What exactly is Aids? What does the infamous HI-virus do? You may well argue that these questions are inane, considering that the pandemic has raged for more than a quarter of a century and that these terms have been widely used and discussed in the mass media. Yet, they are both absolutely relevant questions, because there is still a lot of confusion. The topic is eternally controversial, so its vocabulary tends to be used and manipulated to support one point of view or the other. Many people don’t even know the difference between HIV and Aids, as becomes apparent every time a well-meaning visitor comes to HOPE Cape Town and asks to see the “Aids babies”. The difference between HIV and Aids is critical: Aids is not a pathogen, nor an illness, but a syndrome. When the HI-virus has worn down the immune system, the body has no defences against viruses and bacteria. The patient then clinically enters into the final stage of a process that, without intervention, will inevitably culminate in death. The term commonly used for that stage is “full-blown Aids”. But note that the patient does not die directly from the consequences of the HI-virus’ attack, but from a so-called opportunistic illness which exploits the immune weakness of the body. In Cape Town’s township that opportunistic illness is mostly tuberculosis. But back to the basics: HIV is the acronym for Human Immunodeficiency Virus and refers to the pathogen which first resided in the bodies of Central African monkeys – in peaceful coexistence with the host animals. At some point in the last century the virus (Latin for “poison”) was transmitted to humans, possibly after the consumption of simian meat. Then the laws of evolution kicked in, setting off a battle of life and death because the human immune system can’t expel this invader.
How does one become infected? Most people will immediately answer: by having sex. A simple enough answer to a simple question – and that is precisely why the actual process of infection is usually ignored. To put it in simple terms, nobody gets infected through sex. Rather, the virus is transmitted through the exchange of bodily fluids. This delicate distinction may seem pedantic, but in the dialogue about Aids prevention and the stigmatisation of infected people it is crucial.
Sexuality does not just mean the mechanical exchange of bodily fluids; it’s also an expression of affection and love between spouses and life partners. The challenge we are facing is to reduce or even neutralise the inherent dangers of exchanging bodily fluids.
Besides the sexual context, there are other ways of contracting HIV. Every accident, every needle prick, every jointly used razor, every blood transfusion creates the risk of infection.
Blood, sperm, pre-ejaculate and vaginal secretions are the bodily fluids that contain the highest concentration of HIV. Breast milk has a lower density of the virus, but it is transmitted in great volumes during the regular nursing of infants. We can safely ignore all other bodily fluids as potential transmitters. There are no documented cases of tears, saliva or sweat causing contagion.
The virus also can’t penetrate skin. Provided the skin is healthy, blood or sperm present no hazard. The virus can penetrate skin only through open scratches, wounds or injuries to the epidermis.
And it’s not just HIV-negative people who must avoid the exchange of bodily fluids, but also people who already are infected. They can be infected a second time, because the HI-virus mutates when it is being replicated and “individualises” itself in the human body. This medical fact should bust the myth that those who are HIV-positive don’t need to protect themselves anymore. HIV is a so-called retrovirus, which means it cannot replicate by itself. To replicate, the virus needs cells on to which it can attach itself – the white blood cells, the generals of our immune system. They are then converted to produce new HI-viruses, in their thousands per millilitre of blood. These settle in the whole body, but according to latest studies especially in the intestinal tract. If pathogen finds an unsuitable host, the virus loses its potency and dies off. And what happens after infection? In the first stage after contagion many people suffer from flu-like symptoms, swelling of the lymph nodes, and aches in the head, throat and muscles. The virus reproduces in its millions, particularly in the first few weeks after infection – at that time the risk of transmission to others is extremely high. The second stage is called the asymptomatic phase because the infected person now feels completely well. But the virus keeps spreading in the blood, inconspicuously and slowly, and gradually weakens the immune system by corrupting the CD-4 cells, which in healthy bodies help fight off invaders, but now become hosts for the virus through which to multiply. That phase can take years. The infected person is apparently healthy, and the infection can be determined only through an HIV antibody or PCR test.
In the third stage serious symptoms appear: significant weight loss, skin fungi, herpes, skin ulcers like Kaposi’s sarcoma, dysentery, sustained fever and so on. In the fourth and final stage the virus finally conquers the immune system, and the patient becomes susceptible to serious illnesses such as tuberculosis, though even harmless infections can be lethal.
The majority of antiretroviral medicines on the market stop the reproduction of the virus in the white blood cells. But pathogens that proliferate at a rapid pace also make “mistakes” – that’s how genetic mutations of the virus occur. These mutated strains of HIV, creating what is known as resistance, can compromise the efficacy of the antiretroviral drugs. That’s why it is important to inhibit the multiplication of the pathogens in first place. If fewer viruses are produced, the possibility of mutation decreases. That can be achieved only through a fixed regimen of dosages of antiretroviral agents in the body. There are two reasons why no method of removing the virus from the body has been found so far: firstly, the virologists don’t know yet exactly where in the body all the pathogens are hosted; secondly, the virus can pretend to be “sleeping”.
Recent research has intensified to combine medications with a view to easing the use and load of the pills. The product Atripla, for example, covers the necessary daily cocktail of medications with a single pill.
In America a drug going by the name MK-0518 has been developed. It inhibits the so-called integrase enzyme of the HI virus – the integrase adds viral genetic material into the host cell’s DNA, which then allows the infected cell to produce new copies of the virus. Parallel to that pharmaceutical research,
testing continues on microbicide gels which can be applied to the vagina before sexual intercourse to kill the virus before it can reach the blood stream. Research is also being conducted into anti-HIV vaccines, but the scientists dampen our hopes: it might be ten years or more before there will be any breakthrough. Even though after the many reports about the vaccine trial in Thailand.. there is a long way to go…
Filed under: HIV and AIDS, HIV Treatment, Medical and Research, Aids, aids babies, antiretrovirals, HAART, hiv, opportunistic diseases, virus
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