THE CHANGING FACE OF HIV
Living longer and managing the complications.
More than 30 years ago, in 1981, the first cases of HIV/AIDS were diagnosed. It was quickly realized that this was a new disease that caused severe and unusual infections and cancers in previously healthy young adults. A new described virus, named the Human Immunodeficiency Virus (HIV), was confirmed to cause this devastating disease. It was later determined that HIV had originated in sub-Saharan Africa in the early 20th century, and then spread throughout the world by the 1970s and 1980s. HIV progressively weakens infected people’s immune system over several years until they develop AIDS. Initially, AIDS was usually fatal.
”Changes in the body’s visible fat stores occurred which were often troubling to patients, and diminished their quality of life making it difficult for them to take their medications regularly.”
Understanding transmission
HIV is transmitted by an infected person through exposure to their blood or blood products, during sexual intercourse through contact with semen, but not sperm, or vaginal secretions containing HIV, and by passage of HIV from a pregnant mother to her foetus through the uterus or by breastfeeding via breastmilk. Casual transmission of HIV does not occur, and it is not found in sweat. Transmission by ‘friendly’ kissing does not occur.The information by which the virus is spread was important as this knowledge was translated into specific recommendations which changed many peoples’ risk behaviours and prevented new infections. This was also reassuring to health care workers, families and friends taking care of these ill patients.
Addressing an epidemic
In the early part of the epidemic, in western countries, most HIV infected people were young gay men, injection drug users, the socially disenfranchised and heterosexuals. E ective anti-HIV drugs were initially not available and therapy was limited to treating the specific AIDS-related complications. Although these treatments were initially successful, patients’ health continued to deteriorate as their immune systems weakened. Patients succumbed as multiple complications occurred. People who survived usually remained very ill, were unable to work, and needed help to get through a routine day. Tremendous e orts by patients’ extended communities provided much needed support but many remained isolated due to fear and misinformation.
By the mid-1990s combinations of powerful anti-HIV drugs were available in western countries, and progressively in developing countries as well, where most of the world’s more than 35 million HIV infected people currently live. These drugs control HIV replication leading to recovery of the immune system. Today AIDS occurs far less often in people taking these drugs. The early available anti-HIV drugs, despite being effective against HIV, had limitations and side e ects, particularly the need to take many pills daily. They also sometimes caused severe intestinal and neurologic problems, increased blood sugar and cholesterol levels. Changes in the body’s visible fat stores occurred, which were often troubling to patients, and diminished their quality of life making it difficult for them to take their medications regularly.
A new era of aging with HIV
Since those early days continuing research and development of new drugs has led to many more positive changes in HIV therapy and outcomes. Today’s drug combinations are much better tolerated, have far fewer side e ects, and can often be taken as a single daily pill. This has resulted in a completely new HIV era. Most people with access to these drugs and who take them regularly feel well, and lead essentially normal lives, although they require regular follow-ups. Currently treated patients are likely to have almost the same long-term survival as the general population, a development that was not even considered 15-20 years ago, when the impact of AIDS was the most devastating.
As a result people are now aging with HIV. Some patients are developing medical conditions typically occurring in the elderly, but which may occur at a younger age leading to concerns about premature aging in some patients. Patients may be at risk for heart attacks, strokes, as well as osteoporosis and bone fractures. There is also concern about mild memory problems occurring. Some problems related to body fat stores still occur including generalized obesity and particularly abdominal obesity in some patients. Targeted treatments of these complications are being actively investigated. There has also been a shift in the type of persons exposed to HIV. More new infections are occurring among older people and socio-economically disadvantaged groups, although some younger adults continue to engage in high-risk activities and continue to remain at risk.
In many ways, HIV has been successfully transformed into a chronic, and mostly manageable infection. HIV continues to challenge us with evolving manifestations, and to demand that we respond to new challenges, expectations and responsibilities.