Question regarding HIV positive

Factual Questions
1

I’m NOT seeking medical advice.

A friend has just learned that her son (age 20) has been diagnosed HIV-positive. She realizes that HIV is not necessarily the death sentence it once was, but is understandably pretty badly shaken.

“Fred” has a (something) Count of 220, and is starting drug therapy in two weeks. Fred’s Mother understands that a Count of less than 200 is a critical point of some sort.

She’s a competent, capable, and very intelligent woman who will certainly be supportive of, and helpful to her son. She’s proudly self-sufficient, and will need no help from us beyond emotional support.

But I suddenly realize that I’m woefully ignorant about HIV-AIDS, and for my own information I wonder if someone can give me a dumbed-down idea of where things stand for someone like Fred, “generally speaking.”

Mods: of course feel free to delete or close this thread if this constitutes solicitation of medical advice.

Thanks all.

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2

I’ve known plenty of HIV+ people, some do very well, others do not. Some pop a few pills have no side effects and live normally. Others have horrible side effects and can’t stand to be on the medications.

I’ve known of people who had it from the early 80s and are still around, others I’ve known of die rather quickly even with the meds.

It really is an individual thing.

Historically an antiretrovial was administered. This worked for awhile then then virus adapted an rendered it useless. This led to the development of cocktails drugs. These are a series of two or three antiretroviral drugs administered at the same time. This can be one combination pill or several pills, taken several times per day.

HIV so far seems to be unable to outwit antiretrovirals when multiple types are taken.

This is where it can become problematic. Some antiretrovirals are more toxic than others. Some strains of HIV are more agressive than others. So often for the first year the patient has to spend an good deal of time at the doctor’s office doing trial and error. You have to balance off the type of drug with the ability of the patient to deal with such things.

The antiretrovirals can produce things like the “AIDS hump” and other physical signs, though by no means does everyone get this.

So once you find the correct drugs to treat the HIV, you see your doctor at regularly scheduled visits and he checks to make sure things are going askew. If they do, they adjust the meds.

Fred will most likely be able to live a “normal lifespan” but he will undoubtedly have issues. He won’t be able to have sex without a condom ever. Even if his viral load goes to zero (indicating no HIV) this is a testing issue. The virus still exists in the body but it’s so low that it’s not measurable. He can still pass it on.

HIV is not spread causally, so there’s no worries about Fred playing with your kids or drinking from the same cups or sharing food with him. As long as you don’t have unprotected sex with Fred or do IV drugs with him, you will not get HIV.

The best thing for Fred is to find some support groups in his area. If he lives in a big city like Chicago there are plenty of groups.

Also note HIV is NOT a disablity so Fred is going to have to work. Even if he gets very sick as long as he is classed as HIV+ and not having AIDS, he cannot get medicaid or other disabilities. People diagnosed with AIDS can.

So Fred needs to prepare for periods in his life where he may not be able to work and needs to save some cash to carry him over those periods 'cause he’ll have down time in his life, which could be a long one.

3

This is important, even if he’s with another person who’s also HIV-positive. It appears that someone with HIV can pick up a slightly different strain of the virus from someone else, and if that strain isn’t close enough to the one they’re infected with already, it may not be kept in control by the antiretroviral (anti-HIV) medications that person is on. (Like with bacteria, HIV has strains that are resistant to certain drugs but not others.) Suddenly the CD4 cell count goes from being decent to bottoming out, and the person needs to use different medications. Considering that this will be a lifetime battle, you don’t want to needlessly exclude a drug option.

I’ve worked with quite a few patients with AIDS, and seen many stay very healthy and active, including one who came back from pretty much the brink of death, emaciation, organ shutdown, to become a well-muscled and active man years later. One has been HIV-positive since probably the late '70s (developing to AIDS eventually) and is still working today, though he has the fairly distinctive gauntness that many people with AIDS develop. Another patient died in his 50s from a heart attack rather than AIDS-related complications; he had a family history of heart trouble, and was a smoker.

Fred may have a relatively easy time of it. He may need a couple pills a day and be fine for a long time. Then again, he may need to be switched on his meds multiple times, take a handful of pills a day, maybe an injection or two. He might need medications to deal with the side effects of his anti-HIV medications, problems like diarrhea, high cholesterol, even diabetes.

AIDS does still kill, though. There are a whole lot more treatment options these days, and more being researched every day, but death from AIDS-related causes does happen.

4

The “count” referred to is the T cell count. T cells are a type of immune cells, which are the specific target Of HIV. A decrease in Tcell count not only is an indicator of the level of infection but is also a marker of how functional an immune system the person has.

Best wishes to your friend’s son!

5

Thank you, folks! Exactly the kind of info I was hoping for.

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6

Just adding that 200 T-cell/CD4 count is considered important because per the guidelines of the Centers for Disease Control, dipping below 200 means that the person is no longer considered to merely be HIV-positive, but to have met criteria to be considered to have AIDS. There are other criteria that would qualify someone, but those are basically being diagnosed with various rare diseases that in many cases only people with compromised immune systems get.

Having AIDS basically means that not only do you test positive for HIV, but your immune system is now (or was before you started on anti-HIV treatment) not very good at fighting off illness, and increased safety measures should probably be taken. This may include a more “tough” anti-HIV drug regimen, and perhaps precautionary antibiotics/antiviral drugs.

7

Thanks again.

8

Interesting. Just yesterday I read this article:

http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp

that was linked from here:

http://boards.straightdope.com/sdmb/showpost.php?p=12234640&postcount=26

9

Uh, so, like, if the viral load goes to zero, can this person be deemed as cured, in a way ? But I guess if s/he stops taking the medication, viral load goes up again ?

10

Well, I hate using “cured” like that - the usual expectation is that the person can still pass the virus on, though the previously-posted link shows that maybe unprotected sex is OK if the person meets various conditions, which require close monitoring of their viral situation. But their immune system’s quality should be good, and they can often be taken off of various “prophylactic” meds like antibiotics and perhaps other anti-virals. So hopefully - any drug side effects aside - they’re feeling a lot better if their viral load is way down.

The viral load doesn’t really go down to zero, exactly; it drops past a certain threshold at which we can’t measure it that well any longer. People call it “zero” or “undetectable” or sometimes “trace” but the test results will say something like 'less than 50/75/whatever copies per [whatever the measurement volume is, I forget atm]."

And yes, if the person stops the meds, the viral load level will be detectable again and creep up. Also, stopping meds and/or not taking the meds as often as they should be are the main causes of the virus becoming resistant to those meds.

11

“or was before you started on anti-HIV” - can you clarify this? My question is, if you had AIDS, but then treatment knocked things back into the “just HIV+” realm, are you still considered to have AIDS? In other words, is crossing over into full-on AIDS a one-way door? How (if at all) is someone who made that leap, but got their counts back to OK levels, handled / treated differently from someone who never crossed over that line?

12

Viral load and T cell count are the 2 routine blood tests used to track the disease, when to initiate, and how effective antiretroviral therapy is.

I’ve never seen viral load listed as zero, but alway as undetectable; no you’re not cured just below the test thresthhold. We could probably create a more sensitive test, but I’m not sure if there’d be a benefit.
It’s not HIV that makes you sick, it’s the opportunist infections that take advantage of your depleted immune system. Thus you can pass from ‘just having HIV’ to having AIDS and back to just having HIV depending on how well the virus is suppressed, and how well your immune sys if functioning.

I’ve know a number of people who have residual disability from back when they ‘had AIDS’ and an opportunistic infection caused some permanent damage that now have good Tcell counts and low viral loads.

A whole lot of work has been down on preventling vertical transmission, having healthy kids is definitely not off the table.
Drug resistance is much like other pathogens in that incomplete or inconsistent treatment lets the virus develop resistance, however, HIV is much better at this than other bugs. It’s not uncommon for people that are in and out of jail, or adolescents going through a rebellious stage to be taken off meds entirely until they’re in a place where they can manage their disease consistenly.

Best of luck

13

No, as outlierrn has already capably noted. The virus is there, oftentimes hiding in the hijacked cells as a bare genome and minimally replicating. But it can gear up any time the defenses falter. So it would not be deemed as a cure.

Contrast to Hepatitis C, where a viral load below detectable thresholds on two occasions six months apart is generally considered to be a cured case. Not always, but most of the time.

14

It’s counted as a one-way trip. It can take up to a decade for the illness to progress to being considered AIDS, however, so many people aren’t diagnosed until it’s progressed, because there aren’t really symptoms early on.

15

The AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.

By CDC definitions this is true, but in practical terms a persons treatment and quality of life maybe the same as when they were ‘just’ HIV+, IME.