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AIDS symptoms/life expectancy
bush baby thingamy
flying_colours wrote in little_details
(Sorry, mods, I accidentally hit the send button WAY too early)

I have a character who has been infected with HIV for quite some time without knowing it. He's only just found out now that the illness has hit the full-blown AIDS stage. This character is a friend to the main characters and doesn't have a very central role, so I'm very flexible as to details.

Firstly, I know that after the initial HIV symptoms present themselves there might be no symptoms years before the illness progresses to AIDS. How realistic is it that he would have ignored the initial symptoms, and not gotten tested until he's at the AIDS stage, and how long might he have been positive without knowing? I'm finding it's an average of about ten years, but is it likely that an otherwise fit and healthy man might still develop AIDS in a shorter timespan, say two or three years?

Secondly, once the illness hits the AIDS stage, and he begins getting infections, what is his life expectancy likely to be? Age-wise he's in his mid-40s and has always been quite fit and healthy. He's been feeling under the weather for a while, which he attributed to other factors, but now he's got something that's landed him in the hospital. I'm flexible about the kind of AIDS related illnesses he may have - pneumonia seems like the likeliest contender, so for ease I'll probably go with that. How does a person go from being diagnosed with pneumonia to finding out that he has AIDS? What kind of treatment would he receive? Would the pneumonia definitely kill him, or can it be treated? What other symptoms might be present?

I think basically I'm just unsure of how the illness manifests itself after it gets to the AIDS stage, and how long a person who has never received any treatment could be expected to live from that point on. Google is turning up some articles, of course, but they're too vague.

Oh yeah, and the setting is the USA, in the present day or just a little into the future, but obviously not long enough ahead for any major breakthroughs in HIV treatment!

Thanks for any help!

"I'm finding it's an average of about ten years, but is it likely that an otherwise fit and healthy man might still develop AIDS in a shorter timespan, say two or three years?"

Just second-hand information from my mother, who's an infectious disease specialist, but she's told me that she's had patients who were young and otherwise healthy and developed full-blown AIDS 2-3 years after the initial HIV infection. It might depend on the strain of the virus? But it's definitely likely.

At the other extreme, there's people who have prognoses on the order of decades. It's all over the place these days.

Yeah, definitely. I was just thinking in terms of the scenario the OP wants to write.

Thanks! Do you know if the people who developed AIDS very quickly were resistant to any of the drugs that they were given, or if their life expectancy was significantly shorter than that of the average HIV+ person?

yep, its al dependent o strain. Some strains develop quickly, some slowly, and if you have multiple strain infection, they can work synergistically.

Secondly, once the illness hits the AIDS stage, and he begins getting infections, what is his life expectancy likely to be?

Most of my experience with friends dying of AIDS was in the pre-protease inhibitor cocktail days. Once HIV went to full-blown AIDS, it was still quite some time before the T-cell count went from healthy to zero, and then the fatal infection--at least two or three years, with bouts of this or that cropping up during that time, needing treatment.

Nowadays, as soon as that HIV test results came back (see below), your character would be treated for the specific opportunistic illness (pneumonia), and put on a cocktail of protease inhibitors which could extend his life indefinitely (I have friends still healthy after 25 years). Although possibly the longer he's waited, the less successful this will be (http://www.forbes.com/feeds/hscout/2009/04/01/hscout625704.html>. I'm not sure what gains have been made in treating the individual opportunistic infections, but I'd say at least 2-4 years, with some of the time he's doing okay and some of the time he's hospitalized or undergoing outpatient treatment.

How does a person go from being diagnosed with pneumonia to finding out that he has AIDS?

Pneumonia is a very likely bet for your character's infection. It's a very specific pneumonia that people with AIDS get (http://aids.about.com/cs/conditions/a/pcpguide.htm). As soon as it was recognized in the hospital, they'd be running an HIV test as well.

More info for your fic about symptoms he's ignored, what he might get, etc.: http://aids.about.com/od/hiv101/u/Basics.htm#s5

I'd just like to second this. After 1995, none of my friends living with HIV have died from it -- though the medication is nasty and expensive and loaded with side-effects (and side-effects from the drugs to control the side-effects).

Life expectancy with AIDS has changed drastically depending on the era. When I came out in 1993, it was about ten years. I hear that when the disease first appeared, it ran its course at a terrifying rate, and you couldn't count on more than a couple of years.

I'm not an expert on the technical details of the progression of the illness, but I will say that it's very plausible that your character would ignore the initial signs of HIV and not get tested. It's obviously incredibly difficult to get the news that you have HIV, so even if he suspected he might have it, I could imagine that he would blame the symptoms on something else and deny the possibility that it could be HIV.

Also, your icon is amazing.

Since the initial signs of HIV are basically just like a cold, almost nobody gets tested at that point.

On average, asymptomatic illness lasts 10 years. Once a person has clinical AIDS (defined as having an AIDS-defining illness, such as PCP pneumonia, cytomegalovirus infection, toxoplasmosis, and several others), prognosis varies based on how low their T-cell count was, whether they can get medications, and whether the virus mutates to develop resistance to the meds.

With HAART (modern treatment cocktails), HIV+ patients are living long enough to die of heart disease rather than AIDS. There are some patients in my clinic who've been HIV+ since the 80s and are doing fine. One man's in his mid-60s.

http://www.avert.org/hivstages.htm
http://en.wikipedia.org/wiki/AIDS_defining_clinical_condition
http://www.google.com/search?&q=hiv+natural+history

Anecdotally speaking, I have a close friend who was unaware she had aids until her T-cells were virtually non-existent. With treatment from that point on, her T-cell count is awesome, and she no longer tests positive for HIV at all. (And just for the record, this is not an urban myth nor a friend of a friend of a friend. This is someone who stood up for me at my wedding, and whom I stood up for at hers.)

Progression from HIV to AIDS is sped up based on a number of criteria: co-infection with other STIs, Hepatitis (A,B, C, etc) or another immuno-inhibiting disease.

Green Grrl is correct, as soon as someone tests positive for HIV medical care and treatment are encouraged. Most healthy folks (without prior disease, drug use/addition, genetic vulnerabilities) would take approx 7-10 years to progress to symptoms of immuno-suppression, which may get someone in to get tested. Otherwise the next step usually is during an acute illness that is unresponsive to multipple attempts to clear it, due to immuno-deficiency issues caused by HIV/AIDS. Those are folks who are diagnosed with AIDS at the get go.

As for prognosis, if the person in adherent and responsive to their combination therapies, viral load (making more virus) for HIV can be virtually non-existent and therefore the person has a higher chance of being a long term survivor or HIV/AIDS, few if any symptoms and good recovery for the T-cells.

Hope this helps.

How quickly an infection can progress varies on both the specific strain(s) of the virus a person contracted and the genetics/immune system of that infected person. There are cases where people will contract a super-strong HIV virus that can progress to AIDS within a year after initial infection (such as people with the HIV-3 strain), and cases where people don't progress to AIDS for decades years.

If your character just found out he has AIDS, I would guess-timate that his CD4 count is around 200, which means that he'd have a life expectancy of 15-20 years with the right antiretroviral cocktail a.k.a. HAART. FYI, an AIDS patient's CD4 count relates to how far his disease has progressed; a patient reaches full-blown AIDS when his/her CD4 count is 200 or lower. If you want me to go into more detail on the type of cocktails available, let me know. You can probably even do a more specific search into your character's AIDS if you type in "AIDS + CD4 + count" into google.

Without treatment, he'd have maybe 7 years, but that also varies with what virus strain(s) he has and his specific genetics. HIV is a really weird virus, so you really have a lot of room to choose how severe you want to make your character's condition. There's also a case where, once he finds out he's infected, that he will choose to sleep around with other AIDS patients under the belief that that won't do anything if he's already screwed anyways... and then catch an even faster-moving HIV strain and maybe wind up with less than a year to live.

Pneumonia does not have to kill off your character. I'm not a doctor, but more than likely if a patient is presenting with pneumonia (or any other disease common in immune-compromised patients) and there are no obvious reasons for this person to have this infection, then the doctor will test for HIV and do a T-cell count on his blood work. He'd also probably present with other illnesses on top of the pneumonia -- but it probably shouldn't be anything too serious if he didn't seek treatment before he went to the hospital. He could have had chronic sinusitis (stuffy/running nose) before the pneumonia, which feels like a cold that won't go away. He'd probably be really prone to food poisoning. He also might have some mild chronic fungus infections like thrush on his tongue or athlete's foot.

Generally, opportunistic diseases in AIDS patients are treatable, but not curable. For instance, if the pneumonia's caused by a bacteria or PCP infection, it is treatable with antibiotics; but because his immune system is decimated from AIDS, the pneumonia-causing organism will still be in his body in low levels, and he'd have to keep taking antibiotics for the rest of his life on top of his antiretroviral treatments. The same goes for any other illnesses he has.

Nrgh. I should also say that different virus strains can be resistant to different kinds of HIV treatments, which has an effect on how fast a disease can progress. Good luck!

I'm not a doctor, but more than likely if a patient is presenting with pneumonia (or any other disease common in immune-compromised patients) and there are no obvious reasons for this person to have this infection, then the doctor will test for HIV and do a T-cell count on his blood work.

Yes. That's basic protocol.

Generally, opportunistic diseases in AIDS patients are treatable, but not curable. For instance, if the pneumonia's caused by a bacteria or PCP infection, it is treatable with antibiotics; but because his immune system is decimated from AIDS, the pneumonia-causing organism will still be in his body in low levels, and he'd have to keep taking antibiotics for the rest of his life on top of his antiretroviral treatments. The same goes for any other illnesses he has.

However, isn't exactly true. Current CDC guidelines state that once a person's CD4 count is above 300, prophylactic treatment for OIs should be stopped.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e324a1.htm?s_cid=rr58e324a1_e see table 1.
http://aidsinfo.nih.gov/default.aspx

Type 2

(Anonymous)

2009-09-19 07:56 pm (UTC)

I was wondering if Type 2 HIV is different and how long someone can live with type 2. My friend got HIV 5 years ago and he said he only has 3 to 6 months to live. Can this be true...how does he know. He does not look that sick. What can he do?

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Brown Mark

2014-07-27 07:14 am (UTC)

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