It  has recently been broadcast that there has been an outbreak of HIV in the state of Indiana. Governor Mike Pence declared the situation a state public health emergency, as he announced a HIV epidemic for Scott County, Indiana. This however is not the only region in the U.S. that is experiencing an increased incidence of HIV infections; Atlanta Georgia has also recently seen new cases at epidemic proportions. According to and article in Atlanta Daily World, “Atlanta ranks number one among U.S. cities when it comes to the rate of new HIV cases diagnosed”. What’s most disturbing, is that the article states that ” by the time patients are diagnosed in Atlanta, almost one -third have advanced to clinical AIDS”.

HIV the virus that causes AIDS has been around now for over 30 years, and although there still is no cure, the disease has become manageable – to the point of being considered a chronic disease. So, the last thing you’d expect to hear is that there is an ‘epidemic’ of the virus right here in America. You might be surprised because the once mass hysteria and phobia surrounding the disease has been sociably ameliorated.  Public health awareness campaigns rightfully designed to erase the stigma – that prevented many people from being tested and seeking treatment, have been largely successful. Why then is this happening now? What can we learn from this current news about a 3 decade old plague?

What constitutes an Epidemic?

Don’t let big words scare you. Whenever in a given time and particular location you have a large amount of people coming down with an infectious disease, it is said to be an epidemic. So, if all of a sudden everyone is your neighborhood came down with the flu around the same time, then there is a flu epidemic in your community. In the case of Indiana, 79 people in Scotts County were newly diagnosed with HIV infection, in the same times period that normally only saw 5 new cases. In Atlanta, 2 to 3 patients a day are reportedly diagnosed as having HIV at Grady hospital.

What’s the cause of these outbreaks?

The outbreak in Indiana is being linked to intravenous (I.V) drug use, stemming from a small town in Scotts County, named Austin. The rural town is said to have been plagued with addiction. The problem in Atlanta seems to be due to a lack of testing. People are not getting tested for years, which is evident by the fact that a third of these cases are newly diagnosed as already progressed to AIDS. Untreated, HIV has a latency period of about 9 years before it progress to AIDS.

Origin of HIV/AIDS

HIV is an acronym that stands for Human Immunodeficiency Virus. HIV is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). The virus was first isolated by Dr. Luc Montagnier and his team in France , 1985. Another group of researchers in the United States led by Dr. Robert Gallo,  helped link the virus to the cause of AIDS.

There are two known types of the virus – HIV1 and HIV2. Together with several simian immunodeficiency viruses(SIV) they comprise a family of primate lentiviruses. The two human viruses are related to different SIV and therefore have different evolutionary origins. SIV has long  been present in non-human primates and does not cause disease in the primate species that they naturally infect. However, cross-species transmission may lead to disease in other primates, and is said to be the origin of human HIV evolution. Cross species transmissions may have occurred many times before it was able to take hold in humans to epidemic proportions. The most probably interaction of humans with primate SIV is through the slaughter and preparation of primate ‘bushmeat’ for human consumption in Western and Central Africa.

HIV diagnosis and treatment

HIV is a retrovirus, which in short  uses an enzyme know as reverse transcriptase to transcribe its single-strand RNA into DNA (double-stranded genetic material). It gains entry into your white blood cells (CD4 lymphocytes and macrophages) where it replicates and takes over the cells genetic factory, forcing it to produce more of the virus, or killing it altogether.

Once infected your immune system will take about 3 to 8 weeks to make antibodies against the virus. Most tests diagnose infection by testing for antibodies, but some test look for the virus itself. Most people will develop antibodies within the first 3 months after transmission, rarely it may take up to 6 months. For this reason routine testing is necessary to detect HIV infection, if you are tested before your body has developed antibodies to the virus, you may test negative when truly you may be infected. It may take up to 6 months to test positive for the virus.

Initial symptoms of early HIV infection may mimic does of the flu or other temporary viral infections; like the common cold. For this reason few people know they are infected or seek testing. Also – as mentioned above – there is a long asymptomatic period from the time of HIV infection to the onset of AIDS. More sever symptoms manifest as: persistent generalized swollen lymph nodes, on-going or recurrent fever, continuous weight loss, chronic diarrhea, chronic cough,  and thrush (oral fungal infection).

Antiretroviral drug therapy consist of a cocktail of multiple different drugs,   used to target HIV and prevent it from binding to immune cells, thereby preventing entry and replication. It is the most effective treatment to date, as there is no vaccine to cure or prevent HIV infection. Life long use of antiretroviral drugs carry side-effects of heart, live, pancreas, kidney, and bone marrow disorders, as well as the development of drug resistant HIV.

Why haven’t scientist found a cure?

It has been extremely difficult to develop against HIV because of the inherent  nature of the virus. HIV rapidly evolves both within communities and within infected individuals. Within the 2 types of HIV,  there are many subtypes; determined by their viral diversity or genetic variation. This also, is the reason for the emergence of drug resistant strains of the virus, which has proven to be the single largest setback in the treatment of HIV. Additionally, drug therapy is only capable of lowering the amount of HIV in the plasma (bloodstream and lymphatic fluid), but there are viral reservoirs in various immune cells within the organs of the body.  These tissue  reservoirs prevent the viruses within them from interacting with the drugs that prevent their replication.

Summary

In the United States, HIV is primarily spread through sexual intercourse and intravenous drug use. The best way to protect oneself still remains to be abstinence and the use of condoms. Programs across the country have been established to exchange used needles and syringes, in an effort to prevent transmission from sharing needles during drug use. The most important preventative measure is for all persons of a community to know their HIV status by getting tested regularly. If you are infected, early diagnose and treatment can prevent the progression to AIDS  and the transmission to others.