WORLD AIDS DAY 2018: Dealing with HIV/AIDS

The other day at the local stationery store, I walked past an excited bunch of school kids buying supplies for a poster competition at school. Among other stuff, I noticed the leader of the kid gang – a bossy, chubby little girl – reminding the others repeatedly about the red ribbon. And the rest of the pack exclaimed in chorus, “The red ribbon, we forgot the red ribbon.” Curious, I asked them what they would do with the red ribbon. Animatedly, they say they’re going to sport the red ribbon badge all week till December 1.

December 1 was declared World AIDS Day in 1988. Cut to 30 years later, the HIV/AIDS epidemic still refuses to die down.

The World Health Organization (WHO) has declared HIV/AIDS to be one of the most alarming global health issues in recorded history. Unfortunately, India ranks third in the list of countries most affected by HIV/AIDS. As of today, AIDS has killed over 41.5 million people worldwide while 36.5 million people are living with HIV.

India has over 2 million people living with HIV. In 2017 alone, AIDS wiped out a whopping 69,000 people off the Indian census!

What caused this epidemic of mammoth proportions?

AIDS was first thought to be a disease that only affected homosexual men engaging in unprotected intercourse. But soon after, female partners of men with HIV/AIDS were also found to contract the disease. It was thus postulated that HIV/AIDS is exclusively a sexually transmitted disease.

It was only when children born to HIV positive mothers also tested positive for the virus that mother to child transmissionwas declared as another route of transmission. While the hippie culture of the 60’s and 70’s gave us the likes of The Beatles and Rolling Stones, it also left behind the practice of sharing needlesfor drug abuse. The increasing number of drug users also led to a sharp increase in the number of people living with HIV/AIDS.

The highly infectious nature of the virus combined with Government apathy resulted in an HIV/AIDS explosion.

HIV/AIDS – Symptoms, Signs and Sequelae:

AIDS is caused by the virus called Human Immunodeficiency Virus (HIV). The virus integrates with the host’s genome and stealthily attacks the most important cells that help build a strong immune system, the CD4 T-helper cells.

Eventually, the affected person is left with a weakened immune system. The person loses all his defenses against diseases and is potentially vulnerable to even the most harmless of infections.

When a person experiences unexplained weight loss of more than 10% body weight, unexplained diarrhoea lasting over a month or unexplained persistent fever for a month or more, that is usually when he/she visits the doctor. However, all of these are rather late signs of an HIV infection by which time the virus has already wreaked havoc.

The HIV patient is susceptible to a plethora of infections ranging from lung, oral, and skin ulcers to potentially fatal brain infections and cancer. An AIDS patient often lands up in what is known as the ‘HIV Wasting Syndrome’. Patients with HIV Wasting Syndrome were said to be suffering from ‘Slim’s Disease’ because of the profound muscle wasting associated with the disease.

HIV/AIDS – Diagnosis & Treatments:

The diagnosis of AIDS is made by an elaborate clinical history and examination of the patient followed by detailed laboratory blood work. A battery of rapid tests and supplemental tests are used to establish the diagnosis of HIV. A rapid test kit generally requires less than 30 minutes for diagnosis but should always be confirmed by supplemental tests such as Western Blot and Viral Load Testing to ascertain the count of the virus in the blood stream.

In India, The National AIDS Control Organization (NACO) has set up specific strategies for accurate testing of HIV in the country.Viral load monitoring also helps ascertain the response of the patient to therapy.

The NACO has also established numerous care, support and treatment groups catering to HIV patients at different stages of the illness. The HIV infected person may be apparently healthy for as long as 6-8 years following the exposure, depending on his immunity. These groups provide not only medical treatment but also much needed psycho-social support to ensure a better quality of life.

With the advent of Anti-retroviral Therapy (ART) against the virus, AIDS patients today have better chances of survival, contract fewer infections and in general lead a better quality of life. Anti-retroviral medication do not kill or eliminate the virus. A combination of these drugs under a supervised regimen prevents growth of the virus and decreases the viral load. People with lower viral loads stay healthier for longer and reduce further transmission in the population. The WHO recommends ART for all HIV positive patients as soon as the diagnosis is established. ART drugs are chosen according to established treatment guidelines, co-morbid conditions and lifestyle factors.

For the first time ever, more than half of the global population living with HIV is receiving anti-retroviral treatment, a record 19.5 million people.

Benefits of Exercise in HIV Treatment:

Besides a sustained course of these medicines, exercise is also one of the most useful supplemental therapies for improving the quality of life in HIV infected individuals. The most commonly asked questions are:

  • Does exercise treat HIV?

  • Should an HIV positive individual train differently than those without the disease?

  • Are there any benefits of exercise in AIDS treatment?

Well, here is what you need to know:

  • Exercise doesn’t fight the virus. Once contracted, the disease stays. The load of virus in the body however can be decreased to undetectable levels with Highly Active Anti-retroviral Therapy (HAART).

  • An HIV patient’s training program need not be any different from what he used to do before he/she contracted the virus.A lifter can continue to lift. A basketball player can continue to play basketball. A runner can still train for the season’s next big marathon. Nevertheless, the fitness levels may decrease post infection. It is therefore recommended that an HIV positive person should start slowly, building on his strength and endurance gradually as any other person would do. He/she must start from as less as 10 minutes of physical activity a day and progress to up to an hour of per day for 4-6 days a week.

  • Including strength training in a HIV patient’s training regimen prevents muscle wasting and HIV related weight loss.It improves body composition, strengthens the bones, and decreases the chances of osteoporosis. Not only that, exercise combats the side effects of HIV medicines by improving cholesterol ratio, lowering blood sugar levels and reducing the risks of cardiovascular events.

  • A person suffering from HIV is not only physically weaker but also psychologically drained.The social stigma and the impending fear of death makes him/her lose hope and leads him/her into a deep abyss of depression. Exercising has been proven, time and again, to decrease stress levels and combat depression.

So far, HIV/AIDS has been a medical mystery. There has been an ongoing attempt to discover better methods of prevention and cure for this deadly disease. We have advanced enough to increase longevity and improve the quality of life of people living this nightmare. While we are yet to find a medical breakthrough in the field of HIV medicine, we can definitely do our bit by educating ourselves and our younger generations, creating awareness and eliminating the social stigma associated with HIV/AIDS.

Go ahead and sport the red ribbon this December 1st as a mark of solidarity with those living with HIV/AIDS.

Author: Dr. Isra Halim (MBBS, MD, DNB)

References:

  1. UNAIDS (2017) ‘Ending AIDS: Progress towards 90-90-90’[pdf]

  2. Guariglia DA, Pedro RE, Deminice R, Rosa FT, Peres SB, De Moraes SM. Effect of combined training on body composition and metabolic variables in people living with HIV: A randomized clinical trial. Cytokine. 2018 Jun 11.

  3. John DO, Tella BA, Olawale OA, John JN, Adeyemo TA, Okezue OC. Effects of a 6-week aerobic exercise programme on the cardiovascular parameters, body composition, and quality of life of people living with human immune virus. Journal of exercise rehabilitation. 2018 Oct;14(5):891

  4. https://www.cdc.gov/hiv/default.html