[lizknope]

I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.

[SoftTalker]

He doesn't have AIDS, he's HIV-positive.

[kstrauser]

I understand the difference between those statements, but confess that I'm not clear on the important distinction. Are there situations where untreated HIV doesn't progress to AIDS? Is the virus more transmissible in someone with AIDS than someone who's still at the HIV-positive stage?

Asking here because I don't know, and I think an answer might help others know, too.

(And to clarify, I genuinely don't know, and I'm asking from a supportive POV.)

[freeone3000]

We are unaware of any situations where HIV+ doesn’t turn into AIDS without treatment.

But being HIV+ is simply having a virus, not actively dying. HIV+ status also never clears - later tests that are “negative” mean your viral load is undetectable, at which point you can no longer transmit HIV to others. Undetectable = Untransmissable.

[SoftTalker]

FTA, it seems that a (very) small number of people develop effective antibodies againt HIV.

"These antibodies are very, very rare, but they can be found in blood samples from a small number of people living with HIV.

The vaccine causes the immune system to produce more of these "broadly neutralizing" antibodies.

[kstrauser]

That all makes sense. A couple things I’m still not clear on:

* If someone has a negative test after treatment, but that’s not counted as “cured”, does that imply it could (or maybe will) come back if treatment is stopped?

* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?

Thanks for your earlier answer. I know this specific infection has lots of difficult history. It’s hard to formulate my questions without sounding suspiciously close to a sea lion or something, but I sincerely want to know. And yes, I could google it but then it wouldn’t be an interesting conversation, or one others could read and learn from.

[freeone3000]

* If someone has a negative test after treatment, but that’s not counted as “cured”, does that imply it could (or maybe will) come back if treatment is stopped?

Yes. HIV+ patients require antiretroviral treatment for the remainder of their lives. Most are able to manage with a pill regimen. This is not to say it is cheap or side effect free, but most HIV+ people are able to live normal lives with outpatient support.

(To link it back, PrEP is the same drug used to treat; ex, emtricitabine + tenofovir. Dosage, schedule differs. Other antiretrovirals may be chosen.)

* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?

Public health does talk about Inflenza (and other viral positive) individuals. Public messaging is usually with the term “carrier” - but in jargon, this implies that the individual will likely mot develop the disease themself, and will remain asymptomatic, which is untrue for HIV. NCoV-19, recently in the public eye more than any other virus, has a lot of literature around positive tests vs disease.

[kstrauser]

1. What a freaking miracle. Growing up in the 80's, the notion was terrifying. I was straight and it was something my friends and I discussed. I can't imagine how awful it must've been for gay communities. Again, what a miracle.

2. OK, fair point.

Thanks for the info! I know HIV isn't exactly "no big deal" today, but seeing it go from "you're certain to die" to "it's annoying to have to take medicine forever" is still a wonder of modern science.

[rsynnott]

> What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?

Generally if you have the influenza virus, you’ll also have the disease that that virus causes. This is true of most viruses. I’m not sure any other virus does the “undetectable and untransmissible, but still _there_” thing; generally, if you get viral load to undetectable for most viruses, it will go away entirely. HIV is unusually good at dealing with the human immune system.

[est31]

HIV virus inserts itself into the DNA of long lived cells in your organism, and it stays around as long as those cells stay around, which is (unless u have blood cancer and your doctors decide to kill those cells) your entire life.

That constant low level stream of HIV viruses in your body can cause the virus to return at any moment you stop the therapy. So you have to take daily pills for the rest of your life to stop that stream from exponential growth and killing all of your immune system.

The last part is what is referred to as AIDS: your immune system is so weak that even the simplest pathogens can kill you, which they usually do once you reach AIDS stage.

There are a couple of viruses that can lay dormant in you and cause problems later on. Many of them insert themselves into the DNA of long living cells.

Without therapy, HIV will progress to AIDS in a couple of years in basically 99.9% of patients. Some very rare cases are known where HIV patients survive without getting AIDS and therapy, via broadly neutralizing antibodies. But again, less than a tenth of a percent. Everyone else would die without a therapy.

Being HIV positive isn't a death sentence, if you take your meds (and started taking them early after HIV infection) you can live for as long as someone who isn't HIV positive. In fact studies show that the effect of regularly going to a doctor and getting your blood checked actually improves your life chances. HIV positive people can do 99% of the things normal people can, although they are not allowed to donate blood (for good reason).

Having AIDS though is a major impairment and you are on your way to death at that stage (1-3 years to live). So it makes sense to distinguish the two.