The history of HIV/AIDS: everything you need to know!

First, let us have a look at the virus that causes AIDS - the HIV. HIV is the Human Immunodeficiency Virus, it causes a viral infection that attacks the immune system, especially white blood cells called lymphocytes or CD4 + cells. As they get destroyed, the immune system is prevented from functioning properly.

A person carrying this virus is said to be seropositive, he or she presents a positive serodiagnosis (the search for infectious diseases in the patient's serum), which means that his or her serum contains specific AIDS antibodies, the p24 antigen, a substance foreign to the patient's body, and thus capable of triggering an immune reaction by causing the synthesis of antibodies. The number of CD4 + cells in his or her body is over 200.

It is important to understand the difference between an HIV-positive person and a person with AIDS, for whom the HIV virus has evolved into a disease, with a breakdown of immune defenses and the development of opportunistic infections. The number of CD4 + cells in the patient's body is less than 200. Opportunistic infections are caused by germs which are usually not very aggressive, but can cause infections in people with the immune deficiency (due to an organ transplant, chemotherapy, or AIDS) .

AIDS stands for Acquired Immunodeficiency Syndrome. This is the last stage of the HIV infection. It is a sexually transmitted disease.

HIV and AIDS: some numbers 

In 2020, there were 37.7 million people living with the HIV virus worldwide, including 25.4 million in Africa and 1.7 million children.

1.5 million people were infected in 2020 and 680,000 people died from AIDS-related illnesses.

In 2019, the estimated number of HIV infections in the U.S. was 34,800. Over 1,189,700 people had HIV at the end of 2019. Of those people, about 87% knew they had HIV.

What is the origin of AIDS? 

HIV, the virus responsible for AIDS, is thought to be the result of a mutation in a virus found in certain monkeys on the African continent. This could have happened as a result of a bite from an infected chimpanzee, or a scratch received while cutting the meat. The contamination took place in the 1940s and it accelerated towards the end of the 1970s. AIDS was first described in 1981 and it spread from Africa to the North American continent.

It was in 1983 that the researchers at the Institut Pasteur identified the HIV virus for the first time. Retrospective studies have proved the presence of the virus in a 1959 serum, and have also shown that it has been active since the end of the 19th century.

About forty species of monkeys are naturally infected with retroviruses (a group of viruses consisting only of RNA), they are Simian Immunodeficiency viruses (SIV), which, when transmitted to humans, become HIV viruses.

There are two main types of the HIV virus: HIV-1 and HIV-2. HIV-1 was discovered first, and has spread worldwide, while the latter happens to be less pathogenic, and is mostly found in western Africa.

What are the symptoms of AIDS and the HIV? 

The clinical signs of the HIV vary depending on the stage of the infection. During the first few weeks, patients may remain asymptomatic or develop flu-like symptoms with fever, headache, erythema, or sore throat.

As the infection gradually weakens the immune system, other signs and symptoms may appear, such as swelling of the lymph nodes, weight loss, fever, diarrhea and cough.

Left untreated, the infection can progress to AIDS which can cause such serious conditions as tuberculosis, cryptococcal meningitis, severe bacterial infections, and even certain types of cancer, such as lymphomas or Kaposi sarcoma, among others.

In the absence of treatment, the natural course of the infection can be schematized in 4 phases:

• Primary infection: it is the invasion of the body by the HIV, the immune response is set up, antibodies are developed. This phase lasts from a few weeks to a few months. The risk of a virus transmission is high;
  
• Asymptomatic phase: lasts 5 to 10 years, people have no symptoms but the virus is gradually spreading and the number of CD4 + lymphocytes is slowly dropping;
  
• Acceleration phase: the immune system is exhausted and the number of CD4 + lymphocytes is dropping rapidly;
  
• AIDS stage: Opportunistic infections develop, and without antiretroviral treatment, the disease quickly becomes fatal.
  

How is HIV diagnosed? 

A blood test is run to confirm the diagnosis: it is able to detect the presence of anti-HIV antibodies, as well as the presence of the antigen called p24.

The quick tests provide the results the same day. There are also self-tests. However, it is necessary to confirm the result via an official test, performed by a healthcare professional, in a lab or at a hospital.

The aim of the tests is to detect the antibodies produced by the patient as part of his or her immune response. These antibodies develop within 28 days from the onset of the infection.

It is possible to determine the stage of the HIV infection using additional tests which quantify the extent of the virus multiplication - the plasma viral load, but also by assessing the level of CD4 + lymphocytes.

How is HIV transmitted? Who is at risk? 

HIV can be transmitted through the exchange of body fluids with an infected person: blood, breast milk, semen or vaginal fluids. It can also be passed from mother to child during pregnancy and childbirth.

Even today, it is observed that there is a lack of knowledge regarding the ways of transmission. It is therefore important to remember that the virus is NOT transmitted by kissing, shaking hands, hugging, coughing or sneezing, swimming in a swimming pool, using the same toilet seats, sharing sheets or towels, sharing cutlery at mealtime, donating blood, through mosquito bites, etc.

Some populations are at a higher risk of contracting an HIV infection, including people with multiple sex partners, those who do drugs, are held in prisons or other closed settings, as well as sex workers and their clients, people living in the areas with a high HIV prevalence, and transgender people.

How is HIV treated? 

Since 2016, the WHO recommends a lifelong antiretroviral therapy (ART) for all people living with HIV.

Antiretroviral therapy consists of one or several drugs. Very often it is just one pill taken once a day, several days a week, or every day.

Medications used to treat HIV are substances which have been designed to block different stages of multiplication of the HIV, or to reduce its ability to infect new CD4 + lymphocytes: they are called antiviral or antiretroviral medications. They can be prescribed by all doctors, but the first prescription must be done by a hospital doctor.

HIV treatment is a combination of several antiviral substances which belong to different classes. Most commonly, it consists of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRT) or protease inhibitor.

It is important to mention that people living with HIV that undergo an antiretroviral therapy and whose viral load is suppressed, do not pass the virus on to their sexual partners. Also, effective antiretroviral therapy helps prevent mother-to-child transmission during pregnancy, childbirth and breastfeeding. It allows patients to live a better life with HIV, without the fear of transmitting the disease.

Antiretroviral therapy does not cure the HIV, but suppresses the virus replication and strengthens the immune system, allowing it to restore its ability to fight opportunistic infections and certain types of cancer.

By boosting their immune system, antiretroviral therapy helps people living with HIV to live longer and healthier lives.

How to prevent contaminations? What are the risk factors? 

Ensuring early access to antiretroviral therapy for people with HIV and encouraging them to continue treatment is essential, it allows not only to improve their health, but also to prevent the transmission of the disease.

Here are a few recommendations that can help reduce the risk of infection:

• The use of a male or female condom,
• Regular screening for HIV and STDs,
• Voluntary medical circumcision of men,
• The use of antiretroviral drugs as a preventive measure,
• Setting up an antiretroviral therapy to prevent mother-to-child transmission.

Certain behaviors and situations increase a person's risk of contracting HIV:

• Unprotected anal or vaginal penetration;
  
• The presence of another sexually transmitted infection (STI) - syphilis, herpes, chlamydia, gonorrhea or bacterial vaginosis for example;
  
• Sharing needles, syringes, other injection equipment between the drug users, or using contaminated solutions;
  
• Injections, unsafe blood transfusions, tissue transplants, medical procedures that lead to cutting or piercing the skin under non-sterile conditions;
  
• Accidental needle sticks, especially among health workers.

There is a preventive treatment, a PrEP (pre-exposure prophylaxis) - a medication called Truvada®, which is intended for people who do not have HIV. It can be taken either daily, or the day before an unprotected sex and during the two days after. It is recommended for people who are most at risk. 

AIDS today, or what is it like living with HIV?

The threat of HIV continues to affect humanity 40 years after the first cases of AIDS were reported. Despite all the medical advances, such as triple therapies, the development of tests, the knowledge of the subject and the tools to defeat AIDS, what blocks the eradication of this disease is the combination of economic, social and cultural inequalities, that hinder the development of the solutions to prevent and treat HIV.

However, thanks to medical progress, living with HIV today means being able to live a long and healthy life, despite all the hardships and difficulties, from the announcement of the diagnosis to regular follow-up visits.

The follow-up visits with a set of specialists (infectiologist, cardiologist, hepatologist, nephrologist, etc.) are planned according to a well-defined schedule.

Psychological follow-up care is essential, there are numerous patient support groups and associations created to support people fighting against the disease.

There is no cure for HIV today, however the first person cured of HIV does exist. His name is Timothy Brown and he functionally recovered from HIV and lived without it for 10 years. Researchers have also announced that another patient has been HIV-free for some time now.

In the event of a possible risk of being infected, when deciding to stop using condoms while in a relationship, or when planning a pregnancy, doing a screening test allows you to know if you are infected with HIV and to start treatment if necessary. This step is essential and there are many places where your can do the test: labs, free information, screening and diagnostic centers, family planning and education centers, patient support groups and associations (AIDS United, National AIDS treatment Advocacy Project, The Well Project, AIDS Health, etc.) and other services.

You can also call the AIDSinfo Hotline at 800-448-0440, or visit this website, if you have any questions or need help.