What is HIV?


Human Immunodeficiency Virus or HIV are one of two lentiviruses (HIV-1 or HIV-2) which are a subclass of retroviruses.

HIV affects the CD4+ cells of the immune system which are a type of lymphocyte.  When the HIV enters the CD4+ cell, it releases its RNA, and a transcriptase enzyme uses the RNA to produce DNA which becomes a permanent part of the cells DNA thereafter.  This process is the reverse to how human cells usually work, therefore the name retrovirus.  Once the HIV DNA has embedded in the cells DNA the HIV is replicated every time the cell divides.  Initially the HIV may be inactive and causing no specific harm to the immune system.  Once the HIV becomes activated it takes over the CD4+ cells normal functions, rapidly replicating itself and releasing HIV into the system which go on to infect other CD4+ cells progressively resulting in destruction of the CD4+ cells making a person carrying the virus severely immunocompromised.  Untreated, HIV will progress to Acquired Immunodeficiency Syndrome or AIDS.

HIV-1 is the most common form of HIV and usually responds well to treatment with antiretroviral medications.  A person diagnosed with HIV who takes their medications regularly can usually expect to achieve an undetectable viral load within a relatively short period of time allowing the CD4+ cell count to return to normal levels.  Current evidence suggests that a person who maintains an undetectable viral load can live a healthy and long life and has low or no chance of transmitting HIV to another person.

HIV-2 is far less common in the general population, but has a great incidence in sub-saharan African populations.


Signs and symptoms

HIV is transmitted through contact with infected body fluids such as blood, semen or vaginal fluids.  Whilst HIV can be detected in very low levels in saliva or other body fluids the risk of contracting HIV through contact with these fluids is extremely low or non-existent.Once a person becomes infected with HIV they will usually have no symptoms for between 1-4 weeks.  Following this mild “flu-like” symptoms of cough, sore throat, mild fever, and rash may appear and generally last for 1-2 weeks similar to what you would expect from a common cold or flu infection.  Once these initial symptoms subside, a person may remain asymptomatic for months or even years.

Once the HIV becomes activated and CD4+ cell counts begin to decline more significant signs and symptoms begin to appear:

Increased susceptibility to secondary infections that progressively take longer to recover from.
Swelling of the lymph nodes around the neck and groin.
Frequent and persistent diarrhoea and other gut symptoms.
Thrush infections of the mouth or vagina.
Progressively worsening fatigue
More significant fevers particularly at night
Weight loss
Anaemia

As the condition progresses a person with HIV may begin to experience infections and other symptoms affecting the lungs, nervous system and digestive tract.



The conventional approach and their downsides

Treatment of HIV will usually involve a combination of 2 or more antiretroviral medications.  The types of medications used might include:

Nuceloside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitorsIntegrase inhibitors
Protease inhibitors

These types of medications block the function of specific enzymes that HIV needs to replicate itself.
Some people may need to take other medications such as fusion inhibitors or attachment inhibitors which prevent HIV from being able to enter the CD4+ cell.

The latest generation of antiretroviral medications have been shown to be very successful in reducing viral load to undetectable levels and allowing the CD4+ cell counts to recover to normal levels.

The current approach to treating HIV is to commence antiretroviral therapy as soon as possible after diagnosis.  HIV positive people who regularly take their prescribed medications can expect to live a long, healthy and normal life with little or no chance of transmitting HIV to another person.


Root causes of HIV
In people living with HIV, the virus itself can be considered the root cause of the disease.  Whilst modern antiretroviral therapy is very effective in controlling HIV and allowing the immune system to recover, there are several other factors affecting a person's overall health and wellbeing that can be taken into consideration:

Supporting a person's overall immune health to ensure they remain well and have optimal resistance to other common infections reducing the chance of the immune system becoming stressed and allowing HIV to become opportunistically active.Repairing and rehabilitating other body systems that have been affected by HIV during the time from contracting the virus, to diagnosis, commencement of medications, and achieving an undetectable viral load.  This may include gut health, respiratory health, nervous system health, and correction of dysfunction in hormone pathways.Prevention strategies to reduce the risk of developing other conditions associated with HIV infection such as elevated cholesterol and development of cardiovascular disease, chronic kidney disease, osteoporosis, and some cancers.

Current evidence suggests that over 50% of people living with HIV in Australia use one or more forms of complementary medicine to address these factors.
Braun, L., Forrester, CA. & Rawlins M. et al (2016) Complementary medicine use by people living with HIV in Australia - A national survey. International Journal of STD & AIDS, 27(1), 33-38,  https://doi.org/10.1177/095646245573122 
Poucher, V., Gourmelen, J., Bureau, I. & Bouee, S. (2020) Comorbidities in people living with HIV: An epidemiologic and economic analysis using a claims database in France, PLoS ONE, 15(12); e0243529, https://doi.org/10.1371/journal.pone.0243529

Contributing factors
The main risk factors for contracting HIV are:
Men who have sex with menUnprotected sexNeedle sharing with intravenous drug useHaving other sexually transmitted infections (STIs) such as syphillis, gonorhoea, chlamydia, herpes, or vaginosis.

For people with access to adequate healthcare, the most significant risk for HIV progressing and other complications developing are:
Not being consistent with taking antiretroviral medications allowing the viral load to become detectable and the HIV virus to become active.Having other comorbid conditions that compromise the immune system or limit the effectiveness of HIV treatments.

Functional testing considerations
See root cause above (this will be dependent on the individual presentation of each patient).

The functional medicine approach
This will be dependent on the individual presentation of each patient.

Common misconceptions
The most common misconception about HIV, is that people living with HIV are unwell and cannot live a long and healthy life. For those who are HIV positive, and have access to adequate health care, taking regular antiretroviral medications, and living a health promoting lifestyle, means they can expect to live a long, healthy and normal life with little or no risk of transmitting HIV to another person.