HIV positive. Undetectable on ART

[lukin4me78]

1 hour ago, Scott Virginian said:

-- how does the virus remain in the body, even with medicines coursing through a person, so that it can recur if they stop their meds?  Where and how does it lurk?

 

This article from the Mayo Clinic is a fairly easy layman terms read:  https://newsnetwork.mayoclinic.org/discussion/forty-years-of-hiv-aids-will-the-epidemic-end/

"The reason why it is so difficult to cure HIV is that once HIV infects a person's body, it integrates into the host genome of several cell types. Those cells then hide in any of the lymphoid tissue, such as the lymph nodes, the liver and the spleen. And they lay there as what we call "latent" or "hiding", as long as the person is on HIV therapy. Anytime a virus does leave a cell, it gets taken care of by HIV therapy. But if the infected individual stops the HIV therapy, that latent virus will come back. To cure HIV, you have to eliminate those hiding viruses in the cells or that latent viral reservoir..."

 

Quote

-- why precisely is this damn thing so hard to eradicate from the body like so many other viruses that we survive all the time?

There are two main reasons.  The first is this above, regarding the "hiding" capability of the virus.   Secondly, the virus' ability to mutate (or change its own form) rapidly means that targeting the virus itself is rather difficult.  Essentially - while there are two main forms of HIV (HIV-1 and HIV-2), those main groups have thousands of mutations.  Medicine can target certain markers that are similar, but even at that - the virus can mutate.  This is what people in the tread are talking about when they refer to resistance and why stopping medication "to give their body a break" is not a good idea.

Mutation rate is not really easy to make layman term-ed, but here's an article that makes a good attempt.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574155/

 

The best thing is that you are wanting to learn.   Please continue to educate yourself -- and keep asking questions!

 

HTH 

[Guest]

1 hour ago, Scott Virginian said:

What @BenjaminNicholas wrote here makes me want to ask a genuine question; hopefully someone knows the accurate information.  Does anyone know (or can someone point me to a layman's explanation from a credible source, and I'll read it) --

-- how does the virus remain in the body, even with medicines coursing through a person, so that it can recur if they stop their meds?  Where and how does it lurk?

-- why precisely is this damn thing so hard to eradicate from the body like so many other viruses that we survive all the time?

Thank you.  Trying to learn.

Hopefully this is easy to understand. The virus enters the infected person's cells, and has enzymes which cause the host's cell to make DNA copies of its genetic material, and also to integrate that genetic material into the host cell's DNA. So basically the virus is "hiding" in the host's own nucleus. Even when a person with HIV is "undetectable," he still has the virus's genetic material in the nucleus of a countless number of his own cells. HIV medications stop the virus from replicating, but cannot get rid of the genetic material in the infected person's own cells/nuclei. Most viruses can't hide this way (though some can, and I think we all know herpes is forever). The reason it's difficult to eradicate is that one would have to be able to identify and eradicate every cell that hosts the virus in its nucleus. 

https://www.niaid.nih.gov/diseases-conditions/hiv-replication-cycle

The dashed line in the cell of this picture is supposed to represent the nucleus:

[Rudynate]

On 2/15/2023 at 8:05 PM, pubic_assistance said:

In fact, some "undetectable" gay men are sloppy about taking their HIV therapy medication and this creates a "viral rebound" effect.  The HIV infection becomes active and infectious again within a few weeks of forgetting to take their meds.

Science article attached below.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046528/

I cannot believe that if someone forgets to take their meds one day that " The HIV infection becomes active and infectious again within a few weeks of forgetting to take their meds."  It is certainly not optimal, but they certainly don't go from undetectable to infectious in a matter of weeks becaue they forgot one dose.

[lukin4me78]

3 minutes ago, Rudynate said:

I cannot believe that if someone forgets to take their meds one day that " The HIV infection becomes active and infectious again within a few weeks of forgetting to take their meds."  It is certainly not optimal, but they certainly don't go from undetectable to infectious in a matter of weeks becaue they forgot one dose.

This does not happen by missing a single dose.  Almost all meds today have a 36 hour half life.  A person would have to not take the medicine for at least 2 days before they would see relevant development.  And it is not a delayed affect.  If they go for 3 days, the virus starts building.  
 

FYI on the U=U conversation - a person is considered transmissible at 200 copies per deciliter.  Most doctors start asking questions when a person tests above 50/dl.  Tests can pick up as little as 20/dl.  

[Rudynate]

13 minutes ago, lukin4me78 said:

This does not happen by missing a single dose.  Almost all meds today have a 36 hour half life.  A person would have to not take the medicine for at least 2 days before they would see relevant development.  And it is not a delayed affect.  If they go for 3 days, the virus starts building.  
 

FYI on the U=U conversation - a person is considered transmissible at 200 copies per deciliter.  Most doctors start asking questions when a person tests above 50/dl.  Tests can pick up as little as 20/dl.  

That sounds more like it. I imagine even the most militant have occasionally forgotten a dose

[pubic_assistance]

1 hour ago, Rudynate said:

It is certainly not optimal, but they certainly don't go from undetectable to infectious in a matter of weeks becaue they forgot one dose.

Obviously.

And no one said anything about "one dose".  The research shows that a significant number of gay men are forgetting multiple doses during the course of the month.  At a certain point,if you're consistently sloppy about your meds, it has a slingshot effect and the virus begins to reproduce again.

[pubic_assistance]

3 hours ago, Scott Virginian said:

how does the virus remain in the body, even with medicines coursing through a person, so that it can recur if they stop their meds?  

HIV medication is a TREATMENT, not a CURE.  There is currently no way to eradicate the virus from your system.. Just keep it in check.

[Marc in Calif]

4 hours ago, pubic_assistance said:

The research shows that a significant number of gay men are forgetting multiple doses during the course of the month.  

I haven't seen this conclusive research about only gay men. Don't most HIV medication studies work with populations of "persons living with HIV (PLWH)" whoever they might be -- men, women, straight, gay, trans, and bisexual?

Here's an example:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525920/

Edited March 11, 2023 by Marc in Calif

[Marc in Calif]

On 2/15/2023 at 8:05 PM, pubic_assistance said:

In fact, some "undetectable" gay men are sloppy about taking their HIV therapy medication and this creates a "viral rebound" effect.  The HIV infection becomes active and infectious again within a few weeks of forgetting to take their meds.

Science article attached below.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046528/

That article does not describe the study's population sample as "gay" at all. The researchers studied "sixteen consenting HIV‐positive patients with very small HIV reservoir and minimal on‐going viral transcription."

We can assume that those sixteen people included any or all of the following: straight, gay, bisexual, women, men, trans.

Or did I miss something?

[Scott Virginian]

Thank you to @lukin4me78 @Unicorn and @pubic_assistance for the education. That’s some Sci-fi movie level scary shit, at least to me. Yikes. 

[Marc in Calif]

Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018582/

Edited March 11, 2023 by Marc in Calif

[CuriousByNature]

This has been a very informative series of posts.  What I continue to take from the ongoing conversation is that every individual needs to take responsibility for their own health in EVERY situation.  Do not trust that someone is healthy just because they feel like they are healthy - I know two people who felt completely fine and were dead within four weeks from a cancer they didn't realize they had until it was much too late.  There are ways to reduce the risk of contracting an STD/STI but there is no way to eliminate it completely, short of total abstinence.  Everyone has their own level of risk tolerance and comfort, but your partner is not responsible for ensuring or protecting your sexual health.  Only you can do that.

[DWnyc]

On 3/11/2023 at 3:09 PM, Marc in Calif said:

Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018582/

This seems very true from anecdotal experience. I constantly hear bi / straight guys say that they stay away from Prep and other services primarily because they don’t want prescriptions or services in their record. They don’t want the risk of their partners, employers, the government etc finding out. Or be put in a category by their insurance companies.

Regardless of if that is a rational position it needs to be addressed for true disease prevention / protection of others. 

In some countries you can walk into a pharmacy and buy prep and other antiretrovirals without a prescription but that doesn’t address regular testing and monitoring for side effects. 
 

 

[rvwnsd]

2 hours ago, DWnyc said:

This seems very true from anecdotal experience. I constantly hear bi / straight guys say that they stay away from Prep and other services primarily because they don’t want prescriptions or services in their record. They don’t want the risk of their partners, employers, the government etc finding out. Or be put in a category by their insurance companies.

 

 

As my physician once said (20+ years ago) when he asked me if I wanted my HIV test run through insurance, if you test positive your insurance will certainly find out when they start paying for those HIV treatment prescriptions. 

[Marc in Calif]

5 hours ago, DWnyc said:

I constantly hear bi / straight guys say that they stay away from Prep and other services primarily because they don’t want prescriptions or services in their record. They don’t want the risk of their partners, employers, the government etc finding out. Or be put in a category by their insurance companies.

This is exactly right. The bisexuals are typically closeted about their activities and try to stay under the radar -- even for health maintenance, prevention, and treatment. 

I just don't get it. 🤷‍♂️