Human Immunodeficiency Virus
Posted: Saturday, October 30, 2010
by John Laurusonis
Doctors Medical Center
In 1986, I was privileged to be involved in some of the early research on HIV. It was a rather idealistic situation in which 100% of members of all the armed services were tested for HIV. The ones who were positive were referred to a large teaching and research hospital to establish extensive individual data bases. If underlying illness such as syphilis or other STD's, or AIDS-defining illness such as pneumocystis pneumonia were discovered, treatment was initiated. The big difference between then and now, however, is that we had nothing with which to directly treat the Human Immunodeficiency Virus itself. By the time an AIDS-defining illness presented, it was usually months until that person died, or even sooner. It was a very helpless and frustrating situation for a caring physician.
At present the CDC is trying to greatly expand the scope of HIV testing . It is recommended that the rapid HIV test be performed on everyone 15 to 64 years old, either on annual physical exams or with any illness that possibly resembles acute HIV. It is also recommended at the earliest confirmed time of pregnancy with a repeat near the end of the pregnancy. The reason for this is that there are 1.1 million people in the U.S. who have HIV, and one in five doesn't know they are infected. When they don't know, they usually present in the later stages of the disease. With increased testing it is hoped that the spread and severity of the disease can be reduced.
The rapid tests for HIV are extremely sensitive, though before the test is confirmed a sample has to be examined with the Western Blot or IFA tests. The rapid tests are done with blood samples, and some require only an oral swab. Testing used to involve obtaining written informed consent from the patient, but now physicians can say, "You will be tested for HIV unless you specifically opt out of testing, and sign a statement that you decline testing."
HIV affects certain lymphocyte white blood cells called CD4 cells, and causes them to die. This is why immunity to the disease is so dramatically decreased. When the CD4 count falls below a certain measurable level, it is deemed time to start antiretroviral therapy (ART). The absolute number of actual viral particles can now be measured, and this number can also be used to start ART.
There are a considerable number of antiretroviral drugs available at this time. Skilled usage of them includes determining if the virus is resistant and if adverse effects of the drugs might be anticipated. Usually three of the drugs are given as a "cocktail" to avoid viral resistance. The patient is checked every three months for CD4 count and viral load to see if the cocktail is working or if new drugs need to be used.
Once again, early diagnosis and treatment is the key to survival. If you are a patient , and the doctor says, "We are going to check you for HIV unless you opt out," don't be offended or get your feelings hurt. It's sort of like being scanned at the airport: nobody said you had a bomb; it's just what is done to protect everyone's safety, including yours. The doctor is simply doing his job. If you turn up positive, the doctor has probably just saved your life. There will be a lot of repercussions like "Where did I get this?" and the psychological shock and denial of having a chronic illness, but these can all be dealt with on an individual basis.
Don't be a mortality statistic. Get tested on a regular basis (e.g., annual physical, Pap smear, pregnancy, etc.). If you have HIV you should follow-up with your doctor every three months. Take your ART every day, exactly on time and without missing a dose. With more universal testing and treatment, we hope to minimize the incidence of this disease, and to manage it over several decades, rather than the too common short survival of AIDS once the HIV has progressed.
John Drew Laurusonis
Doctors Medical Center
www.doctorsmedicalctr.com
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