HIV/AIDS

Schematic diagram of an HIV.

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Acquired Immune Deficiency Syndrome (AIDS) is a collection of opportunistic diseases that almost inevitably lead to death when untreated. AIDS has been conclusively demonstrated to be caused by long-term infection with the Human Immunodeficiency Virus (HIV), except for HIV denialists (who deny that HIV causes AIDS, or that HIV even exists). In short, HIV suppresses the body's defenses against infection, leaving it vulnerable to just about anything that attempts to invade.

Disease

Definition

According to the Centers for Disease Control's 1993 guidelines, AIDS is defined as an HIV infection plus any of the following:

• CD4 count (i.e., CD4 T lymphocytes count or T-cell count) less than 200 per microlitre blood, or
• CD4 percentage less than 14% of total lymphocytes, or
• any of the following illnesses: pulmonary TB, recurrent pneumonia, invasive cervical cancer, or
• expanded definition including 23 clinical conditions published elsewhere.

The World Health Organization uses a different staging method for HIV disease.

Pathology

Main symptoms of acute HIV infection

After infection with HIV, the virus quickly replicates in lymphatic tissue and travels through the blood to infect most areas of the body. The largest consequence of this is the "hijacking" of certain immune cells (any that express the protein CD4, which is the target of the viral antigen), especially so-called Helper-T cells, or CD4+ (CD4 positive) cells. The virus capsid contains two proteins, called Reverse Transcriptase and DNA Integrase, along with the viral strand of RNA. Reverse Transcriptase performs reverse transcription on the viral RNA, thus converting it into DNA, and DNA Integrase then "injects" the viral DNA into the host DNA in the cell nucleus. One of the primary methods of control in HIV-positive patients is therefore Reverse Transcriptase Inhibitors (RTIs).

Early in the infection, the immune system holds the infection at bay, often causing "Acute Retroviral Syndrome," a flu-like illness. Patients often have swollen lymph nodes. After approximately 8–10 years of infection, the immune system begins to lose its battle. This is primarily seen in the loss of numbers of CD4+ cells, however the changes are somewhat more complex. When the CD4+ cell level drops low enough, AIDS becomes apparent. The first symptoms of the illness are generally night sweats, weight loss, and oral thrush.

Contagion

HIV is transmitted by exchange of precious bodily fluids, especially when direct exposure of the bloodstream is involved. Sex is the most common mode of transmission due to the frequency of events, though it's not the most dangerous single event. A direct blood transfusion has a well over 90% chance of infection, which is why blood donations are heavily screened and tested. Sharing a dirty needle has a much lower chance at .63% per event, but much like sex, heroin is rarely a one-time event. There's almost no chance of transmission with proper condom use. Unprotected sexual intercourse, however, varies wildly by act. There's a .04% chance of transmission for vaginal insertive (as in, the chance to acquire HIV from an infected partner being on the receiving end of vaginal intercourse), .08% vaginal receptive, .11% anal insertive, and 1.38% for anal receptive per act. Oral, receptive or insertive, has a less than .01% chance of transmission.

Notably, anyone on the receiving end of both vaginal and anal gets the short end of the stick when it comes to HIV, and almost all other STDs for that matter. If you are receiving from someone other than a longterm partner, please insist on proper protection. If they don't care enough about your safety to wear a condom, dump them.

There is no effective vaccine for HIV specifically. However, there are indirect effects from other vaccines. HIV transmission is much more likely when other diseases such as HPV or Hepatitis are present. Being vaccinated against those reduces the chance of HIV transmission, even if slightly.

These days, effective antiretroviral therapy (ART) means an HIV infection can be controlled simply by popping a few pills daily. Access to any halfway decent healthcare (though that in itself is a not a given in far to many places in the world) combined with early diagnosis can prevent HIV ever progressing to the AIDS stage and you can lead a long and healthy life the same as anyone without a HIV infection. It is no longer a death sentence. Early diagnosis is key to for the best outcomes though, which usually is dependent on regular testing. Because the initial symptoms that occur from the initial infection are often mistaken for a bout of flu, lasting just as long before clearing up on their own, early detection can easily be missed. In these cases HIV will go undetected for possibly years, quietly destroying your immune system, until you get seriously ill from an opportunistic infection that we associate with AIDS. At this point, the HIV infection can be treated with ART the immune system will bounce back. The opportunistic infection can be treated, but there is a risk that it can cause permanent damage to your health before it is, not to mention the risk of passing on an undiagnosed HIV infection to others before it is picked up. Ultimately, thanks to modern medicine, HIV should not be the death sentence it once was.

Opportunistic Infections (OIs)

The hallmark of AIDS is the appearance of opportunistic infections, meaning infections with organisms that do not usually cause human disease, unless given the right "opportunity". This opportunity is the reduction in cell-mediated immunity, first seen in patients with certain cancers or on anti-rejection drugs for organ transplantation.

These infections include:

• Pneumocystis jiroveci, previously Pneumocystis carinii
• Candida albicans (the cause of thrush and vaginal yeast infections)
• Staphylococcus aureus (primarily causes skin infections)
• Toxoplasma gondii
• Cytomegalovirus
• Streptococcus pneumoniae (the primary cause of pneumonia in AIDS patients)
• Mycobacterium tuberculosis (TB)
• Mycobacterium avium complex (atypical mycobacterium)
• Cryptococcus neoformans (a cause of meningitis)
• Epstein Barr virus (which leads to a type of lymphoma)
• Human herpesvirus-8 (which causes Kaposi's sarcoma)

History

“”Facing the greatest public health crisis of his administration, Ronald Reagan was not heroic. He was a dithering coward.

—Laura Helmuth

Early

Based on genetic analysis, the origin of the virus has been traced to a single transmission of chimpanzee to human in 1920 in what was then Leopoldville, Belgian Congo (now called Kinshasa, Democratic Republic of the Congo); most likely the chimpanzee came from neighboring Cameroon as part of the bushmeat trade. The illness was first recognized in the early 1980s in the US as gay men presented to their doctors with a rare lung disease called Pneumocystis carinii pneumonia (PCP). Early on, the "gay disease" took on a variety of names, including "gay cancer" and "Gay-related immune deficiency" (GRID). The CDC noticed an increase in requests for drugs needed to treat this illness and launched an epidemiological investigation.

Randy Shilts in his book And the Band Played On: Politics, People, and the AIDS Epidemic identified Air Canada flight attendant Gaëtan Dugas as "Patient Zero", the first person to contract HIV and spread AIDS in the US, but this has been refuted by a new epidemiologic analysis; HIV arrival in the US preceded Dugas by a few years and arrived from Africa via Haiti. The earliest likely person to have died from AIDS in the US was a 16-year-old in 1969. Dugas was likely erroneously identified as patient zero because 1) he was a relatively early disease carrier in the US 2) he had over 2500 sex partners by his own admission, 3) he had an unusual name that his sex partners were more likely to remember, and 4) he had a 'O' for 'from out of town' on a chart of known sexual contacts of early victims that was later misinterpreted as a zero.

Sexidemic

The early epidemic-phase of the disease occurred in two main branches; in the US and other developed countries, and in sub-Saharan Africa. In the US, the early epidemic was primarily spread by anal sex (mostly among homosexuals), intravenous drug use, and blood transfusions. In sub-Saharan Africa, transmission was, and remains, widespread among heterosexuals, as anal sex is widely practiced as a means of contraception. Infection rates have dropped in industrialized countries, largely due to acceptance of safe sex practices. Currently, most new infections worldwide are in sub-Saharan Africa.

Safety

Social and political responses to the AIDS epidemic of the 1980s have included the "safe sex" movement, with demands for greater availability of contraception, greater awareness of the risks of unprotected sex, and more comprehensive sex education. Sadly, however, the fact of the matter was that Ronald Reagan refused to mention AIDS on television until the disease had spread so widely that it was no longer just an American but global pandemic. Reports from the CDC going back to 1980 were alerting the government of the numbers of infections and what that meant, but queers, dopers, and Haitian refugees can fuck themselves. Only when celebrity Rock Hudson turned into a walking skeleton before everyone's eyes did the Gipper catch the drift. Hell of a job.

The movements for safe sex and comprehensive sex education have been met with continuing resistance from conservatives, who see them as implying approval of promiscuous lifestyles and hence contributing to "moral decline." (Apparently saving lives is moral decline.)

Quack treatments

See the main article on this topic: Quack HIV/AIDS treatments

There is no cure or vaccine for HIV as of present time (though one drug used to treat HIV is also highly effective as a prophylactic against HIV infection when taken regularly: tenofovir disoproxil/emtricitabine in combination, commercially known as Truvada, or colloquially as "PrEP"). Thus, unsurprisingly, there has grown a field of quack medical treatments purporting to treat AIDS. These treatments are ineffective and range from the harmless but worthless to potentially deadly.

HIV/AIDS and religion

“”When any man hath an issue out of his flesh, Because of his issue, he is unclean. Every bed whereon he lieth is unclean, And everything whereon he sitteth, unclean, And whosoever toucheth his bed shall be unclean, And he that sitteth whereon he sat shall be unclean, And he that toucheth the flesh of the unclean Becomes unclean, And he that be spat on by him, unclean Becomes unclean.

—Diamanda Galás, "This Is The Law Of The Plague", adapted from Leviticus and Psalms

American fundamentalism

Since AIDS initially appeared to be impacting only the gay community, some religious fundamentalist groups, proclaimed that the disease was a divine retribution for homosexuality, or for promiscuity and moral decline. Analogies were made to Sodom and Gomorrah, and semi-Biblical slogans such as "if you live by the flesh, you will die by the flesh" were coined; and of course references were made to Biblical predictions that plagues would mark the beginning of the apocalypse.

These ideas have lost traction among most religious groups, although one study suggests that 23% of Americans still think AIDS is God's punishment for… well, something. Global statistics of religious propaganda and belief based on AIDS being "retribution from God(s) for act XYZ" are unknown, as of present times. A few obnoxious extremists who have still clung to the punishment idea included the late Pat Robertson, the late Fred Phelps and the late Jerry Falwell. Placards held by members of Phelps' Westboro Baptist church in their homophobic picketing activities regularly include slogans such as "Thank God for AIDS." (Well, sure, if you wanted to portray your God as one of peace…)

Considering that first responders to accidents, babies born to infected mothers, or faithful wives/husbands infected by their partners all have exposure to AIDS, it is difficult to see what these innocent people have done to gain God's Wrath. Only Jehovah's Witnesses may perhaps imagine those who got the disease from blood transfusions are at fault. But we'll take schadenfreude at the fact that one of the most important Christian rock records was actually about AIDS.

Other superstitions

Many other myths and superstitions have grown up surrounding AIDS, including the belief that the disease originated from a man having sex with a monkey or (non-human) ape, and contracting a simian disease from it. In societies with a poor education or awareness of AIDS, or a high level of prejudice, sufferers are often ostracised in the false belief that any kind of contact could spread the disease. In sub-Saharan Africa, the belief, known as virgin cleansing myth, is widespread that sex with a virgin will cure AIDS. This has had… unpleasant results.

See also

• HIV/AIDS denialism
• ACT UP
• C. Everett Koop
• Luc Montagnier

External links

• See the Wikipedia article on HIV/AIDS.
• Human Immunodeficiency Viruses and Human T-Cell Lymphotropic Viruses IARC Monograph Volume 67 (1996) International Agency for Research on Cancer