Email 41: HIV or AIDS Confusion ~ Living with HIV in the Philippines

Email 41: HIV or AIDS Confusion

Posted by Pozziepinoy on 9:55 PM

"Dear Pozziepinoy,

I was diagnosed with hiv last june 2012 and by that time my dr. told me that my CD4 count is lower that 200.

As of this moment I take my ARV's every day as my doctor has prescribed. Gusto ko lng po malaman if tumaas ulit ang CD4 ko magiging HIV na ulit yung virus or still it's AIDS pa din since lower than 200 yung intial CD4 ko. I hope masagot nyo po ito natatakot lang po talaga ako since AIDS na po yung virus sa katawan ko now...

(Translation: As of this moment, I take my ARV's every day as my doctor has prescribed. I want to know if my CD4 will go up, will the virus be still HIV or would it be AIDS since my intial CD4 was lower 200. I hope you will be able to answer this as I am really scared since I have AIDS now in my body...)

XXX"

POZZIEPINOY'S REPLY

Hi XXX,

Thanks for your email. Thank you for reading my blog too. I am glad that through it. you were able to reach me to ask your question.

Let us define HIV and AIDS again.

First, human immunodeficiency virus or HIV is the virus that we have right now. HIV infects vital cells in the human immune system such as helper T cells (specifically CD4 T cells), macrophages and dendritic cells. HIV infection leads to low levels of CD4 T cells through three main mechanisms: First, direct viral killing of infected cells; second, increased rates of apoptosis in infected cells; and third, killing of infected CD4⁺ T cells by CD8 cytotoxic lymphocytes that recognize infected cells. When CD4⁺ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections.

Acquired immunodeficiency syndrome or AIDS is a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive.

So what is the difference between the two?

1. HIV is the virus which attacks the T-cells in the immune system. AIDS is the syndrome which appears in advanced stages of HIV infection.

2. HIV is a virus. AIDS is a medical condition.

3. HIV infection causes AIDS to develop. However, it is possible to be infected with HIV without developing AIDS.

4. Without treatment, the HIV infection is allowed to progress and eventually it will develop into AIDS in the vast majority of cases.

There are also 2 classifications for AIDS:

1. Center for Disease Control (CDC) defines AIDS as having any of the two: as cases with CD4 counts below 200 or HIV cases with AIDS defining illnesses. If the person is diagnosed with HIV and AIDS, the AIDS can't be reversed back even though the CD4 recovers and goes above 200.

2. World Health Organization (WHO):

The clinical staging and case definition of HIV for resource-constrained settings were developed by the WHO in 1990 and revised in 2007. Staging is based on clinical findings that guide the diagnosis, evaluation, and management of HIV/AIDS, and it does not require a CD4 cell count. This staging system is used in many countries to determine eligibility for antiretroviral therapy, particularly in settings in which CD4 testing is not available. Clinical stages are categorized as 1 through 4, progressing from primary HIV infection to advanced HIV/AIDS. These stages are defined by specific clinical conditions or symptoms. For the purpose of the WHO staging system, adolescents and adults are defined as individuals aged ≥15 years.

In our country, since we have facilities to detect the CD4 and the presence of AIDS defining illnesses, we basically follow the CDC Classification and WHO Clinical Staging. Doctors both specify the CD4 count and the stage of the disease.

CD4 is the basis for the prescription of ARVs and prophylaxis. If CD4 is 350 and below, ARV's are automatically prescribed. If CD4 is below 200, prophylaxis is prescribed.

As defined by CDC, once you are diagnosed with HIV/AIDS, the AIDS part can't be removed anymore even though your immune system as recovered, that is if your CD4 has gone above 200 and you have no more AIDS defining illnesses. This can only be reversed until the time that health professionals can change their definition of AIDS.

AIDS are just four letters. Like for me, my CD4 is already high and I don't have any more opportunistic infections and still my diagnosis is HIV/AIDS. Just change your perspective and not think about it. Your focus now is to get well and your immune system to rebound fast.

I hope I was able to answer your question XXX.

Feel free to email me again if you have other questions.

Stay healthy,

Pozziepinoy