sex does not occur (2).

#5 HIV always leads to AIDS and death
In the past, this statement was true, as untreated HIV typically develops into AIDS after about 10 years. AIDS patients often display the symptoms that many people associate with HIV, including rapid weight loss and skin discoloration, and are very susceptible to other health complications, including pneumonia, tuberculosis, and certain cancers. And it is these opportunistic infections and cancers that lead to the death of most untreated AIDS patients within three years.

Nowadays, effective ART medication can reduce the replication of HIV in the blood to an undetectable level, meaning that HIV patients can live relatively normal lives and their HIV never develops into AIDS.

#6 Only men who have sex with men can catch HIV
False. Although men who have sex with men account for the most cases of HIV in the U.S. (65% in 2019), HIV can also be transmitted through heterosexual contact (23% of cases in 2019) (2).

During anal sex, the risk of catching HIV is much higher in the receptive partner, but transmission to the insertive partner is still possible. During vaginal sex, either partner can get HIV.

Oral sex is also a potential transmission pathway but the risk is a lot lower than anal or vaginal sex. Generally other factors must also be present for transmissions to occur, such as mouth ulcers, bleeding gums, and the presence of another STD (2).

#7 If myself and my partner are both HIV-positive, there is no need to use protection
This statement only holds true if both partners are on ART and maintaining viral suppression and have an undetectable viral load, which prevents HIV transmission. If both partners do not have viral suppression, it is very important to use condoms during every sexual encounter. This is because there are different strains of HIV. If you each are infected with a different strain, it is possible that you (or your partner) could become infected with two different strains. This is known as HIV superinfection and may cause problems with treatment and cause some people to get a lot sicker a lot faster, particularly if the new strain is resistant to the ART medicine that was controlling the original HIV strain (2).

#8 HIV can be cured
Unfortunately, there is still no cure for HIV. Although ART significantly reduces the amount of HIV in the blood and can achieve viral suppression in most people, it does not eliminate the virus completely. ART medications must be taken as prescribed for life otherwise the viral load will increase and can eventually lead to AIDS.

Some people choose to take alternative medicines (e.g., herbal medicines) with the misconception that they will provide a cure for HIV. However, herbal remedies do not work, and can even interfere with the effectiveness of ART medicines if taken concurrently.

#9 An HIV diagnosis means that I can never safely have a child
Thankfully an HIV diagnosis is not the death sentence it used to be, nor does it prevent most people from making a family.

If an HIV-positive mother-to-be maintains viral suppression throughout her entire pregnancy (including labor and delivery), as well as giving HIV medications to the baby for the first 4-6 weeks, it can reduce the risk of HIV transmission to less than 1% (2).

In addition, an HIV-positive man can still safely father a child, by ensuring that the HIV is not transmitted to his female partner. This is through keeping an undetectable viral load with ART medication. The female partner may also opt to take PrEP to further reduce the risk of catching HIV during sex.

#10 A negative HIV test result means that I definitely don’t have HIV
Unfortunately, this is not always the case. Even with advanced laboratory testing techniques, there is still a “window period” post-exposure where an HIV-positive person will still test negative on an HIV test. This is because a certain level of the virus is required in the blood before it is detectable by HIV tests.

The 4th generation HIV test that we offer can usually detect the p24 antigen from HIV within 18–45 days weeks post-exposure. However, in some cases, an HIV infection may not be detected from a finger-prick blood sample until 90 days post-exposure. Therefore, a false-negative test result may occur within the first three months. Retesting after three months is recommended.

If a potential exposure is suspected, post-exposure prophylaxis (PEP) is available as an emergency medication to reduce the risk of infection. This must be started within 72 hours of exposure to be effective.

Conclusions:
Although there are still many common misconceptions about HIV, the good news is that it is now a very treatable disease, and most infected people can live long, productive lives using adequate antiretroviral medication.

References:
1. HIV/AIDS Fact Sheet. WHO Reviewed July 2021.
2. HIV Basics. CDC Reviewed 2021.

Posted in HIV

HIV Quick Facts

What is HIV?
Human immunodeficiency virus (HIV) is a sexually transmitted disease (STD), which occurs by contact or transfer of blood, semen, pre-ejaculate, and vaginal fluids. HIV can also be transmitted from an infected mother to her infant during pregnancy, childbirth, or through breast milk. HIV targets the cells of the immune system and in the absence of effective treatment, it can develop into acquired immunodeficiency syndrome (AIDS) (1).

What causes HIV?
HIV is caused by infection with one of two types of HIV. HIV-1 is the most common and most contagious. HIV-2 is less infectious and is predominantly confined to infections in West Africa.

What are the symptoms of HIV?
Many people infected with HIV are unaware of the infection in the early stage (acute, stage 1), as they may not experience any symptoms or only mild symptoms (e.g. headache and sore throat) that can be easily confused with other illnesses (2). Other people experience more serious symptoms, including:

  • High fever
  • Swollen lymph nodes
  • Skin rashes
  • Diarrhea
  • Mouth ulcers
  • Muscle aches
  • Sore throat with persistent coughing
  • Chills
  • Night sweats

The second stage is called chronic HIV infection or clinical latency and generally doesn’t cause any symptoms.

AIDS is the third stage of an HIV infection when the virus has destroyed so many of the host’s immune system cells (2). The symptoms can include:

  • Rapid weight loss
  • Extreme fatigue
  • Pneumonia
  • Skin discoloration
  • Memory loss
  • Depression
  • Increased susceptibility to other infections such as tuberculosis, severe bacterial infections, and certain cancers

Who is at risk of HIV?
Populations that have an increased risk of HIV include men who have sex with men, injecting drug users, individuals in correctional facilities, sex workers (and their clients), and transgender individuals (3).

How is HIV diagnosed?
HIV infections are usually diagnosed by the detection of HIV antigens and antibodies in a blood sample. It is important to note that there is a window period of 45-90 days, during which HIV diagnostic tests may produce a negative result, although infected individuals can still transmit the virus to others. Follow-up testing is recommended for any individuals with a negative result who may have been exposed to HIV (3).

How is HIV treated?
Although there is no cure for HIV, effective antiretroviral therapy (ART) ensures that infected individuals can live relatively normal lives and prevents the transmission of HIV. Individuals at risk for HIV can also take HIV medication called pre-exposure prophylaxis (PrEP), which is highly effective for preventing HIV (3).

References:
1. Weiss RA. (1993) How does HIV cause AIDS? Science, 260 (5112), 1273-1279.
2. Symptoms of HIV. Clinical Info HIV.gov. July 2020.
3. HIV/AIDS. World Health Organization.

Posted in HIV

How is HIV treated?

There is no cure for HIV. However, antiretroviral therapy (ART) is a very effective treatment to prevent the progression of HIV and to prevent the transmission of HIV to others. It enables HIV-positive individuals to live relatively normal, healthy lives (1).

What is ART?
ART is a life-long daily treatment that must be strictly followed. It is a combination of different HIV medicines (HIV regimen) that work by suppressing the replication of the virus. This reduces the amount of HIV in the body, known as viral load. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood (2).

When this viral load is at undetectable levels (viral suppression), it doesn’t mean the virus is gone completely, but it does prevent the disease from progressing and means there is effectively no risk of passing HIV to others through sex (2). It also reduces the risk of transmission through shared needles and syringes, from a mother to her baby during pregnancy and at birth, and during breastfeeding. However, current recommendations in the United States state that HIV-positive mothers should not breastfeed their babies even if they have an undetectable viral load (2).

At the end of 2019, an estimated 59% of individuals on ART had achieved suppression of the HIV virus with no risk of transmitting the virus to others through sex (1).

It is important to remember that ART does not prevent the transmission of other STDs. So just because you or your partner are on ART, other safe sex practices are still important.

What are the HIV medicines in an HIV regimen?
There are seven classes of HIV medicines, which are classified based on how they fight HIV (3):

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Protease inhibitors (PIs)
  • Fusion inhibitors
  • CCR5 antagonists
  • Integrase strand transfer inhibitors (INSTIs)
  • Post-attachment inhibitors

HIV regimens can differ between individuals and are selected based on various factors, including possible side effects, potential drug interactions, and disease progression.

When to start ART?
ART should be started as soon as possible following an HIV diagnosis. It doesn’t matter how healthy you are or how long you have had HIV.

ART is life-long and must be taken as prescribed on a daily basis. If ART is not taken consistently, drug-resistant HIV strains can develop, meaning the medications will no longer be effective (2).

Routine viral load and CD4+ T cell monitoring are important to ensure that treatment is effective and maintaining viral load at undetectable levels in the blood (3).

If the treatment is discontinued, HIV will continue to replicate increasing the risk of HIV transmission and the disease can progress to AIDS (3).

What are the potential side effects of ART?
HIV medicines available nowadays generally cause fewer side effects than some HIV medicines used in the past (4). However, some people do still experience a range of side effects, which can include:

  • Nausea and vomiting
  • Diarrhea
  • Difficulty sleeping
  • Dry mouth
  • Headache
  • Rash
  • Dizziness
  • Fatigue
  • Pain

What other treatment options are there?
Methods are also available to reduce the risk of contracting HIV. Pre-exposure prophylaxis (PrEP) is a daily medication that individuals at high risk of HIV (e.g. partner of an HIV-positive person) can take to minimize their risk of HIV infection. There are currently two FDA-approved PrEP medications that reduce the risk of contracting HIV via sex by up to 99% (5).

Post-exposure prophylaxis (PEP) is an emergency medication that must be started within 72 hours of exposure. PEP is a short course of medication that reduces the risk of infection but should not be used to replace other HIV and STD prevention methods (6).

References:
1. HIV/AIDS. World Health Organization.
2. HIV Treatment. CDC. Reviewed May 2021.
3. HIV Treatment: The Basics. NIH.gov (Reviewed March 2020)
4. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Clinical Info. HIV.gov (Updated June 20201)
5. FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. FDA News Release. (October 2019).
6. PEP (Post-Exposure Prophylaxis). CDC. (Reviewed May 2021)

Posted in HIV

Viral load and viral suppression. What do they mean?

HIV refers to the human immunodeficiency virus, which is a viral infection that targets the body’s immune system cells, such as macrophages, dendritic cells, and helper T cells (specifically CD4+ cells) (1). In the absence of effective treatment, the number of CD4+ cells declines, eventually leading to a loss of cell-mediated immunity and the development of acquired immunodeficiency syndrome (AIDS) (2).

Although there is no cure for HIV, there are very effective medicines available to prevent the progression of HIV and to prevent the transmission of HIV to others through sex.

These medicines, called antiretroviral therapy (ART), reduce the viral load, which refers to the amount of HIV in the body. Consistent use of ART keeps the viral load low and enables the immune system to recover and maintain a high CD4+ T cell count.

When the viral load is very low, it is referred to as viral suppression. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood (3). This can also be called an “undetectable viral load”.

When this viral load is at undetectable levels (viral suppression), it doesn’t mean the virus is gone completely, but it does prevent the disease from progressing and means there is effectively no risk of passing HIV to others through sex (3). It also reduces the risk of transmission through shared needles and syringes, from a mother to her baby during pregnancy and at birth, and during breastfeeding. However, current recommendations in the United States state that HIV-positive mothers should not breastfeed their babies even if they have an undetectable viral load (3).

At the end of 2019, an estimated 59% of individuals on ART had achieved suppression of the HIV virus with no risk of transmitting the virus to others through sex (4).

ART is life-long and must be taken as prescribed on a daily basis. If ART is not taken consistently, drug-resistant HIV strains can develop, meaning the medications will no longer be effective (3).

Routine viral load and CD4+ T cell monitoring are important to ensure that treatment is effective and maintaining viral load at undetectable levels in the blood (5).

References:
1. Cunningham, AL, et al. (2010) Manipulation of dendritic cell function by viruses. Curr Opin Microbiol, 13 (4), 524-529.

2. Weiss RA. (1993) How does HIV cause AIDS? Science, 260 (5112), 1273-1279.
3. HIV Treatment. Reviewed May 2021. CDC.
4. HIV/AIDS. World Health Organization.
5. HIV Treatment: The Basics. (Reviewed March 2020)HIVinfo. NIH.gov.

Posted in HIV

What is the difference between HIV and AIDS?

HIV refers to the human immunodeficiency virus, which is a viral infection that targets the body’s immune system. If HIV is untreated, it can progress to acquired immunodeficiency syndrome (AIDS) (1).

HIV can be transmitted through certain bodily fluids (blood, semen, pre-seminal fluid, vaginal and rectal fluids, and breast milk). HIV is most commonly spread through vaginal or anal sex, or sharing needles, syringes, and other drug equipment. It can also be spread from a mother to her baby during pregnancy, childbirth, or breastfeeding (2).

Although there is no cure for HIV, there are effective medications (antiretroviral therapy, ART) to control the virus infection. ART slows down the replication of the virus to stop the disease from progressing and also prevents transmission to others (2).

There are three typical stages of an HIV infection (3).

  • Acute infection is when HIV is most infectious, although many people may not show any symptoms or only mild symptoms that are easily confused with other illnesses.
  • The second stage can be known as chronic infection, clinical latency, or asymptomatic HIV infection, as most individuals do not show any symptoms.
  • However, if HIV is left untreated, the damage to the body’s immune system gradually gets worse and worse and leads to the third stage known as acquired immunodeficiency syndrome (AIDS).

AIDS occurs due to the serious damage to the immune system caused by HIV. Symptoms can include rapid weight loss, extreme fatigue, depression, pneumonia, and increased susceptibility to other infections such as tuberculosis, severe bacterial infections, and certain cancers.

HIV disease progression can vary widely. Typically, untreated HIV infections progress to AIDS in 8-10 years, but it can be shorter or longer for some people. Most of those with untreated AIDS only survive about three years or less, depending on opportunistic infections and cancers (2).

References:
1. Weiss RA. (1993) How does HIV cause AIDS? Science, 260 (5112), 1273-1279.

2. HIV/AIDS. World Health Organization.
3. Symptoms of HIV. Clinical Info HIV.gov. July 2020.

Posted in HIV

What are the symptoms of HIV?

Human immunodeficiency virus (HIV) is a sexually transmitted disease, with three typical stages of infection – acute infection, chronic infection, and acquired immunodeficiency syndrome (AIDS). Symptoms differ depending on the stage of infection.

Acute HIV Infection
The initial phase of acute HIV infection is when HIV is most infectious (1), even though many individuals are unaware that they have contracted HIV, as they do not display any symptoms, or only experience mild symptoms. Other people experience more serious symptoms within 2-4 weeks after infection, which can last for just a few days or for several weeks (2, 3). Symptoms can include:

  • High fever
  • Sore throat
  • Swollen lymph nodes
  • Skin rashes
  • Diarrhea
  • Mouth ulcers
  • Muscle aches
  • Persistent coughing
  • Chills
  • Night sweats

Chronic HIV Infection
The second stage of HIV infection can also be known as clinical latency or asymptomatic HIV infection. The virus is still multiplying during this stage, but only at very low levels, and many individuals do not show any symptoms. However, without HIV treatment, individuals in this stage can still transmit HIV (2).

AIDS
HIV targets cells of the immune system reducing the ability to fight other infections and eventually progressing to AIDS (stage 3 of HIV infection) in untreated individuals (2). The symptoms of AIDS include:

  • Rapid weight loss
  • Extreme fatigue
  • Pneumonia
  • Skin discoloration
  • Memory loss
  • Depression
  • Increased susceptibility to other infections such as tuberculosis, severe bacterial infections, and certain cancers

How quickly does an HIV infection progress?
HIV progression can vary widely. Typically untreated HIV infections progress to AIDS in 8-10 years, but it can be shorter or longer for some people. Most of those with untreated AIDS only survive about three years, or less depending on opportunistic infections and cancers.

Nowadays, effective HIV medications, called antiretroviral therapy (ART), are available treat HIV. Although these medications do not cure the disease, they reduce the replication of HIV in the blood to an undetectable level. This enables infected individuals to live relatively normal lives and prevents the transmission of HIV (1).

References
1. HIV/AIDS. World Health Organization.
2. Symptoms of HIV. Clinical Info HIV.gov. July 2020.
3. HIV Basics: About HIV. CDC. November 2020. 

Posted in HIV

A brief history of HIV

Chimpanzees as the source of HIV-1
Human immunodeficiency virus (HIV) shares many similarities with Simian immunodeficiency virus (SIV), which is a virus that attacks the immune systems of monkeys and apes. Researchers discovered a strain of SIV, called SIVcpz, in a chimpanzee that is almost identical to HIV-1 in humans (1). It is believed that this virus was spread to humans through hunting of the chimpanzees, where the virus was transmitted during consumption of the chimpanzee or the chimpanzee blood getting into wounds on the hunter (2). The much less common HIV-2 was transmitted from sooty mangabey monkeys in likely the same hunter scenario (3).

African origins of HIV
Although the earliest verified HIV case is from a blood sample collected in 1959, there were numerous earlier clusters of deaths from opportunistic infections, which are a now known to be ‘AIDS-defining’ patterns (2). Retrospective analyses of the 1959 blood sample have allowed scientists to create a ‘family-tree’ ancestry of HIV, from which it has been concluded that the first transmission of SIV to humans (and the subsequent small changes to become HIV) occurred around 1920 in what is now Kinshasa in the Democratic Republic of Congo (4).

Around the time that HIV began to spread, Kinshasa had a growing sex trade and was also a transport hub, enabling to virus to spread around the country and further into Africa (5).

Spread around the world
In the 1960s, many Haitian professionals who had been working in DR Congo returned to Haiti, unwittingly bringing HIV with them (5). Around this time, HIV is believed to have also spread to other regions of the world. People often think of the HIV epidemic starting in the 1980s, but by this point, HIV had likely already spread to five continents (North America, South America, Europe, Africa, and Australia), infecting between 100,000 and 300,000 people (6, 7).

HIV in the US in the early 1980s
In June 1981, there was a report of Pneumocystis carinii pneumonia (PCP) in previously healthy, homosexual men in LA (8). This was the first official report of what became known as the AIDS epidemic. At the same time, an unusually aggressive cancer named Kaposi’s Sarcoma was reported in groups of men in New York and California (9).

The original names given to this infectious disease were related to the word ‘gay’ due to the cases occurring in homosexual males. However, soon cases were reported in other populations, including heroin users and hemophiliacs. By September 1982, the spreading epidemic was officially called acquired immunodeficiency syndrome (AIDS) (10).

Discovery of the cause of AIDS
In May 1983, researchers at the Pasteur Institute in France reported the discovery of a new retrovirus called Lymphadenopathy-Associated Virus (or LAV) that could be the cause of AIDS (11). Scientists working at the USA National Cancer Institute isolated the same virus and called it HTLV-III. LAV and HTLV-III were later acknowledged to be the same, and renamed HIV (12).

First testing for HIV
The first commercial blood test to detect HIV was an ELISA licensed by the FDA in March 1985. This enabled HIV screening of blood donations at the blood banks. In 1987, a more specific western blot test kit was approved for detecting HIV antibodies. A testing kit became available to healthcare providers in 1992, and the first rapid HIV test in 2002 (7).

How quickly was the epidemic growing?
By the end of 1985, AIDS had been reported in every region of the world, with 20,303 reported cases in total. This nearly doubled to 38,401 reported cases by the end of 1986, and 71,751 reported cases by the end of 1987. By December 1990, there were already over 100,000 AIDS cases in the US and over 307,000 AIDS cases reported worldwide. However, actual numbers were predicted to be closer to a million, and an estimated 8-10 million people were living with HIV worldwide.

Despite the approval of effective HIV treatments, the numbers kept escalating. By December 1996, an estimated 23 million people around the world were living with HIV, 30 million by 1997, and 33 million by 1999. In 1999, the WHO announced that AIDS was the most common cause of death in Africa, and the fourth biggest cause of death worldwide, with an estimated 14 million AIDS deaths having occurred by this point. AIDS-related deaths reached a peak in 2005, and by 2013, the death rate had fallen by 30% (7).

HIV drugs
In March 1987, the FDA approved the first antiretroviral drug, zidovudine (AZT), as treatment for HIV. However, it wasn’t until the approval of highly reactive antiretroviral treatment (HAART) in 1995 that there was such a noticeable decrease (60-80% decline) in AIDS-related deaths, and this was only in those countries that could afford it (13). In the early 2000s, antiretroviral drug prices were reduced for developing countries and a global fund was created to reduce the spread of HIV (7). By 2017, more than half the global population affected by HIV was receiving effective HIV treatment, which prevents the development of AIDS and the transmission of HIV if viral load is undetectable (14).

References
1. Gao F, et al. (1999). Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature, 397 (6718), 436-441.
2. Sharp PM & Hahn BH (2011). Origins of HIV and the AIDS pandemic. Cold Spring Harb Perspect Med. 1 (1), a006841.
3. Chen Z, et al. (1997). Human Immunodeficiency Virus Type 2 (HIV-2) Seroprelavence and Characterization of a Distinct HIV-2 Genetic Subtype from the Natural Range of Simian Immunodeficiency Virus-Infected Sooty Mangebeys. J Virol. 71 (5), 3953-3960.
4. Faria NR, et al. (2014). The early spread and epidemic ignition of HIV-1 in human populations. Science, 346 (6205), 56-61.
5. Origin of HIV & AIDS. Avert. 30 Oct, 2019.
6. Mann JM (1989). AIDS: A worldwide pandemic. Current Topics in AIDS Volume 2, edited by Gottlieb MS, et al. John Wiley & Sons.
7. History of HIV & AIDS Overview. Avert. 10 Oct, 2019.
8. Epidemiologic Notes and Reports (June 1981). Pneumocystis Pneumonia – Los Angeles. MMWR. 30 (21). 1-3. 
9. CDC (1981). Kaposi’s Sarcoma and Pneumocystis Pneumonia among Homosexual Men- New York City and California. MMWR, 30 (25), 305-308.
10. HIV and AIDS Timeline. CDC. 21 Oct 2020. 
11. Barré-Sinoussi F, et al. (1983). Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science, 220 (4599), 868-871.
12. Marx JL (1984). Strong new candidate for AIDS agent. Science, 224 (4648), 475-477.
13. James JS (1995). Saquinavir (Invirase): first protease inhibitor approved – reimbursement, information hotline numbers. AIDS Treatment News, 22 (237), 1-2.
14. UNAIDS (2017). Ending AIDS: Progress towards 90-90-90. [pdf]

Posted in HIV