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On the Today show, actor Charlie Sheen told interviewer Matt Lauer that he is HIV-positive. This was once considered a death sentence, however, the treatment for Human Immunodeficiency Virus has advanced to the point now where people can continue to lead long, healthy, productive lives -- as long as they take their medication.
In fact, HIV is considered more of a chronic disease, as opposed to an acute, deadly illness. Despite this, there's still considerable stigma attached to the diagnosis and considerable shame on the part of those diagnosed. To a large extent, the stigma has carried over from the 1980 s, the height of the AIDS epidemic, when fear and panic seized the population, both nationally and globally.
Once diagnosed, patients are monitored for disease progression by having their viral load and T-cell count checked regularly. Patients are started on lifelong treatment with antiretrovirals (ART). Successful treatment can nearly eliminate the risk of transmission to the fetus during pregnancy (vertical transmission) or to the sexual partner as the probability of transmission depends on the amount of virus present in the blood.
Some studies have shown that viral load is a better predictor of the time to progression of AIDS and death, independent of T-cell counts. There is some confusion or potential confusion surrounding the concept of what it means to have an undetectable viral load." To begin with, it doesn t mean that a person infected with HIV is now cured of the disease. It also doesn t mean that if screened for HIV the test won t yield a positive result, since screening tests check for the presence of an immune response to the virus, not the virus itself.
Viral loads measure the amount of virus present in a milliliter of blood. When fewer than 20-50 copies of HIV are present per milliliter sample of blood it is clinically referred to as an undetectable viral load, but it does not mean that the virus is entirely eradicated and though the risk of transmission is greatly reduced, it is not zero.
There is also significant evidence that by taking pre-exposure prophylaxis (PrEP), or a once-a-day pill in HIV-negative people, the rates of disease transmission are significantly reduced. A randomized controlled trial of couples from Kenya and Uganda, published in NEJM, followed 4,747 couples randomly assigned to receive a once-daily single medication, tenofovir, combination of tenofovir-emtricitabine, or placebo. The study revealed that both medications conferred protection against infection with HIV in heterosexual men and women.
The ultimate goal of treatment for HIV is to suppress the activity of the virus. PrEP is just one tool of many at our disposal for reducing its incidence and prevalence. Continuing to keep the discussion regarding HIV as part of our regular discourse will hopefully de-stigmatize those living with the disease, like Mr. Sheen, who once said that he survived reckless binges of illegal drugs due to "tiger blood" coursing though his veins. Clearly, that was just talk and he is not immune to infection.
