HIV/AIDS in the Body & with the Socioeconomcally Disadvantaged
What does HIV and AIDS look like in the body? Does HIV/AIDS have unique manisfestations amongst the socioeconomically disadvantaged? What do they look like, and why is it important that they be targeted?
HIV/AIDS in the Body
HIV (human immunodeficiency virus) attacks the body’s immune system by attacking the CD4 cells, also called T cells, which help the immune system fight off infections. The immune system is the body’s defense system against pathogens, infections, and poor health, and the CD4 count is an indicator of the health of this system. In a healthy immune system, when the CD4 count is abnormally high, this often indicates that the body is fighting off an infection. And when the CD4 count is abnormally low, this often indicates the immune system has been compromised.
When left untreated, HIV reduces the number of CD4 cells in the body, making the individual more likely to develop other infections and infection-related cancers. Eventually, HIV destroys so many of the body’s CD4 cells that the immune system cannot protect the body against infections and disease. These infections that develop when the immune system is weakened are called opportunistic infections and often signal that the individual has developed AIDS, the last stage of HIV disease.
There is no cure for HIV, so once infected, the illness is lifelong. The current medical approach is to control HIV by treating it with antiretroviral therapy, called ART.
Antiretroviral therapy helps control the virus and helps reduce the viral load in the body. The lower the viral load of HIV in the body, the less likely the individual is to develop an opportunistic infection and thus develop AIDS. And the less likely the individual is to pass on the HIV virus to others. With a low HIV viral count, an individual has the potential to live as long a life as his or her HIV-negative peers.
The Three Stages of HIV Infection
The three stages of HIV infection are: Acute Infection, Clinical Latency, and AIDS (Acquired Immunodeficiency Syndrome).
Acute Infection – Within 2-4 weeks of infection, many people develop severe flu-like symptoms or symptoms similar to those of mononucleosis. Symptoms include fever, swollen glands, sore throat, rash, muscle and joint pains, and headaches. This stage is also called “primary HIV infection” or “acute retroviral syndrome” and is the immune system’s response to the body being infected with HIV. During this stage, large amounts of the HIV virus are being produced in the body. The immune system produces larger amounts of CD4 cells to respond to the presence of HIV in the body, in an attempt to defend the body from invasion. The HIV virus then uses the CD4 cells to replicate itself and destroys the cells in the process, causing the CD4 count to drop rapidly and resulting in the flu-like symptoms. Eventually, the immune system will bring the viral count back down to a relatively stable level of the virus called a viral set point. This is when the CD4 count will start to increase again, but it may not return back to pre-infection levels. During this acute HIV infection stage, HIV positive individuals are at a very high risk of transmitting HIV to those they have sexual relations with or with whom they share needles.
Clinical Latency Stage – During this stage, which is also called “asymptomatic HIV infection” or “chronic HIV infection,” HIV positive individuals experience no symptoms or only mild ones. They are still able to transmit HIV to others. This stage lasts an average of eight to twelve years, during which there is continual, rapid viral replication as the disease progresses to the AIDS stage, and there is a continuous decline in the number of CD4 cells. When the CD4 cell count drops below 400, constitutional symptoms occurs, such as fever, weight loss, fatigue, night sweats with a strong, unpleasant odor, diarrhea, and persistent generalized lymphadenopathy. The individual then starts to have infections; oral or vaginal candidiasis, oral hairy leukoplakia, herpes zoster (shingles), herpes simplex, and listerosis are commonly developed.
AIDS stage – The diagnosis of HIV is made when one of the two criteria is met: 1) When the CD4 count drops below 200, signaling that that this point the individuals’ immune system is severely damaged. At this point, the individual is highly susceptible to developing an opportunistic infection 2) The individual may have a CD4 count above 200 but develops an AIDS-defining condition. AIDS defining conditions are cancers and infections that are life-threatening in individuals with HIV and include certain forms of cervical cancer and tuberculosis. 90% of patients die of opportunistic infections, 7% die of cancers, and the other 3% die of other causes. The opportunistic infections HIV patients develop include Pneumocystis carinii pneumonia, Kaposi’s Sarcoma, candidiasis, coccidioidomycosis, cryptosporidiosis, cytomegaloviral infections, toxoplasmosis of the brain, HIV encephalopathy, and tuberculosis. HIV does not cause death itself but the opportunistic infections themselves are the cause of death. According to UNAIDS, as of 2015, tuberculosis remains the leading cause of death among people living with HIV, accounting for a third of all deaths.
HIV/AIDS Manifests Itself Uniquely Amongst the Socioeconomically Disadvantaged
Socioeconomically disadvantaged individuals often are delayed in starting treatment and often struggle with continuing treatment. The World Health Organization’s June 2016 HIV treatment guidelines recommend that all HIV positive individuals begin antiretroviral treatment immediately upon an HIV-positive diagnosis. In response, by 2017, many low- and middle- income countries had adopted this standard. However, many factors complicate the initiation of and adherence to treatment for socioeconomically disadvantaged individuals.
However, many factors complicate the initiation of and adherence to treatment, including:
Not all resource-limited countries provide antiretroviral treatment to all HIV positive individuals. Some make treatment available when the CD4 count is less or equal to 500; others make it available at a CD4 count less or equal to 350. Both of these numbers signify an immune system that is already significantly compromised and at greater risk of developing AIDS.
Socioeconomically disadvantaged individuals must navigate numerous challenges in order to access testing, and to start receiving and continue treatment, including:
limited and unstable finances;
limited and undependable transportation;
limited time availability due to work hours;
limited freedom and movement due to abusive home dynamics;
preexisting illnesses including active tuberculosis;
social stigma and fear of consequences, including rejection and alienation should the HIV diagnosis become public;
lack of sufficient/adequate nutrition;
lack of personal self-discipline, especially since often times they did not have attentive and available parents to raise them when they were children; and
children who cannot be left alone at home.
Mental health complications, including preexisting addictions and depression resulting from a positive HIV diagnosis.
One of the most influential factors in HIV antiretroviral medication adherence is social support. Unfortunately, with broken family/community support systems and high poverty levels, this social support is often glaringly lacking for those HIV positive socioeconomially disadvantaged individuals.
Consequences of Starting HIV Antiretroviral Therapy Late
Life expectancy for HIV-positive individuals who do not start antiretroviral therapy until they have developed AIDS is significantly shorter than those who start it earlier. After developing AIDS, if they do recover, it is often with a reduced physical capacity, including limited mobility, so that these individuals cannot function as they previously did.
Unfortunately, many socioeconomically disadvantaged persons in resource-limited countries do not start antiretroviral therapy until they have developed AIDS and are in front of a medical worker who is testing their blood to understand why their particular medical condition is so severe. It is often when the blood test comes back positive during this now life-threatening condition that the individual learns that they have both HIV and AIDS.
This is why there are many HIV-positive individuals who lose their mobility, including the ability to walk or to use one or both arms, after suffering from AIDS-defining conditions which include Kaposi’s Sarcoma, tuberculosis, toxoplasmosis of the brain, and HIV encephalopathy. It means they now need physical therapy in order to regain the use of their limbs so they can provide for themselves, care for their children, and move forward with their lives. If workers are not available to help with their physical therapy, which unfortunately often is the case, this means they often won’t and don’t get better. It is often the difference between having a future and hope in front of them versus sinking into further socioeconomic hardship and poverty.
It is in this context that HIV-positive individuals often becoming a burden to any available family or community members who already struggle daily just to have food to eat and somewhere to live. Having to care for a HIV-positive family member who cannot take care of themselves or provide for themselves means they are unable to go to work or that they must share the insufficient wages they do make, if they are fortunate to have work, with this now incapacitated family member.
If HIV-positive individuals’ health continues to deteriorate after developing AIDS, facilities who attempt to take care of these individuals struggle in providing sufficient palliative care, as they are often strapped for health care workers. Depending on the facility, often minimal nursing care is given because providing more attention is not possible. Oftentimes, HIV-positive patients spend their last days by themselves being minimally attended and with few or no visitors at their bedside, due to many factors, social stigma and ostracization due to their diagnosis being two of them.
Jesus Loves These HIV/AIDS Patients and Wants Us to to Help Them
It is in this context that we at LoveAIDS say that Jesus loves the HIV patient and that we choose to be the hands and feet of Christ to these individuals: We bring hope and hands and feet that help patients get better and regain their mobility. And we offer kindness, attention, and the message of God’s love through actions that provide gentle palliative care as they pass from this life unto the next.