FREQUENTLY ASKED QUESTIONS: HIV/AIDS FACTS
These questions have been compiled from students questions during lectures, day to day conversations and those submit through the website. These questions focus on HIV/AIDS FACTS. If you would like to see some of the questions asked of me and my perspective of life with HIV check out FAQ PERSPECTIVE. If you have a question not listed here, please contact me.

ABOUT THE VIRUS

What is HIV/AIDS?

HIV stands for Human Immunodeficiency Virus. It is the name given to the virus that causes AIDS.
AIDS stands for Acquired ImmunoDeficiency Syndrome. It is the name given to a set of defined symptoms caused by the virus.
The difference between the two is this simple:
HIV is what you catch and transmit. HIV is the virus that effects your Immune system.
AIDS is a Doctors diagnosis based on current medical and government data defining a set of symptoms caused by HIV. 

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What is the most common way of getting HIV?

Your blood stream coming in contact with any of the four fluids (Blood, semen, vaginal fluids, and breast milk) that can transmit HIV.
The most common methods for this to happen are:
Unprotected sex
Sharing of needles
Breast feeding

For more information on the transmission of the virus and ways to protect yourself, Check out HIV/AIDS Education and the Guide to Risk Activities.

How do they monitor it's progress?

HIV is monitored in many ways. The two most used methods now are two blood tests used comparatively.
The first test monitors T-Cells, or CD4 cells. They are a specific white cell in your immune system. The lower they are the weaker your immune system is.
The second test is called a Viral Load. This is the newest test, which actually counts active virus in the blood stream. The higher the viral load, the more active the virus is.
Doctors use these tests together to monitor the progress of the virus and determine if medications are working or not.

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What is a T-Cell?

Okay, here is a very simplistic overview of what a T-Cell is.
A T-Cell (also known by different names depending on the test you get) is a specific kind of white blood cell in your immune system that is attacked by the virus. It is kind of the 'General' of the army. It is what tells the rest of the immune system what to do - what foreign agents to attack. With out the T-Cell the rest of the immune system just doesn't know what to do.
This is why it is used as a monitor for how badly the immune system has been compromised by HIV (and often in other conditions that compromise the immune system - like chemotherapy).
In a normal system there should be about 700 to 1000 T-Cells. 500 is considered the low end of 'normal'. Below that Dr.'s begin to worry. The amount of T-Cells can vary in a system from hour to hour if you test it that often. They are only a loose indicator - which is why the Viral Load test became so useful (Viral Load test actually tells how much of the virus is active in the system).
When someone is telling you about their blood work, remember: T-Cell count - Up (more generals to direct the army) Viral Load - Down (less of the enemy).

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What physically happens (that you can see) to your body?

Nothing.
There are no physical (or mental) symptoms that are specific to HIV or AIDS. Your body will look the same with or without HIV or AIDS.
There are no physical symptoms that you can feel. You don't get a fever or headaches and you don't feel sick. It is possible to live your whole life with HIV and not know it. Only an HIV anti-bodies test can tell if you have the virus.
The virus effects your immune system. This is something that you can't see or feel directly. As your immune system weakens, opportunistic diseases will take advantage of your body; these are the symptoms that manifest physically on the body. These are the symptoms of the Opportunistic infection - NOT HIV/AIDS.

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How long does it take before you know you have the disease?

Right after that test comes back Positive (the second time), you know.
There are no physical symptoms of the HIV virus. You can't tell that you have it until you have had the test. You can suspect you have it, or fear you have it, or think you have it - but you don't know you have it until you have had the test.
Just as you can't tell someone else has it by looking at them - you can't tell you have it by looking at yourself or judging by the way you feel.
Example - Some people will develop flu like symptoms as the virus initially establishes itself in the body. Not all people do. How many times have you had the flu and not been HIV Positive?
Semantics - No one has ever died or gotten sick from AIDS/HIV. They die or get sick from the complications arising from the opportunistic infections taking advantage of what HIV does to the immune system.
To answer the question directly - indefinitely. Without a test you could live your whole life without knowing you have the virus. You just won't know why you couldn't recover from the accident or disease.

Back to Top             Linked question - What are the steps a person goes through in the process of getting AIDS?

What are the steps a person goes through in the process of getting AIDS?

You engage in a risk activity.
You acquire the virus.
Your immune system becomes weaker, until you fit some medical criteria for AIDS.

These are the only absolute givens. Everything else is a variable.
The HIV/AIDS virus effects persons in as individual a way as there are individuals. This is one of the reasons HIV is a very personal thing. One persons experience with the virus is not the same as the next persons. Infected in different ways, find out in different ways, deal with it differently, different incubation periods, different medical regiments, different opportunistic infections, different complications. It's all similar, but different. As unique as you are.
Here is a HIV/AIDS time line that will show just how different the range of infection can be.

• Person becomes infected.
• Incubation period. The time from point of infection to onset of AIDS: ranges from 2 to 15 years or more. About 50% of people with HIV develop AIDS within 10 years (the other 50% are slower)
  1. Acute infection. Person may have flu-like symptoms. May last for one or two weeks.
  2. Window period - time it takes for antibodies to become detectable: usually within 3 to 6 months.
  3. Asymptomatic Period - May last from 6 months to over 10 years. The infected person looks and feels well.
  4. Symptomatic Period - May last several years. The infected person may have enlarged lymph glands, tiredness, weight loss, fever, chronic diarrhea, or yeast infections, among other conditions. ( They may still look well.)

• AIDS - Only a Doctor can diagnose AIDS (it is a medical definition which generally hinges on a T-Cell count lower than 200 and a defined Opportunistic infection). Average survival after diagnosis of an AIDS-indicator illness (or opportunistic infection) is 1½ to 2 years. A few people live more than 5 years.
  People with AIDS may have illnesses healthy people usually don't get (or fight off easily). They may have more severe versions of other illnesses.
• MAXIMUM SURVIVAL IS NOT KNOWN.

Back to Top                Linked question -  How long does it take before you know you have the disease?

How does the virus work?

It works like all viruses, but here are some specifics. (This may get a little technical, but I have tried to keep it as simple as possible.)

(All Viruses)
Regardless of the type of host cell, all viruses follow the same basic steps in what is known as the lytic cycle:

1. A virus particle attaches to a host cell.
2. The particle releases its genetic instructions into the host cell.
3. The injected genetic material recruits the host cell's enzymes.
4. The enzymes make parts for more new virus particles.
5. The new particles assemble the parts into new viruses.
6. The new particles break free from the host cell.

Those viruses that do not enter the cell must inject their contents (genetic instructions, enzymes) into the host cell. Those viruses that dissolve into a cell simply release their contents once inside the host. In either case, the results are the same.

Once inside the cell, the viral enzymes take over those enzymes of the host cell and begin making making copies of the viral genetic instructions and new viral proteins using the virus's genetic instructions and the cell's enzyme machinery. The new copies of the viral genetic instructions are packaged inside the new protein coats to make new viruses.

Once the new viruses are made, they leave the host cell in one of two ways:

• They break the host cell open (lysis) and destroy the host cell.
• They pinch out from the cell membrane and break away (budding) with a piece of the cell membrane surrounding them. This is how enveloped viruses leave the cell. In this way, the host cell is not destroyed.

(HIV specifics)

There are many kinds of viruses, for example the hepatitis viruses that infect liver cells and cause hepatitis, or the herpes viruses that infect nerve cells and cause herpes, and HIV which infects the immune system. 
The immune system will produce anti-bodies to any virus. Each anti-body is specific (there is a different one for measles, hepatitis, and HIV - see TESTS) and allows the immune system to track down viruses and destroy them. In the case of HIV, it infects the immune system, thus the immune system begins to fight itself.

    HIV is a Retrovirus

HIV belongs to a class of viruses called retroviruses, which have genes composed of ribonucleic acid (RNA) molecules.   In contrast, the genes of humans and almost all other organisms are made of a related molecule, deoxyribonucleic acid (DNA) .   
Like all viruses, HIV can replicate only inside cells-- commandeering the cell's machinery to reproduce.   However, only HIV and other retroviruses use an enzyme called reverse transcriptase to convert their RNA into DNA, which can be incorporated into the host cell's genes.   Since only retroviruses use this enzyme (i.e., and it is not used by the host cell), treatment strategies have focused heavily on this enzyme.   

    Structure of HIV

The viral envelope.    HIV has a diameter of 1/10,000 of a millimeter and is spherical in shape. The outer coat of the virus, known as the viral envelope, is composed of two layers of fatty molecules called lipids.    These lipids actually come from the membrane of a human cell when a newly formed virus particle buds from the cell.   

Embedded in the viral envelope are proteins from the host cell together with copies of a complex HIV protein that protrudes from the envelope surface.   This Envelope protein, known as Env, consists of a cap and a stem that anchors the structure in the viral envelope.   Much of the research to develop a vaccine against HIV has focused on portion of this complex envelope protein.   

The viral core (or capsid).   Within the envelope of a mature HIV particle is a bullet-shaped core made of 2000 copies of another viral protein (p24.)   The core surrounds two single strands of HIV RNA, each of which has a copy of the virus's nine genes.   

The core of HIV also includes another protein (p7), the HIV nucleocapsid protein; and three enzymes that carry out later steps in the virus's life cycle: reverse transcriptase, integrase and protease.   

    Steps in Viral Replication
The replication of HIV within the body occurs in a predictable sequence of nine steps:

0. Attachment/Entry: The virus attaches to a particular type of white blood cells (CD4+ T Cells)
1. Reverse Transcription and DNA Synthesis: Viral RNA is transcribed to DNA and replicated
2. Transport to Nucleus: The new DNA moves into the nucleus
3. Integration: The new DNA is integrated with the host cell's DNA
4. Viral Transcription: New copies of the viral RNA are produced.
5. Viral Protein Synthesis: Viral proteins are produced.
6. Assembly of Virus: Components of the virus gather near the cell membrane and form by a 'pinching' action of the membrane.
7. Release of Virus: The new virus "buds" off from the host cell
8. Maturation: Long strands of viral RNA and protein are cleaved into smaller segments by proteases.

Now in the case of HIV, the immune system is producing new virus and fighting itself.

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Why is it so hard to find a cure?

First, viruses have no cure. Not even the common cold virus. In the case of the common cold, the virus is in cells that can be found and destroyed by the immune system. HIV is using the immune system to reproduce.
Because of the way a virus works (See how the virus works), it will be difficult to ever find a cure.
A cure would entail finding something that could identify the specific DNA or RNA in the host cell that belonged to the virus (which is now wound up in our own DNA) and cut it free or eliminate it while leaving the DNA of the host in tact.
Vaccines, which would prevent the virus from ever replicating in the body, are in the works. This would prevent any new infections, but not 'cure' the people that already have the virus.

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Does having HIV/AIDS limit what you can do physically?

HIV - No, not really. It will depend on the person, but in general with HIV the person looks and feels healthy in all respects and can do anything that he or she did before. There is also nothing that says they can't get better then they were either (for example, if you are an athlete training for an event, you can still run faster with practice or get stronger).
AIDS - This is a medical diagnosis of how far the immune system as been compromised. Since it also includes having been subject to an Opportunistic Infection, it is possible that there are now physical limits to the things you can do. What is limited depends on the Opportunistic Infection and how well the patient recovers.

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Can you get HIV from Animals?

No. 
The H in HIV stands for HUMAN, and tells us that the virus ONLY effects Humans.
There are related strains of the virus in Animals, but they do NOT cross species.
    Related strains would include SIV (Simian Immune Deficiency Virus - effecting Primates) FIV (Feline Immune Deficiency Virus - effecting Cats) EIAV (Equine Infectious Anemia Virus - effecting Horses) BIV (or BIDV Bovine Immune Deficiency Virus - effecting Cows), CAEV (Caprine arthritis-encephalitis virus - effecting Sheep and Goats)

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ABOUT THE MEDICATIONS

I read something about Medications they are using to fight AIDS. Could you explain what they are and how they are working?

The drugs used to fight HIV/AIDS are called Antiretrovirals (Anti-retro-virals : It's a mouth full - and it gets worse). These drugs fall into three different categories, depending on how they work.

Nucleoside Reverse Transcriptase Inhibitors (Nucleoside Analogs or "Nukes")
This drug mimics one or more components of the HIV's DNA or RNA and interrupts the viral replication process. They work by blocking the reverse Transcriptase enzyme essential for viral replication. This terminates the viral DNA chain, halting the replication process before it is completed.

Protease Inhibitors (PI's)
These drugs block the process by which HIV reassembles itself inside a cell. Specifically, these drugs disable protease, an enzyme that is necessary for cutting large viral peptides into smaller, functional units, in order to create active, new viral particles. The resulting virus is defective and not infectious.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI or 'nerts')
Like the nucleoside analogs, this class of drugs inhibit HIV replication by interfering with the reverse Transcriptase enzyme for viral replication. These drugs have a different mechanism of action and a distinct side effect profile from the other drugs.

The 'cocktail' is a combination of at least two drugs (preferably from different groups) to help stop the replication of the virus in as many places as possible.

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Is it true that with the weakened immune system (AIDS) patients can't tolerate the meds and it won't do them any good?

No.
The question really boils down to a patient / Doctor decision on whether the risks (or side effects) outweighs the benefits (of stopping or slowing the virus's progression). This question is relevant in any stage of the disease. Many do not tolerate or react well to the medications - others do. Some have severe side effects - others don't.
Patients and Doctors need to communicate their desires and tolerances in the debate of Quality vs. Quantity of life. This is what will determine whether the medications are doing them any good.

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What are the side effects of the medications out there? Can they be helped with vitamins?

The side effects range from headaches to nerve damage, and it varies from person to person. Different drugs react differently in different people. Some people have no side effects - some have all the side effects - some only have one or two of them and in different degrees of severity.
The most common are - (in no particular order)
headaches, nausea, diarrhea, upset stomachs, appetite loss, rashes, gas, rashes, fatigue, insomnia, vomiting, dizziness, drowsiness, fevers.
Mental side effects - anxiety, confusion, depression, inability to concentrate, nightmares, paranoia, more rarely: suicidal tendencies (most of these are only associated with the drug Sustiva, but others have displayed them)
Some of the more rare and sever side effects can be - Kidney stones, elevated liver enzymes, hair loss, peripheral neuropathy, anemia, muscle loss (or 'wasting syndrome'), unexplained pains, pancreatitis, liver inflammation.
Long term side effects - Changes in blood sugar levels (development of Diabetes), changes in fat levels and how the body stores it, bone marrow suppression, damage to mitochondria, fluctuations in red and white blood cell counts, lactic acidosis (which can cause liver and kidney failure), pancreatitis.

Can they be helped with vitamins?
Maybe - Once again - like these drugs, different things react differently in different people.
The only symptom that I have tried to alter with vitamins and diet was diarrhea - I had no luck. It didn't matter what I ate, drank, or how much anti-diarrheals I took, I had diarrhea until I stopped taking the medication. In fact, it only took 24 hours for the diarrhea to stop after the ceasing of the medication.

All of this information can be gotten from the drug manufactures, the pharmacist, magazines, and on the web. Specific drugs have specific side effects - this is a run down of the most common from them all.

Could you be more specific about which drugs cause which side effects?

Yes I can, with the help of a Chart Published in POZ magazine.

(PI's) Protease Inhibitors - This class of drug blocks the process in which HIV reassembles itself inside a cell. Specifically, they block Protease, and enzyme necessary for cutting viral peptides into smaller, functional units, in order to create new active viral particles.

(NRTIS or 'Nukes') Nucleoside Reverse Transcriptase Inhibitors - This class of drug mimics one or more of the components of HIV DNA or RNA interrupting the viral replication process. Specifically, it blocks the reverse transcriptase enzyme, inserting a nucleoside analog into the new viral DNA strand which terminates the replication process before it is complete.

Nucleotide Reverse Transcriptase Inhibitors - Nucleotide analogues are very similar to nucleoside
analogues (or 'nukes') preventing HIV from entering the nucleus of healthy T-cells and preventing the cells from producing new virus and decreases the amount of virus in the body. The only difference is that nucleotide analogues, unlike nucleoside analogues, are chemically preactivated and thus require less biochemical processing in the body for them to become active. 

(NNRTIs or 'Nerts') Non-Nucleoside Reverse Transcriptase Inhibitors - Like the nucleoside analogs, they interfere with the reverse transcriptase enzyme essential for viral replication. they have a different mechanism of action and a distinct side effects profile.

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ISSUES AROUND HIV/AIDS

Why do people think it won't happen to them?

This is a good question that I can't really answer.
The best I can do is ask you to think about why you think it can't or won't happen to you, then read all of this site, and do your research to knock all those reasons down.
Know how to protect yourself, and follow through on it (every time, because it only takes once) ... or it can happen to you.

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My question is about risk groups; Why are homosexuals having higher risk than heterosexuals?

Do you have a medical explanation or recommend any link about this matter?
Please forgive me if this question is so stupid!

Your question is not stupid.
Homosexuals are NOT at a higher risk then heterosexuals.
The virus does not discriminate against people. It doesn't care WHO you are, it cares WHAT YOU DO for it's survival.

As you may or may not know America is the only part of the world with a disproportionate number of Homosexual infections. Throughout the rest of the world it is near equally spread across the population (and we in the US are quickly catching up to them in the statistical spread).
Just for those that may not know - you are in a risk group if you have had sex, used intravenous drugs, or come in contact with infected fluids (like blood, semen, vaginal fluid or breast milk). This is all the virus cares about, not your age, race, religion, sex or sexual preference. Thus it is the way people interact within a culture that fills in the rest of the transmission patterns, thus Transmission and sociology (or culture) could be contributing causes.

The CDC (Center for Disease Control) identified the original carrier (to the US) as a Homosexual that traveled extensively. The fact that he was a Homosexual was just chance. This lead to the idea that it was a 'gay virus'. We quickly became educated otherwise, but the stigma remained. However, because the 'zero patient' was gay, the virus spread first in the Homosexual population. Fifteen to 20 years ago our country held marriage and monogamous relationships in the forefront and considered Homosexuality a forbidden thought. With this set up, (relatively speaking) only Homosexuals where having frequent sexual contact with multiple partners that would not come forward and admit it. This made it difficult to track. Also, because it infected a group of people in the minority and that was frowned upon - government agencies looked the other way thinking it would only effect Homosexuals.
In our country it took A LOT of hard work to remove AIDS from the idea that it was "God's retribution" against undesirables like Homosexuals and drug users.
This ignorance is now haunting us as we now catch up to the rest of the world in infection rates among women and children. I still find it funny that now infection rates in Homosexuals is down drastically because they became the most educated against the spread.

None of this has been proven or documented to my knowledge. The CDC does have a Web Page that may have information on infection rates and the reason for them, but every time I have tried to find anything on their pages I get lost in the Scientific jargon and political overtones.

If you want a more medical reason, there are two to consider. The rectum tends to be subject to tiny tears during intercourse. Thus blood, semen and other fluids are combine providing a rich environment for the virus. (Note, this would seem that you would only be at risk if you where the 'bottom' or the one receiving intercourse in the rectum. THIS IS NOT TRUE.) Second, there are different strains of the virus. Our version of the virus doesn't seem to be present in vaginal fluids as much as the versions in Europe and Africa. This is probably due to the virus mutating in different environments in the different cultures.

The best link I can suggest would be AEGIS.COM because it has a comprehensive library and HIV/AIDS search engine.

I hope I have answered your question, and I thank you for it.
Keep asking, and learning.

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Are we actually making any progress against AIDS? I mean you hear that we are and then you hear that we aren't.

Yes and No, depends on what you call progress.
Many that say we are making progress are the ones that want you to believe the epidemic is over because AIDS deaths are down. AIDS deaths are down, because of the advances in medicine and health care (if you can get it).
However, that means that care programs and resources are being taxed and strained because there are more people living with AIDS/HIV. There is still no cure, and the epidemic is just getting started because the rates of new infections is still quite startling.
We are not making nearly enough progress for the care of those living with HIV/AIDS, or in halting the spread of the virus.
This is the proverbial "One step forward, two steps back."

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Does a pregnant woman with AIDS / HIV always pass it on to their unborn child? What are the odds?

No, she does not always pass it on to the unborn child. The odds are getting better (last I heard the odds where - with out medication you pass it to the child with a 1 in 4 chance - with medications it drops to a 1 in 12 chance).
If you are pregnant and HIV+ make sure your Dr. is aware of it. What generally happens is that the mother will start (if she hasn't already) a cocktail of drugs in the last trimester to get the viral load as low as possible. The virus isn't passed on through the umbilical cord - it is passed on during the birth process. Thus by getting rid of as much of the virus as possible - the child has a better chance of not contracting the virus during birth.
The next risk factor for the child is then in post-natal care. You can't breast feed for example. The Dr. will advise you on all the precautions to be taken.
By the way - this is a very new process. There may be some long range problems for the child from the medications that we have yet to see.

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How should you go about telling someone you have HIV? (Disclosure)

This is a big and very personal debate for each person having to face it - not only for HIV/AIDS but for anything that is contagious.

There is no right or wrong way. There is no easy way. Every situation and person will be different.
DO WHAT MAKES YOU COMFORTABLE.

Suggestions:
Know how the virus is transmit and be responsible enough to teach anyone that you tell. Let them decide what risks they are willing to take.
Consider when YOU would have liked to of known from a partner they were HIV positive. Tell the other person then.
If asked, then tell them - they obviously want to know.
Be honest.

If you are told by someone that they are HIV+ and you are upset about the timing on it - ask yourself ... Are you upset because they didn't tell you - or because you forgot to ask?
Don't put the burden on someone else. It is as much your responsibility to ask, as it is for them to tell.

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How does it affect you Family and Friends?

Everyone will be effected differently. Everyone is a unique individual with different information and experiences at there disposal to affect the way they react to someone with HIV/AIDS.
It will however effect them some how. They can't be an important part of someone's life, and not be affected by the information that someone they know and love is now infected with this virus.
I would hope they respond with Love, Support and Understanding - but many times it is also Anger, Fear and Ignorance.

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What research is going on right now?

Most of the research in HIV and AIDS is still centered around treatment or medications.
There is work being done on a Vaccine that will prevent further infections.
Not much has been discovered in the way of a 'cure'.

For the most up-to-date information on HIV/AIDS research I recommend AEGIS.COM which posts the most recent articles and has a search engine for their site. 

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