HIV: An Insidious Agent

The bus is crowded with the usual group of morning passengers. A teenage boy, riding to high school, recognizes many of the faces. As his eyes scan the advertisements along the side of the bus, they stop at a new ad that reads, "48 teens were infected with HIV . . . today." He looks at the others riding to school with him and wonders which of his friends may already have been infected. There's no way he can tell just by looking at them.

The human immunodeficiency virus (HIV) is an insidious agent that gradually weakens and destroys a person's immune system. As a result, someone who has been infected with the virus for a long time readily succumbs to infections by other pathogens. These "opportunistic" infections lead to diseases that are collectively known as AIDS. Thus, while HIV itself does not kill the patient, the development of AIDS does.

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Roughly a million people in the United States have HIV, and 45,000 more contract the virus each year via sexual contact, shared needles, contact with infected blood, and breast-feeding. Women are the fastest-growing segment of the infected population. Worldwide, 75 percent of HIV infections stem from sexual activity, 10 percent result from intravenous drug use, and 10 percent are vertically transmitted from infected mother to baby. Eighty percent of the sexually transmitted HIV occurs by heterosexual contact. Someone who has had other STDs is at increased risk of getting HIV.

People infected with HIV often show no symptoms for weeks or months. The first evidence of the disease may be a flulike illness that occurs when the patient undergoes "sero-conversion"—that is, when the virus can be detected in the blood by a lab test. It may take six months from the time of infection before the tests give a positive result. This means that someone whose test result is negative may still have HIV and be able to transmit the infection to someone else.

HIV is a slow-acting but complicated virus. Because it frequently mutates inside the patient's body, it is quite difficult to treat. As the infection progresses, the amount of virus in the bloodstream increases, while the number of "CD4" immune cells (which are attacked by the virus) decreases. At present, there is no cure for the infection, but the patient may need to take up to 18 pills a day to fight the infection and prolong his life. These medications (called antiretrovi-rals) are not only expensive but may have strong side effects that make the person feel very ill.