How to Live with AIDS? The Elders Diary 2

How to live with AIDS

PART I

HIV causes AIDS. What are these acronyms?

Advertisements that educate office colleagues, patients afraid of informing family members, spouses denying conjugal rights knowing they are HIV+ or have AIDS, thousands of rupees spent from family income towards treatment- un accounted for, the repeated illnesses, lonely visits to the doctor- what is all this? Being HIV+ is not death. Having AIDS is not death. Do not kill the patient before his time is up. With coming years, HIV+/AIDS is to be ‘downgraded’ to a affliction or condition like Diabetes, which with proper physical care and medication and enable a person to lead a life with dignity and contribute towards society in a meaningful manner.

‘Human Immunodeficiency Virus’ (HIV) is a virus that attacks a category of sub-category of White Blood Cells called CD4+ T Cells. Wide spread destruction of these cells causes a condition called ‘Acquired Immuno Deficiency Syndrome’ (AIDS) where the human body is rendered incapable of defending itself against the simplest of infections.
The three most common ways of transmission of HIV are-
a) Sexual contact with a HIV+ person or someone in the latent period, who could be called a carrier, with yet to be diagnosed as being HIV+.  Semen, blood, sputum and vaginal secretions could all result in the transmission of HIV
b) Blood transfusions, using contaminated needles by accident in hospitals or sharing with other drug abusers. Even simple things like contaminated eye-droppers could help in the transmission of HIV
c) Pregnancy- or later thru lactation from mother to child.

HIV does not have a good life span outside of the human body, hence casual contact, social kissing, or sharing of items that are not contaminated by blood or saliva cannot cause HIV transmission. Toilet seats for example unless contaminated by body fluids- are safe.

The ‘AIDS  = death’ stigma with HIV/AIDS that peaked in the late 90’s and early 2000’ has now sufficiently worn itself out where it has become acceptable to try and psychologically accommodate patients suffering with this ailment into mainstream social life. Doctors now have a bouquet of almost 30+ drugs that combat the spread of HIV (reducing the viral load, as its calculated in the human body) and another 44 more  registered with the USFDA alone, are in various stages of testing.

Heterosexual sex, with multiple partners is like a probability game that one day, a member of the chain  will get infected and then spread it in the ‘network.’ With male homosexuality, the chances of tears to the rectal canal are more during anal sex, and therefore the chances of passing the infection are far more than in unprotected heterosexual encounters. Condoms offer the simplest barrier to reducing the chances of transmission, but human nature, lack of convenience of use, and surprisingly, the lack of knowledge of how to properly use them in rural areas, are among various factors that preclude the use of these- thereby resulting in disastrous outcomes for either individual.

Suspicion of being HIV+ comes mostly from within, the knowledge of a risky lifestyle, or indulging in any of the events mentioned above, in conjunction with multiple subtle medical symptoms- oral infections, swollen lymph nodes, repeated unexplained fevers, repeated diarrhea, oral thrush and a possible dozen other such symptoms. In many cases, this may not happen and routine examination by hospitals before routine surgeries that could be needed, unrelated to AIDS will pop up an alarming result. Paranoia that sets in after a casual sexual encounter with a sex worker is at times enough to ‘cure’ a person from his wayward ways, but ironically the negative result just bolsters him after the intense fear of having contracted AIDS passes away.

SO what  does one do? -
After about 2-3 weeks of the ‘event’ whether a sexual encounter or a suspected wrongly administered blood transfusion, or the wrongful use of a needle has occurred-
1. Get an Antibody test. The Antibody test will show positive for HIV. IT is the cheapest of tests and correspondingly needs a high viral count to create those many antibodies to reflect a positive.  A negative result, unfortunately, could mean nothing and a repeat after 12 weeks will clear the debate to a >98% probability.
2. 1week- 3weeks from date of incident a more expensive Antigen Test will show the results and lastly
3. A Polymerase Chain Reaction Test would show viral load (extend of spread of the HIV) within 2w-3w from date of event.

So what happens when the HIV enters the human body is that it attaches itself to the T Cells and infects it with it DNA/RNA which then helps it replicate itself. These new HIV cells then attack other CD4+ T cells and the reaction continues. The quantum of HIV in the body is referred to as ‘Viral Load.’

On the realization that a high risk event occurring the person in question should get a rapid test done in 3W and then a repeat in 12weeks. If the Antibody and Antigen tests return a positive result then immediate Highly Active Anti Retrovial Drug Therapy (HAART) should begin.

PART II

So the patient had HIV/AIDS- now what?

HAART should commence, even on the day of the HIV+ lab test result.  This is usually a cocktail of 3 antiretrovial drugs from two of the five classes of drugs used to attack the mechanisms that HIV uses to replicate itself. The sooner the drug therapy begins the better, so that at all times the HIV load can be kept to a minimum and the stress on the immune system is consequently lower.

The HIV+ individual needs to regularly monitor two variables that affect his condition. The HIV Viral load and the CD4+ density. Viral load can vary from a barely detectable 40-75 copies per ml to over 300,000-500,000 in case of full blown AIDS. In normal humans, CD4+ T Cells are usually between 500-1000 cells/mm3, and if their numbers sink below 200, then the condition can be categorized as the patient suffering from AIDS.

A few years ago, Doctors preferred to wait till the CD4+ count dropped to <350, but no longer so. The current aggressive therapy demands that treatment begin at the soonest. This enables the person to avoid minor infections and lead a proper healthy lifestyle. The HIV has the unique ability to mutate and create strains that are resistant to the current drug cocktail. Therefore repeated tests track the viral load and CD4+ numbers and indicate the efficacy of the current cocktail. These numbers also then indicate the need/necessity to change the constituents of the same.

It usually would take between 8-12 years for the HIV+ persons’ immune system to get overwhelmed and then result in the condition called ‘AIDS.’ This is for an untreated person. With medications that I will discuss later, the period may be prolonged for upto twice that number. Even today Basketball star Magic Johnson enjoys a healthy lifestyle almost 20+ years from going public with this HIV+ status.

The HIV attacks the CD4+ cells, uses them relentlessly to multiply over a decade, and over time overwhelms the immune system leading to a condition where the body cannot defend itself from simple oral infections, vaginal yeast infections, and wounds that refuse to heal and further, if untreated overwhelms the patient leaving him susceptible to dangerous medical conditions like pneumonia and cancers which then eventually lead to his/her death. |

Today, very few cases of cures are mentioned in the press, only two, if memory serves me right- at last count and few cases of patients becoming resistant to HIV. This does not mean that they are HIV-free, its just that they are not in need of drugs to keep the viral load down. Long term outcomes of such people are not known yet. In a few cases, the transition from being HIV+ to AIDs can progress in two to three years inspite of intensive HAART. Unfortunately the mechanism or the reason for such rapid progression of the disease is not known.

PART III

Life with AIDS

Exercise, proper diet, and regular ART will now be the key ingredients to a healthy and productive life. The better care the patient takes with the above, the longer will be the phase of being just HIV+ and not progressing to an AIDS situation.

Knowing to interpret the numbers is very important- for example, if the viral load changes from 20000 to 40000, then has doubled- that’s not good. But an increase from 45,000 to 60,000 may not be really worrisome. Also, for the same CD4+ number, a higher viral load is more dangerous than a lower viral load number. It is very important to maintain strict data and records of ones own health along with notes on ART-cocktail recipes, and parallel alternative medicine therapies that one may try on recommendations.

Currently the 30+ and the 44 new drugs, from five classes that attack different ‘waypoints’ in a HIVs life, are available as a part of the ART. Modern techniques like refining ‘transcriptase blockers’ will attempt to stop the replicating mechanism of the HIV itself. Some of the most brilliant minds in the pharma industry are at work on this- and a few of their areas of interest are as – vaccines that will teach the T cells to give a stronger response to the HIV attacker, anti viral medication that will make the cells more resistant to attacks by HIV and then cell and gene therapy that will alter cell wall composition and essentially try and block the HIV from entering the CD4+ cell itself.

At home, rest, diet and exercise like stated earlier should form a part of daily routine. Attention to small details like the good levels of bacteria in the gut to prevent alimentary canal infections. Proper hygiene prevents pesky fungal infections in the toes, around the neck- almost like diabetes, but just more sensitive.  Learning to care for wounds, bathing the infirm, cleaning up vomit or body fluids, the proper wear of protective gear and the systematic manner to clean the clothes, cloths, utensils to prevent infections is a must. Updated knowledge on the side effects of the drugs being taken- which could have some serious contraindications without warning, like swelling of the oral tissues creating difficulty in breathing or swallowing. Extreme attention and care to personal hygiene, and including visits to the dentist for regular check up and cleanings prevent oral health issues that could have potentially fatal outcomes. As with chronic diseases like cancer or pneumonia, life partners and family members should concentrate on learning about palliative care..

Help and support groups are a valuable source of emotional and mental support. Knowledge of drugs, therapies, success stories are all a part of a HIV+ persons life. 

It should be an endeavor to find like minded people who are bent on defeating this ailment and that effort itself would be a positive contribution from them to society.

An earlier medical-oriented article is at-

http://therealslimkd.blogspot.in/2015/08/how-to-avoid-diabetes.html

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NOTE
Do not ever self diagnose your ailments, the numbers here are to prompt you to take a Doctor opinion faster than you usually would.
As regards, ayurvedic or home remedies, you could continue on them as in the least, they will have a palliative effect. These will not replace Allopathic medication.
Do not every self medicate and never stop any allopathic medication based on anything you read. Always consult your Doctor. If in doubt, get a second opinion.