The story of HIV by HIV

I have been around for some time now. I don’t quite recall when I made the jump from my earlier home among the chimpanzees in Africa – may be around 1930. I know the humans used to hunt for chimpanzee meat. I guess that’s how I crossed over. Since I work silently and slowly, I remained undetected for a long time. I multiplied, lived and traveled from one human to another. Then suddenly, in 1981, people became aware of the illness I lead to. In 1984 I was finally detected. Dr. Gallo, Dr. Luc Montagnier at the Pasteur Institute in Paris, and Dr. Jay Levy at the University of California, San Francisco, all identified me as the cause of AIDS. Each group gave me a different name. Eventually I was called HIV (Human Immuno- deficiency Virus)

Many people find it difficult to understand how I came about. The reason I was able to make the jump from one species to another is because I mutate easily – that is, I can change my form easily. It is because of this ability that I could infect humans. My ability to mutate also makes it difficult for them to make a vaccine against me.

Like all viruses I am a link between the living world and the non living world. I can survive on my own, but to reproduce (multiply) I have to use the genome of a living organism – a bacterium or a plant or an animal. I use the genome of the human white blood cells, especially the CD4 lymphocytes to multiply. My whole life story is about how I can gain entry into a human, multiply in his or her body and then, leave it to enter yet another body. So long as this cycle is not interrupted, I will survive.

How do I gain entry in to a human? This was tough for me. I could not enter through the tough, many layered skin. If the skin had a cut then I could enter easily. But I could not rely on that as a way to gain entry. I need not have worried. I found a very easy way to enter – the mucus membranes of humans have a receptor on their cells that I can attach to. This receptor then transports me effortlessly to the local cell of the immune system. The immune system gets ready to fight me. Here, I gain the upper hand. I ‘infect’ the immune cell, forcing it to make copies of me and release them into the blood. The cell bursts or dies in the process, while I get to infect many more new cells.

I survive and multiply like this in the human body for years (1- 10 years). I prefer to be in blood, breast milk, semen and vaginal fluid. From here I can exit the body and infect another person. In small amounts I enter saliva and other body fluids too, but that is not my main way of exiting the body.

I do not infect any other system; I do not cause any other damage. Other viruses make their presence known very easily and quickly by ‘infecting’ cells like the nasal mucosa. The person begins to cough and sneeze and every one else gets to know that the person has an infection. Since I infect the immune system which is required for fighting infections and preventing cancers, I do not cause any ‘symptoms’ until the immune system is weakened to a point when other bugs begin to infect the person. The person falls prey to tuberculosis, fungi, various bacteria and viruses. These new infections make the person sick. She begins to lose weight, gets diarrhea, cough and fever that last for months together and do not respond to usual antibiotics because I have destroyed the immune system. Now, because the disease is so apparent, people call it AIDS (Acquired Immuno Deficiency Syndrome).

When I first enter a person, I cause no significant illness that can be pinpointed to me. I can remain undetected for 1- 10 years, unless the person gets a doubt and goes for a blood test (ELISA – the enzyme linked immuno sorbent assay). This test detects the antibodies that the immune system makes in order to fight me. The antibodies take time to build up and therefore the test does not become positive until three months after I have entered the body (called the window period). In these three months, I multiply and infect others, while the test remains negative!  After three months, the test will be positive and will remain positive for the rest of the person’s life. There is another test that has been designed to detect me directly. It is called the PCR (polymerase chain reaction) test and it can detect my presence in a matter of days. However it is expensive and is therefore not commonly used.

Once my presence has been detected, life becomes a little tough for me. The person can start taking drugs that interfere with my multiplication. I don’t give up so easily though. I change my form, develop resistance and do what I can to survive. Generally the person has to take 3 different types of drugs every day to keep me under control. The moment the drugs are stopped, I start multiplying. (It is very difficult to kill a virus once it is inside a host – how do you kill something that is neither living nor non-living?)

Is my survival under threat? Well partly. I spread in three main ways: through sexual contact, through contact with blood and from mother to child. People are becoming wiser. I have infected …… people so far. Now people are talking about abstinence from sex, being faithful to each other and using condoms if they cannot be faithful. They are avoiding unnecessary injections and blood is being tested before transfusion. Mothers are being screened and if they are positive, they are being put on treatment. All these actions come in my way.

I am not overly worried though, because even now, there are a lot of people who are unaware of how I spread. Then there are people who think that they are some how immune to me and they indulge in reckless behaviour. I have found the teenagers and young adults to be the most reckless. They are busy experimenting – be it sex, drugs or driving – and they forget that I now lurk in seemingly healthy, ordinary people.

Some questions and answers on HIV

How can one be sure that one does not have HIV infection?

This is easily determined. Every person knows what they have done or are currently doing. If the activity or situation is such that one might acquire HIV infection then the person should test for HIV now and three months after the last high risk activity. If both tests are negative then the person does not have an HIV infection.

How can I be sure that a person is not HIV positive? How can I be sure that my partner or spouse does not have HIV?

You can never be sure that a person is HIV negative. You cannot force another person to go for the test and tell you if it is positive. In any case, the test will be negative for three months and during that time you could get the infection from your partner.

Suppose that the person is really HIV negative. The test is negative on 1st March and on 1st June. The person gets married on 1st June (in some countries it is mandatory to test for HIV before marriage). After one month the person has extra marital sex (with a person who, unknown to both, has HIV infection) and gets an HIV infection. The infection can get transmitted to the spouse. Both will test negative till September. Thereafter the couple will test positive.

Instead of relying on tests to detect the infection (by which time it is too late anyhow), it is better to create a relationship of mutual trust. If you know a person for a long time, if you have developed a close and trusting relationship, then that person will confide in you. He or she may say that he or she had been involved in activities through which he or she might have got HIV infection. HIV tests done now and three months after the high risk activity will settle the issue. Since there is trust and love between the two of you, he or she may come back and tell you their test report. This depends entirely on trust.

What is the extent of HIV infection in India?

Currently about 0.3 percent of our general population (which includes people like you and me) is HIV positive. In some areas, up to five percent of pregnant women are HIV positive. This means that if you attend a marriage, and there are 500 people there, then up to 2 could be HIV positive – unknown to you and probably unknown to themselves.

Can one be cured of HIV infection?

No. We do not have a cure for HIV infection yet. Being a virus (the link between living and non living things) it has the capacity to survive in a dormant state for years. We have drugs that interfere with the multiplication of the virus, but we do not have drugs that can kill or eradicate the virus. So all we can do with drugs is disease control. We can keep the quantity of the virus in our body to a very low level but we cannot get it out of our body.
The HIV mutates very fast. It becomes resistant to the drug being administered pretty rapidly. So we have to use three different types of drugs simultaneously to keep the virus under control. It is like taking three different antibiotics at the same time.

I read in a magazine that there is a cure for HIV.

We often read about claims from people that they have found a cure for HIV or that there is a cure for HIV in alternative medicine. None of these claims have been scientifically validated.

Is there a vaccine against HIV?

There is no vaccine available against HIV. Though the disease is twenty years old, we have not yet come up with a successful vaccine because this virus, unlike polio and small pox viruses, mutates rapidly. By the time a vaccine is developed, the virus has changed its outer sheath and the vaccine cannot work. Some vaccines are at a trial stage in laboratories, but none are available for use.

Why aren’t all sex workers tested for HIV?

Sex workers run a high risk of getting HIV infection because of multiple sex partners. They can test themselves if they wish to. This often happens if they have been counseled about HIV and its effects on the body.
It is important to realize that the sex workers do not approach people in their homes asking for sex. People choose to go to the sex worker and offer them money or gifts to have sex with them. So why should the sex workers test themselves? Nobody is forcing people to have sex with the sex worker.
The government cannot force sex workers to get the test done. Even if the test is done today, what is the guarantee that he/she won’t get the infection tomorrow? Should the test be done daily? In any case, the window period gives a false negative report. What about the customer? Shouldn’t the customer test himself or herself?

Life is not worth living after getting HIV infection.

Being HIV positive can be very depressing. But we met a HIV positive person who was full of life. Here is her story (names have been changed to protect her identity):

A young girl called Rani, the daughter of a government employee, was married to Ramesh. Ramesh fell sick a few months after marriage. He was diagnosed to have AIDS which he had acquired from a premarital relationship. He died two months later. By then Rani had acquired the infection from her husband. Her in-laws blamed her for making Ramesh sick and drove her out of the house after Ramesh’s death. Rani returned to her parents’ house. They encouraged her to study further as she had only studied upto the 10th standard. She also underwent counseling to understand her condition and the various treatment options. Rani did a counseling course and went to work for an organisation. There she met a man who was also HIV positive. They fell in love and got married. Rani and her husband now have a child. She took all the precautions required to reduce the chances of HIV transmission to her baby during pregnancy and after birth. Her baby was tested at 18 months of age and found to be HIV negative. She feels happy and is content with what she is doing. Her family members are willing to look after her child if she and her husband succumb to AIDS.
Should Rani have committed suicide? Rani definitely does not think so.

With treatment, a HIV positive person can live a healthy useful life far beyond 2 – 10 years. With treatment, good nutrition and a positive outlook, people have been known to be living with HIV for over 15 years.

Can one live with a HIV positive person in the same house?

Yes, definitely. Unlike a common cold, HIV is not transmitted by casual contact with an infected person. You can live in the same house, eat together, eat food cooked by a HIV positive person, shake hands and play together, share the toilet and sleep in the same room without getting HIV from that person. Intimate (sexual) contact has to be avoided.

Can mosquitoes spread HIV ?

Unlike Malaria, HIV does not have a life cycle in a mosquito, so mosquito bites do not cause HIV. Only close bodily contact, that allows mixing of body fluids that have a high viral load like semen, vaginal fluid or blood can cause HIV transmission from person to person.

How can HIV be destroyed ?

HIV is a very fragile virus and can be easily destroyed outside the human body. Boiling or hot water, soap, bleaching powder, alcohol or chlorhexidine can be used to destroy the virus.

Can HIV positive children attend normal schools?

Yes they can. Sharing a bench or playing together does not transmit infection. HIV positive children know about their status and they know that their blood can infect others. They are trained to report to a responsible adult if they get hurt and start bleeding. Moreover, HIV transmission will not occur if blood from an HIV positive person falls on intact skin.

How is HIV different from AIDS?

AIDS stands for Acquired Immuno Deficiency Syndrome. This is the last stage of HIV infection, when the infected person begins to fall sick and looks obviously ill.

People who are infected with HIV are called HIV positive. They look perfectly normal in appearance and health for about two to ten years after being infected. By this time, their immune system has been overpowered by the virus and they fall prey to a large number of infections and tumors. This stage is called AIDS. Now the person is visibly sick and, without treatment, usually dies within one year.

When can one suspect that one has AIDS?

HIV infection does not produce any symptoms. On reaching the stage of AIDS, the person begins to feel weak, has significant weight loss, has low grade fevers lasting for over a month, persistent loose motions, rashes, coughs and swollen lymph nodes. All of these symptoms are long standing (over months), persistent and do not respond to routine medication.

Where is HIV found in the body of an infected person?

HIV primarily infects the white blood cells. Besides blood it enters many other tissues and body fluids like semen, saliva and even sweat. However the amount of virus present and the infectivity of the virus differ from fluid to fluid as shown below.

Can HIV be transmitted by open-mouth kissing?

Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, open-mouth kissing could allow HIV to pass from an infected person to a partner through cuts or sores in the mouth. Open-mouth kissing with an infected partner is not recommended.

Who is at risk of getting HIV infection?Can HIV be transmitted by open-mouth kissing?

Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, open-mouth kissing could allow HIV to pass from an infected person to a partner through cuts or sores in the mouth. Open-mouth kissing with an infected partner is not recommended.

Who is at risk of getting HIV infection?

1. A person who has had sex with many people is likely to come in contact with someone who is already infected with HIV.
2. A person who has only one sexual partner in his or her life, but the partner has had sex with other people.
3. A child born to an HIV positive mother.
4. A person who has had a blood transfusion of untested blood.
5. People sharing injection needles, tattoo needles and razors.
6. Medical and paramedical workers who come in contact with body fluids. Examples – doctors, nurses, lab technicians, sanitation staff.

How can I avoid HIV infection?

HIV infection can be reduced through safer sex practices, safe blood transfusions, and avoiding sharing needles and razors. Mother to child transmission can be reduced by testing all pregnant women for HIV and treating those positive with anti – HIV medication.

What are safer sex practices?

HIV transmission through sex can be avoided totally if a person never has sex. This is called abstinence. Since it is natural to want to have sex, the next best option is to have a single mutually faithful sexual partner. Two HIV negative people who have never had sex with anyone other than each other cannot get HIV by having sex with each other.
If a person has more than one sexual partner, there is an increased risk of getting HIV as any of the partners may be infected from their previous relationship. We cannot detect whether a person is HIV positive from their appearance. If one has multiple sex partners, the risk of HIV infection can be reduced (but not ruled out completely), by always using condoms during sex.

What is a condom? How does it reduce HIV transmission?

A condom is a contraceptive device made of latex which prevents direct contact between the penis and the vagina. The male condom is rolled onto the penis while the female condom is a plastic pouch which is inserted into the vagina. Condoms prevent direct contact between the body fluids of the two partners. The risk of HIV transmission falls. The condom may leak or burst or be incorrectly used allowing HIV transmission. Even as a contraceptive, the condom fails to prevent pregnancy in 10 to 15 percent of couples over a one year period.

1. A person who has had sex with many people is likely to come in contact with someone who is already infected with HIV.
2. A person who has only one sexual partner in his or her life, but the partner has had sex with other people.
3. A child born to an HIV positive mother.
4. A person who has had a blood transfusion of untested blood.
5. People sharing injection needles, tattoo needles and razors.
6. Medical and paramedical workers who come in contact with body fluids. Examples – doctors, nurses, lab technicians, sanitation staff.