• Introduction
• HIV and Your Immune System
• Disease Progression
• Checking on Your Immune Health
• Project Inform Strategy for HIV Disease
• Common Blood Tests and What They Tell You
• Interventions Against HIV
• General Health Maintenance
• Supportive Therapy
• HIV Strategy
• Immune Therapies
• Opportunistic Infection Strategy
• When to Start Treatment
• Available Treatments
• The Bottom Line

Introduction

A positive HIV antibody test is scary news but it's not a death sentence. As better therapies continue to be developed, it's entirely possible to live out a normal lifespan after testing positive. The key to living a long life with HIV is availing yourself of health care and suitable therapies.

A positive result is an important medical message that may help you save and extend your life. Whether you took the test or not, sooner or later you would have learned of your HIV status.

If you learn by testing, you have a chance to slow or prevent some of the possible health outcomes. Even if you didn't get tested, HIV would present itself at some point as an infection or damage to your immune system. And, if you had waited for HIV disease to present itself, many of your best medical options would already be lost.

Most testing sites provide counseling to help people handle the news. The real work, however, is up to you. Given the right attitude and the right information, most people can live for a long, long time. Getting informed and taking charge of your health will help you make the best of your situation.

This publication can help you with the things you need to do:

• Develop a strategy to adapt to your new situation;
• Learn more about HIV and how it can affect you;
• Understand the medical tests you'll use;
• Find ways to promote and maintain your health; and
• Learn how to use the services at Project Inform.

Reading this publication is a good first step. It's a little long, but it's worth the time. It's about saving your life.

HIV and Your Immune System

HIV (human immunodeficiency virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). Being HIV-positive does not mean that you have AIDS, but it does mean that you may develop AIDS. HIV attacks your immune system, gradually impairing how it functions.

Your immune system helps keep your body healthy by recognizing and attacking foreign substances, like viruses or bacteria. Over time, if it becomes seriously damaged or weakened by HIV, your body loses its ability to fight certain infections and cancers. These are called oppor­tunistic infections (OIs).

AIDS is the most serious outcome of HIV infection. It occurs once your immune system has been significantly damaged. If you have certain OIs, it will lead to an AIDS diagnosis. This is because the presence of these OIs in your body points to a significantly damaged immune system.

An AIDS diagnosis will also be given if the counts of your immune system cells (called CD4+ T cells or simply CD4s) fall below 200. These cells are the key players in your immune system. Their "normal" range in a healthy HIV-negative person is 500–1,500 cells/mm3.

This gradual destruction of the immune system doesn't happen the same way in everyone, or even at the same pace. In some, it may not happen at all. In a small percentage of people, HIV destroys their immune systems very rapidly, in just a few years. But others remain well for 10–15 years or longer. On average, without using HIV therapy, most people remain well for about ten years before facing their first serious symptoms.

A number of things are well known about HIV infection:

• Viral load tests measure the amount of HIV in the bloodstream. They can generally predict how quickly HIV will damage the immune system. In effect, these tests predict the loss of CD4 cells: the higher the number, the greater the risk of damage to your immune system. Using effective treat­ments can greatly reduce the level of HIV and slow its rate of disease progression.
• CD4 cell count tests measure the level of CD4 cells, a certain type of white blood cell. These tests can measure the decline of your immune health. However, taking HIV therapy can slow the decline of your immune health. In fact, many people who start HIV therapy experience a significant increase in their CD4 counts.
• For long periods, often several years, the body copes effectively with HIV in many people. The number and percentage of CD4 cells fall, but slowly. During this period, most people feel normal and suffer no obvious ill effects. Despite this, most researchers believe that damage is still being done to the immune system. Many scientists believe that early inter­vention during this time may have the greatest impact, though others remain skeptical. They believe the possible side effects from early treatment might outweigh its benefits.
• Without treatment, the body slowly loses its ability to fight infections. Some infections, like Pneumocystis jiroveci pneumonia (sometimes called PCP), become likely when CD4 counts fall below 300 or 200. Minor infections can occur at counts above 300. Other life-threatening infections become more likely when the count falls below 100 or 50.

Disease Progression

HIV is a "spectrum" illness: all who are infected have the same disease, but there are different stages to it. AIDS is the name given only to the later most serious stage. In the earlier and less serious stages, people are HIV-positive, meaning they tested positive on an HIV antibody test but they have no life-threatening symptoms of illness. If left untreated, most people generally progress along the spectrum toward AIDS.

HIV disease can progress slowly or quickly. Several studies have researched the rate at which it progresses when left untreated. Most conclude that about half of HIV-infected people progress to AIDS if left untreated within about ten years of infection. About three out of four (75%) reach AIDS by the 15th year.

These studies conclude that HIV is a progressive disease that leads to symptomatic illness in most people over time. Children born with HIV and people infected through blood trans­fusion seem to get sick more quickly. Studies suggest that when women have access to and seek regular care and monitoring, their progression rates are similar to and perhaps even slower than men. Studies that include people with hemophilia are inconclusive about their rates of progression.

Why people progress at different rates is uncertain. It may be due to differences in the strain of HIV a person gets. Others believe it is influenced by genetic differences in people, while others suspect that lifestyle factors make a difference.