Diseases - Hiv/aids Close-up

The Human Immunodeficiency Virus (HIV) causes Acquired Immune Deficiency Syndrome (AIDS). HIV infection occurs first. If left untreated, it rapidly develops into AIDS. A very small percentage of people with the infection ("non-progressors") remain unaffected. AIDS is the last and most serious stage of HIV. People often use the abbreviations HIV and AIDS interchangeably and sometimes combine them as HIV/AIDS. AIDS is the most deadly of the sexually transmitted diseases. Blood, semen, vaginal secretions, and breast milk transmit it. It also can be transmitted when infected blood is passed to drug users via unclean needles.

AIDS is incurable and invariably fatal. HIV infection, which occurs first, can be treated but not cured. It is not proved — but generally held — that HIV infection will progress to AIDS except in a small minority of cases. Progression can be delayed. The onset of AIDS may take up to 10 years.

HIV destroys the body's immune system. This manifests itself in the reduced presence of a cell in the bloodstream called CD4 lymphocyte. Its presence prevents many deadly infections and cancers. Its absence leads to death from any number of infections, cancer of the lymph glands, tuberculosis, pneumonia, brain infections, and the wasting of the body through weight loss and anorexia.

The main tool in fighting HIV/AIDS today is Highly Active Anti-Retroviral Therapy (HAART). It reduces HIV in the blood and thus preserves high CD4 counts. HAART prolongs life but is a regimen of multiple medications with disagreeable side effects. Strict adherence to the regimen is required to avoid HIV resistance to the treatment. Some strains of HIV easily mutate. We're not there yet, in other words. But life is being extended by the therapy.

Some general indicators. New HIV infections in 2000 were 70% men, 30% women. Men who have sex with men (MSM, as the CDC abbreviates this) had 42% of new infections; 33% were traced to heterosexual contacts, 25% to needle use in drug injections. Lesbian sexual acts do not seem implicated — although they are theoretically possible means of transmission. Seventy-five percent of females infected are infected in heterosexual acts; 25% by needle use. Of women, 64% are black. Among men, 60% are infected in homosexual contacts, 15% by needles, 15% in heterosexual acts. Of men, 50% are black.

Looking at both sexes, African Americans had 12% of the U.S. population in 2000 but had 54% of all new HIV infections, whites 26%, all other races 1%. HIV is thus becoming a major health problem in the black community.

As shown in the main graphic, deaths associated with gay male activity have been dropping as a percentage of total deaths, those associated with needle use and heterosexual contact have been rising in percentage. Women are infected because they are drug users or because they have sex with those infected by needles or by bisexual individuals who also have sex with men. The women pass the disease on to yet others.

Total deaths, fortunately, are down significantly, as shown in the inset. In 1993, 45,598 people died of AIDS. In 2000 the number was down to 15,245, a 66% decrease. New infections in 2000, however, were around 40,000 — we are delaying but not preventing deaths.

To some extent, these numbers hide the total impact of HIV/AIDS. If we look back over the entire history of the disease — which first surfaced in 1981 — we note that 774,467 cases of AIDS have been reported — 82.6% men, 17.4% women, 42.6% white, 37.8% black, and 18.3% Hispanic. We're adding to this total at the rate of 40,000 a year.

A total of 448,060 deaths have been reported as of the end of 2000: 85.2% men, 14.8% women, 46.2% white, 35.5% black, and 17.3% Hispanic. In other words, nearly 58% of those with AIDS have died.

Source: Centers for Disease Control and Prevention. National Center for HIV, STD and TB Prevention. Online. Available: www.cdc.gov/hiv/stats/hasr1301/table30.htm.