What is HIV? A review of the Human Immunodeficiency Virus
Although an HIV diagnosis can feel like a fatal prognosis at first, new medications and technologies enable people to live long and healthy lives. Harmful myths and misconceptions surrounding HIV perpetuate negative attitudes and stereotypes about different marginalized groups of people. The sexually transmitted virion, human immunodeficiency virus (HIV), spreads from person to person through bodily fluids or blood. HIV viruses then infect CD4+ T cells, also known as helper T cells, throughout the body. [1] T cells are supposed to signal to other white blood cells to begin fighting foreign viruses, germs, and bacteria, a collaboration that helps ensure our immune system keeps us safe and healthy against the harmful pathogens that enter our body. When someone contracts HIV, this signalling is compromised. As infection continues, HIV integrates into the genome of the CD4+ T cells and replicates inside of them. [2] Figure 1 gives a simplified model of viral integration. [3] When HIV virions replicate inside of CD4+ T cells, or helper white blood cells, the internal communication of the immune system slows and leads to the weakening of the body, leaving us weak and vulnerable to further attack.
As more and more T cells die due to being hijacked by HIV, the infected individual becomes susceptible to opportunistic infections. These are infections from pathogens that are present in our daily lives, but very rarely is a problem for healthy individuals. In HIV infected individuals, these infections occur more often and more severely. For example, someone may go to the hospital for pneumonia and get a blood panel done that reveals they actually have HIV. [4] While testing may reveal that someone has HIV, presence of HIV virions in blood does not equate to the individual being diagnosed with acquired immunodeficiency syndrome (AIDs). HIV is simply a virus, and AIDS is the final stage of HIV infection, where T cells in an individual drops below a medically defined level, and many people may live with HIV and only develop AIDS years after infection (or never at all, with access to medications). [5]
HIV travels through blood or other bodily fluids such as semen, vaginal fluids, rectal fluids, breast milk and blood. It is especially important to know that HIV travels through the mucosal membranes, specifically the oral, the rectal and vaginal mucosa. [6] Although sexual contact is the most well-known way of spreading HIV, blood is also a mode of HIV transmission and an individual sharing needles with another person, such as for recreational drug use, is also at high risk for infection. [7] Anyone can get HIV, although groups most disproportionately living with HIV infection include men who have sex with other men and those who inject drugs.
HIV and AIDS have been stigmatized in medicine and in society for decades. Following the AIDS epidemic in the 1980s, stigma and prejudice against people who had HIV or AIDS increased substantially. [8] The intersection between different “social forces such as poverty, sexism, racism and others create overlapping and reinforcing stigmatized conditions [that] limits [people’s] ability to access diagnostic and treatment services.” Furthermore, these forces of stigmatization are essential in labeling, stereotyping, separating, and discriminating against different groups of people and individuals on the basis of their health. The lack of adequate education on diseases like HIV reinforces negative beliefs such as “sex workers contracting HIV” or “the LGBTQ+ community contracting HIV” because it only works to perpetuate a negative cycle of harm by neglecting other perspectives of HIV positive individuals. [9] By having an open-mind and being more informed about HIV, people can mitigate the harm that is caused by both the transmission of HIV and the stigma that surrounds it. When people enable harmful attitudes and ideas surrounding HIV, it makes it more difficult for people to get the resources and help that they need.
HIV is not curable, but it is treatable. [10] Due to new advancements in medicine and other technologies, there are many different ways to treat HIV. Before listing all of the new technologies that prove that higher and sustainable HIV-positive quality of life is attainable, it is necessary to acknowledge that medicine and treatments are not accessible to everyone. [11] The life expectancy of individuals with HIV who have treatment is a full lifetime whereas for those without treatment, it is only about 10 years past infection. Please refer to Figure 2 [12] about the lifespan of HIV in the body when it is not treated.
The most advanced treatment today is antiretroviral therapy, commonly known as ART. ART usually comprises a regimen of drugs that targets various stages of the HIV lifecycle to prevent the transmission of HIV by suppressing viral replication. This results in a virus count low enough that HIV is undetectable in the body when tested. [13] Oftentimes, ART is utilized through combining treatments such as NRTI, or nucleoside/nucleotide reverse transcriptase inhibitors. [14] When someone does not have HIV but is at high risk for contracting it, they might want to take PrEP, or pre-exposure prophylaxis. PrEP works similarly to ART in that it reduces HIV replication to maintain the native number of white blood cells. [15] While there are other medications that are used to help treat HIV, these are the current and most comprehensive set of medications for treating HIV. This curated method to stop the spread, transmission, and progression of the disease has worked to slow the spread of HIV substantially.
While the efforts to stop the spread of HIV have been immense, HIV is still an issue globally. More discourse regarding STDs and HIV could help improve education and reform of HIV and even other STD medications. In a larger context, the implications of STDs on different populations is crucial, such as the AIDS epidemic in Africa and its connection to lack of proper resources and medications that are made easily accessible to others in different places. [16] The harm that is caused by HIV can be lessened as new medicines and technologies continue to be developed.
References
- CD4 lymphocyte count: Medlineplus medical test [Internet]. U.S. National Library of Medicine; Available from: https://medlineplus.gov/lab-tests/cd4-lymphocyte-count/#:~:text=CD4%20cells%20are%20a%20type,that%20may%20make%20you%20sick.
- The HIV life cycle [Internet]. U.S. Department of Health and Human Services; Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-life-cycle
- “Integration: NIH.” Integration | NIH, clinicalinfo.hiv.gov/en/glossary/integration.
- What is an opportunistic infection? [Internet]. U.S. Department of Health and Human Services; Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/what-opportunistic-infection#:~:text=Opportunistic%20infections%20(OIs)%20are%20infections,in%20contaminated%20food%20or%20water.
- What are HIV and AIDS? [Internet]. Available from: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids
- Yu M, Vajdy M. Mucosal HIV transmission and vaccination strategies through oral compared with vaginal and rectal routes [Internet]. U.S. National Library of Medicine; 2010. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2904634/#:~:text=HIV%20is%20transmitted%20through%20three,the%20vaccination%20sites%20%5B128%5D.
- Ball LJ, Puka K, Speechley M, Wong R, Hallam B, Wiener JC, et al. Sharing of injection drug preparation equipment is associated with HIV infection: A cross-sectional study [Internet]. U.S. National Library of Medicine; 2019. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6905403/
- “The AIDS Epidemic in the United States, 1981-Early 1990s.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 8 July 2024, www.cdc.gov/museum/online/story-of-cdc/aids/index.html. Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward [Internet]. U.S. National Library of Medicine; 2008. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2835402/
- Treating HIV [Internet]. Centers for Disease Control and Prevention; Available from: https://www.cdc.gov/hiv/treatment/index.html#:~:text=There%20is%20no%20cure%20for,Tap%20to%20unmute
- Landovitz RJ, Scott H, Deeks SG. Prevention, treatment and cure of HIV infection [Internet]. Nature Publishing Group; 2023. Available from: https://www.nature.com/articles/s41579-023-00914-1
- Roberts, Gareth, and About The Author Gareth Roberts Dr Gareth Roberts MB/ChB FRCEM MAcadMed PG Dip is an editorial board member of the St Emlyn’s blog and podcast. He is a consultant in Emergency Medicine at Manchester University Foundation Trust. His research interes. “Pep, Prep and All Things HIV.” St. Emlyn’s, 21 May 2024, www.stemlynsblog.org/pep-prep-and-all-things-hiv-st-emlyns/.
- Kemnic TR. HIV antiretroviral therapy [Internet]. U.S. National Library of Medicine; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513308/
- Holec AD, Mandal S, Prathipati PK, Destache CJ. Nucleotide reverse transcriptase inhibitors: A thorough review, present status and future perspective as HIV therapeutics [Internet]. U.S. National Library of Medicine; 2017. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7219633/
- Washington Health Institute. “What Is Prep and How Does It Work?” Washington Health Institute, 19 July 2022, dc-whi.org/what-is-prep-and-how-does-it-work/.
- HIV and AIDS [Internet]. World Health Organization; Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids#:~:text=Transmission%20is%20ongoing%20in%20all,1.3%20million%20people%20acquired%20HIV.
