Currently, talking about the Human Immunodeficiency Virus (HIV) is a topic of controversy. For many, the virus that produces Acquired Immune Deficiency Syndrome (AIDS) is still synonymous with fatality and, therefore, the vast majority of newly diagnosed patients go through a process of tragedy, in which their own belief is added to the social isolation that their minds dictate when confronted with an entity that, far from meaning death, resembles any other chronic pathology that demands commitment and responsibility.

Why the stigma?

Early in the 80’s, when HIV began to be studied, it was serious diseases that made the presence of this new virus felt, diseases that were poorly understood and therefore, there was no effective treatment. These diseases, called “opportunistic infections” had practically a natural evolution in the host, most of them leading to death.

Later on, it became known that these diseases occurred in the patient once HIV had managed to intensely affect the immune system, hence the organism was not able to initiate the appropriate response to defend itself against these various pathogens.

Today, we know that these infections are partly responsible for the patient’s progression from HIV infection to AIDS. Without specific treatment for opportunistic infections or HIV, the mortality rate was extremely high, and patients who survived for any period of time had a very poor quality of life, being susceptible to multiple complications that, in a short period of time, had a fulminant evolution.

What has changed since those days?

Much has changed since the first cases of Pneumocystis jiroveci (formerly carinii) pneumonia to the present day. Together with the study and understanding of the evolution of the disease, the advent of HIV treatment (antiretroviral), and the management and prevention of opportunistic diseases, have achieved that currently the patient diagnosed with HIV and initiated on time with treatment, has a survival rate equal to that of the general population, in other words, the treated HIV patient dies from the same causes as a non-HIV patient.

How is the follow-up of the HIV-positive patient?

Once diagnosed, the HIV patient is offered all the psychological support he/she needs, based on what has been explained above, so that each patient understands what we have explained so far.

The information about their serological status is strictly confidential, only the patient has the right to inform third parties about their diagnosis, being an exception in the case of a patient with mental disability, in which their diagnosis conditions some management that requires authorization or entails some circumstances. The treating physician will perform a series of laboratory tests before initiating antiretroviral therapy to determine the degree of immune system involvement and to rule out the presence of infections that are not currently manifesting and that need to be managed as well.

Once these results are received, a decision is made as to which treatment scheme is the most advisable, since not all patients require the same medications. The physician recommends, but the patient is responsible for deciding the moment when he/she feels prepared and ready to assume the commitment of the treatment. Once started, treatment cannot and should not be discontinued, and the physician will schedule follow-up appointments depending on the individuality of each case. So far, there is no cure for HIV, and stopping treatment leads to numerous complications.

Dr. David de Luna

Infectiologist