A positive HIV test is scary news…but it’s no longer a 100% death sentence. As better therapies continue to be developed, it’s entirely possible to live a more normal life. The key? Being informed and taking charge of your health.
Despite all the support you will get, particularly in the beginning, the real work is up to you. Given the right attitude and the right information, most people can live longer than they could when HIV/AIDS cases were first being diagnosed.
After your positive diagnosis, you need to do:
- Develop a strategy to adapt to your new situation.
- Learn more about HIV and how it can affect you.
- Understand the medical tests you’ll use.
- Find ways to promote and maintain your health.
HIV and Your Immune System
HIV (human immunodeficiency virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). Being HIV-positive does not mean that you have AIDS, but it does mean that you may develop AIDS. HIV attacks your immune system, gradually impairing how it functions.
Your immune system helps keep your body healthy by recognizing and attacking foreign substances, like viruses or bacteria. Over time, if it becomes seriously damaged or weakened by HIV, your body loses its ability to fight certain infections and cancers. These are called opportunistic infections (OIs).
AIDS is the most serious outcome of HIV infection. It occurs once your immune system has been significantly damaged. If you have certain OIs, it will lead to an AIDS diagnosis. This is because the presence of these OIs in your body points to a significantly damaged immune system.
An AIDS diagnosis will also be given if the counts of your immune system cells (called CD4+ T cells or simply CD4s) fall below 200. These cells are the key players in your immune system. Their “normal” range in a healthy HIV-negative person is 500–1,500 cells/mm3.
This gradual destruction of the immune system doesn’t happen the same way in everyone, or even at the same pace. In some, it may not happen at all. In a small percentage of people, HIV destroys their immune systems very rapidly, in just a few years. But others remain well for 10–15 years or longer. On average, without using HIV therapy, most people remain well for about ten years before facing their first serious symptoms.
A number of things are well known about HIV infection: Viral load tests measure the amount of HIV in the bloodstream. They can generally predict how quickly HIV will damage the immune system. In effect, these tests predict the loss of CD4 cells: the higher the number, the greater the risk of damage to your immune system. Using effective treat¬ments can greatly reduce the level of HIV and slow its rate of disease progression.
• CD4 cell count tests measure the level of CD4 cells, a certain type of white blood cell. These tests can measure the decline of your immune health. However, taking HIV therapy can slow the decline of your immune health. In fact, many people who start HIV therapy experience a significant increase in their CD4 counts.
• For long periods, often several years, the body copes effectively with HIV in many people. The number and percentage of CD4 cells fall, but slowly. During this period, most people feel normal and suffer no obvious ill effects. Despite this, most researchers believe that damage is still being done to the immune system. Many scientists believe that early inter¬vention during this time may have the greatest impact, though others remain skeptical. They believe the possible side effects from early treatment might outweigh its benefits.
• Without treatment, the body slowly loses its ability to fight infections. Some infections, like Pneumocystis jiroveci pneumonia (sometimes called PCP), become likely when CD4 counts fall below 300 or 200. Minor infections can occur at counts above 300. Other life-threatening infections become more likely when the count falls below 100 or 50.
HIV/AIDS Disease Progression
HIV is a “spectrum” illness: all who are infected have the same disease, but there are different stages to it. AIDS is the name given only to the later most serious stage. In the earlier and less serious stages, people are HIV-positive, meaning they tested positive on an HIV antibody test but they have no life-threatening symptoms of illness. If left untreated, most people generally progress along the spectrum toward AIDS.
HIV disease can progress slowly or quickly. Several studies have researched the rate at which it progresses when left untreated. Most conclude that about half of HIV-infected people progress to AIDS if left untreated within about ten years of infection. About three out of four (75%) reach AIDS by the 15th year.
These studies conclude that HIV is a progressive disease that leads to symptomatic illness in most people over time. Children born with HIV and people infected through blood trans¬fusion seem to get sick more quickly. Studies suggest that when women have access to and seek regular care and monitoring, their progression rates are similar to and perhaps even slower than men. Studies that include people with hemophilia are inconclusive about their rates of progression.
Why people progress at different rates is uncertain. It may be due to differences in the strain of HIV a person gets. Others believe it is influenced by genetic differences in people, while others suspect that lifestyle factors make a difference.
Check Your Immune Health
With most illnesses, we wait until a disease shows up before doing anything about it. “If it ain’t broke, don’t fix it.” But in HIV disease, the immune system starts to “break” immediately, not just when OIs show up. So keeping an eye on the health of your immune system is critically important. Two common ways to do this are: (1) noticing when symptoms occur and (2) getting lab tests done. Each can appear to have advantages and disadvantages.