The 0.5% living with an invisible disease.

Understanding HIV.

Sabrina Singh
10 min readJun 4, 2020

When you get a cold, a virus invades your body and proliferates 🦠. That’s until you go to the doctor to get medication or you wait it out and hope some remedy will fix it. The point is, it goes away.

What if this virus is much worse? It is the case for a lot of people. Specifically, human immunodeficiency virus (HIV) is a virus that attacks cells in the body that help fight infection. HIV spreads through certain body fluids and attacks T-cells. Overtime, HIV destroys so many of these cells that the body can’t fight off infection and disease.

How HIV infects T-cells.

How chimpanzees unknowingly caused HIV.

Before we get even further, we have to talk about how HIV originated. You’ll be pretty surprised to find out HIV actually started from chimpanzees 🦧.

For many years scientists theorized as to the origins of HIV and how it appeared in the human population, most believing that HIV originated in other primates. Then in 1999, an international team of researchers reported that they had discovered the origins of HIV-1, the predominant strain of HIV in the developed world.

Scientists were able to identify a type of chimpanzee in West Africa as the source of HIV in humans. They believe that simian immunodeficiency virus (SIV), the chimpanzee version of HIV was transmitted to humans and mutated to HIV when humans hunted chimpanzees for meat and came in contact with infected blood🩸.

A trip across the globe.

The earliest known case of infection with HIV-1 in a human was detected in a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of the Congo. Genetic analysis of the blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s.

Over decades, the virus slowly spread across Africa and into other parts of the world. HIV came to the United States in the mid-1970s and during this time rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York.

In 1982, public health officials began to use the term “acquired immunodeficiency syndrome” (AIDS) to describe the occurrences of opportunistic infections. In 1983, scientists discovered that HIV is what leads to cases of AIDS.

When HIV became more than just a virus.

How is this even possible? Through the destruction of T-cells in the immune system, HIV progressively destroy’s the body’s ability to fight infections and certain cancers. An HIV-infected person is diagnosed with AIDS when his or her immune system is seriously compromised and manifestations of HIV infection are severe.

Acquired immunodeficiency syndrome, a syndrome caused by infection with the human immunodeficiency virus (HIV), with ensuing compromise of the body’s immune system.

Most other AIDS-defining conditions are also “opportunistic infections” which rarely cause harm in healthy people. A diagnosis of AIDS also is given to HIV-infected individuals when their CD4+ T-cell count falls below 200 cells/mm3 of blood. For comparison, healthy adults usually have CD4+ T-cell counts of 600–1,500/mm3 of blood.

Is contracting HIV all that easy?

People most commonly transmit or get HIV through needle use or sexual intercourse. However, HIV can only be transmitted through certain body fluids including blood, semen, pre-seminal fluid, rectal fluid, vaginal fluid, and breast milk.

The truth is that it’s not really that easy to get HIV. It’s estimated that the transmission rate is actually about 0.1% per sex act, or 10% per year.

HIV is a blood-borne virus, which means that the virus must come into contact with the blood to transmit an infection.Touching blood where the virus is present won’t lead to transmission. It can happen if the blood enters an open wound.

Commonly contracted

  • Having sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV.
  • Sharing needles or syringes, rinse water, or other equipment used to prepare drugs for injection with someone who has HIV. HIV can live in a used needle up to 42 days depending on temperature and other factors.

Less commonly contracted

  • From mother to child during pregnancy, birth, or breastfeeding. Although the risk can be high if a mother is living with HIV and not taking medicine, recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.

Rarely contracted

  • Eating food that has been pre-chewed by a person with HIV. The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing. The only known cases are among infants.
  • Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids.

The race against time.

Through years of research, a treatment for HIV has been developed, called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines every day. Unfortunately, ART can’t cure HIV, but HIV medicines help people with HIV live longer, healthier lives. ART also reduces the risk of HIV transmission.

HIV medicines prevent HIV from multiplying , which reduces the amount of HIV in the body (called the viral load). Having less HIV in the body gives the immune system a chance to recover and produce more CD4 cells. Even thought HIV is still present, the immune system becomes strong enough to fight of infections and certain HIV-related cancers 💪.

A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners.

Taking HIV medicines every day and exactly as prescribed also reduces the risk of drug resistance. Most side effects from HIV medicines are manageable, but a few can be serious. Overall, the benefits of HIV medicines far outweigh the risk of side effects.

Exceeding life’s expectations.

Along with the development of medication, the outlook for people living with HIV has significantly improved over the past two decades. Many people who are HIV-positive can now live much longer, healthier lives when regularly taking antiretroviral treatment 📈.

In 1996, the total life expectancy for a 20-year-old person with HIV was 39 years. In 2011, the total life expectancy went up to about 70 years.

If treated poorly or left untreated, HIV infection can develop into stage 3 HIV, or AIDS. A person develops stage 3 HIV when their immune system is too weak to defend their body against infections. A healthcare provider will likely diagnose stage 3 HIV if the number of CD4 cells in an HIV-positive person’s immune system drops below 200 cells per mL of blood.

Life expectancy is different for every person living with stage 3 HIV. Some people may die within months of this diagnosis, but the majority can live fairly healthy lives with regular antiretroviral therapy.

As time passes, people living with HIV begin to develop certain side effects from treatment or HIV itself. These include accelerated aging, cognitive impairment, inflammation-related complications, effects on lipid levels, and cancer.

Opportunistic infections, especially tuberculosis remain a major cause of death for people living with stage 3 HIV. The best way to prevent an opportunistic infection is through regular treatment and getting routine checkups.

What might be a flu might also be HIV.

How does someone know they have HIV? The symptoms are extremely similar to that of a flu. These include, fever, chills, rash, night sweats, muscle aches, sore throat, and fatigue. Symptoms of AIDS are much more severe including rapid weight loss, recurring fever, extreme tiredness, sores, pneumonia, memory loss, depression, and other neurologic disorders.

The global scale and susceptibility of HIV.

In the United States, 1.1 million people live with HIV, but fewer are contracting the virus each year. This may be because of increased testing and advances in treatment. Between 2010 and 2014, the annual number of new HIV infections in the United States fell by 10% 📉.

There are approximately 37.9 million people across the globe with HIV/AIDS. Of these, 36.2 million were adults and 1.7 million were children (<15 years old). Approximately 0.5% of the global population lives with an invisible disease.

Statistics show that male-to-male sexual contact is known to be the leading cause of HIV transmission. Followed by heterosexual contact and injection use.

HIV prevalence around the world.

Countries with the highest of prevalence of HIV include Swaziland, Lesotho, and Botswana. In 2018, Swaziland had the highest prevalence of HIV with a rate of 27.3%.

Despite being available worldwide, not all adults have access to antiretroviral drugs. As of 2016, Europe and North America had the highest rates of antiretroviral use among people living with HIV.

The developed countries of the world, specifically Australia and northern European countries are doing far better than North America at retaining people living with HIV in care and achieving viral suppression. Overall, the countries rated as having the best response to HIV were Luxembourg 🇱🇺, Malta 🇲🇹, Switzerland🇨🇭, Finland 🇫🇮 and the Netherlands.

Countries in which prostitution was legalised and regulated scored higher in HIV response than countries which criminalised it. The indicators of access to treatment and care included the availability of drug resistance testing and lipodystrophy treatments.

The need for treatment and funding.

The search of treatment for HIV/AIDS has been a long term battle. Between 2000–2015, spending on HIV/AIDs globally totalled half a trillion dollars. The total was $562.6 billion over the 16-year period.

Annual spending peaked in 2013 with $49.7 billion. Two years later, $48.9 billion was provided for the care, treatment, and prevention of the disease.

This research is an important initial step toward global disease-specific resource tracking, which makes new, policy-relevant analyses possible, including understanding the drivers of health spending growth. — Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation

Globally, governments were the largest source of spending on HIV/AIDS in 2015, contributing $29.8 billion or 61% of total spending on HIV/AIDS 🌎.

Not only does sub-Saharan Africa have the largest HIV-positive population (24.4 million in 2015), it also depends most substantially on development assistance for health (DAH). South Asia also has a high level of dependence on donor financing, with DAH making up 45% of spending on HIV/AIDS.

The economic burden of living with HIV.

Though there’s been a lot of funding in supporting HIV research, treatment for HIV remains a significant burden for patients. The cost of new HIV infections in the United States is estimated at $36.4 billion, including $6.7 billion in direct medical costs and $29.7 billion in productivity losses.

The average cost of HIV treatment is $14,000 to $20,000 a year. Modern HIV drugs can keep people healthy for decades, but if you take them you could be facing well over $400,000 or more in lifetime costs for HIV treatment.

Data suggests that only about half of low-income people living with HIV are receiving the HIV drugs they need because of cost. A year of optimal HIV treatment costs $18,300 or more while 48 weeks of treatment for HIV and hepatitis C together will cost $29,000 or more.

Private health insurance

  • Depending on the plan you have, this type of insurance can cover healthcare visits and HIV/AIDS treatment programs and medication.
  • Fewer than one in three people with HIV has private health insurance to cover the cost of HIV drugs.

Medicaid or Medicare

  • Almost half of those living with HIV in the United States are covered by one of these federally funded programs. In some states, however, you may not be eligible for Medicaid until you have AIDS or are otherwise disabled by HIV.
  • Medicare part D, which was developed to cover medications including HIV drugs, has a restriction in its annual benefit. Recipients are required to pay $3,051 out of pocket after their initial, basic coverage benefit is used up to cover the rest of the year’s medication needs.

AIDS Drug Assistance Programs (ADAP)

  • These programs are federally funded through the 1990 Ryan White Comprehensive Resources Emergency Act and are administered by individual states, which may also contribute to the funding.
  • People of low income who are living with HIV may qualify for assistance through these programs.
  • States often control their costs by limiting the number or type of medications that they will cover through ADAP.

Emerging leaders of HIV research.

People around the globe continue to research new potential treatments for HIV/AIDS. The aim is to develop drugs which treat all people without drug resistance or all together cure HIV/AIDs.

Delaney AIDS Research Enterprise 🧫

Scientists at DARE are working to characterize reservoir sites where the HIV virus can persist beyond the reach of antiretroviral therapy and investigating the circumstances under which these reservoirs are established.

GeoVax Labs, Inc. 💉

The company’s most advanced vaccines under development are designed to function against the clade B subtype of the HIV virus that is prevalent in the United States and much of the developed world.

ViiV Healthcare 🤱

The company has five investigational medicines and prioritizes research into HIV in children. 24 collaborative research trials in place are investigating the prevention of mother-to-child HIV transmission and paediatric treatment strategies.

Calimmune 🧬

Calimmune has been at the forefront of developing innovative cell-based therapies for HIV/AIDS. They announced groundbreaking news when they reported encouraging results from the first group of participants in an HIV stem cell gene modification study.

The uncertainty of living with HIV.

There’s still a lot of shortcomings with the research into HIV. There’s not current cure for HIV, but most research is looking for a functional cure where HIV is reduced to undetectable and harmless levels in the body permanently.

In AIDS-related research, chimpanzees have been used mainly in vaccine studies that can yield unreliable results. Unlike the human immune system, that of chimpanzees shows little antibody- or cell-mediated response to HIV-1.

The shortcomings and lack of access to testing for many countries weaken the country’s ability to track, report, and respond to the new HIV epidemiological trends. The problems deter the country from identifying and targeting the key subpopulations that need the highest resources.

A few things need to be considered when developing prevention strategies to block new infections using a vaccine 💉. We need to understand immune response mechanisms, develop candidate vaccines, evaluate vaccines in animals, and then validate candidate vaccines in humans, using strictly controlled protocols.

Personal challenges facing the community.

Based on the views and opinions of various groups facing HIV, the main problems they face are ostracism, depression, anxiety, a tendency to get revenge and lack of fear to infect others, social isolation, relationship problems, and fear due to the social stigma.

Treatment of HIV/AIDS patients must decrease the viral load while being accompanied with other social measures to enhance their mental, and social wellbeing.

HIV might proliferate and destroy cells, but through the development of universal treatments, the virus can go away. Similar to a cold 🦠.