Although there are many different factors and assays, which include various types of blood work, there are three main ways used to measure how HIV is progressing in your body by measuring:

• The number of CD4 T-cells/mm3 in your blood
• The HIV viral load, and…
• The number of opportunistic infections you have contracted.

Viral load tests and CD4+ cell counts are given on a periodic basis during doctor visits. These assays determine how much HIV replication is going on in your body and how well your immune system is responding. There are many other tests that are performed as well, but your viral load and CD4+ count are essential to keep you aware of how you are doing overall and whether your HIV antiretrovirals are working properly.

CD4+ Cell Count

Your CD4+ cell count measures the number of CD4+ cells, or T-helper cells, which are the body’s first line of defense in fighting of infection and disease. A normal CD4+ cell count for an HIV negative person is between 800 and 1500. A healthy HIV+ person normally has over 500 CD4+ cells.

When the CD4+ cell count drops below 300 a person is then more susceptible to many opportunistic infections such as bacterial and PCP Pneumonia, tuberculosis, hystoplasmosis and Candidiasis. A high CD4+ cell count is a good thing and indicates that your body’s immune system is able to fight disease. A low CD4+ cell count indicates that it may be time to begin taking medication for HIV.

A CD4+ cell count at 200 or below is an indication of AIDS. But, do not despair if your count gets that low. Many people have temporary lows, only to regain higher CD4+ cell counts and improved health.

Your doctor will tell you what ARV medications are best for you based on your CD4+ cell count.

Viral Load

In simple terms, the Viral Load measures how much virus is in your blood. A low viral load is preferable. HIV viral load tests measure the number of HIV copies in a milliliter (copies/mL) of blood. If the viral load measurement is higher, it indicates that HIV is reproducing, and that the disease is likely progressing faster.

Initially or before treatment, an HIV viral load can be as high as millions of copies. During treatment and monitoring, a high viral load can be anywhere from 5,000 to 10,000 copies/mL. A low viral load is usually between 40 to 500 copies/mL, depending on the type of test used. This result indicates that HIV is not actively reproducing, and that the risk of disease progression is low.

An undetectable viral load is often observed with the medication. This means the viral load is under 50 (copies/mL) as most commercially used viral load assays are only able to detect as low as 50 copies. An undetectable viral load is a good thing.

Having an undetectable viral load does not mean that you do not have or have been cured of HIV. Even though HIV may be undetectable in the blood, it persists in cells and tissues throughout the body as “HIV provirus.” HIV provirus refers to virus that has moved into cells and their nuclei, where it has become integrated with the DNA of the host cell. Much HIV cure research focuses on ways to eliminate HIV in these “reservoirs”.

Put simply, your body cannot rid itself of the HIV virus, even with medication. HIV knows how to hide, but it is always present. No one has been cured of HIV using any medication or other means that is available to the general public.

When people are first diagnosed with HIV, it is rare to begin medication (ARVs) right away. However, when it is necessary to start taking medications, it is important to know that HIV medications (ARVs) are different than other medications, because the virus is different than other viruses. This means that taking your HIV ARV medications is more important than with any other disease. HIV is an extremely adaptable virus. It almost “learns” how to work around HIV drugs and mutates to overcome their effects. In order to avoid this, medication must be taken on regular basis as prescribed – “On time! Every time!”

HIV antiretroviral treatment demands a strict level of daily adherence. This means you cannot take a medication late or miss taking a single dose of your medication without risking that the virus will become resistant to the medication and/or mutate.

Missed doses are also detrimental to the continued positive effects of HIV drugs. For many ARV’s, 90% adherence is required to avoid developing drug resistance.

All of this sounds daunting, until you realize that there are many people who would be happy to help you take your medications on time. There are also numerous technologies and methods that can help to avoid missed doses. Research is continually being performed to find new and effective ways to ensure that HIV medication is taken on time, every time. Some ways to help ensure drug adherence include:

• Ask someone from your church to come visit you or call you everyday to help you remember your medications.
• Set the alarm on your cell phone, computer or other personal electronic device to go off at the times when medication is to be taken
• Many pharmacies, or clinics provide programs where they will send you a text to remind you when to take your medications
• Pick routine, daily activities to coincide with taking your medication: e.g.
  • when you first wake up or go to sleep at night,
  • with meals if you eat at the same time each day (if medication is to be taken with food),
  • before you leave for work or when you return home etc.
• Have others remind you to take your pills.
• Use tools such as pillboxes, journals and beepers that your pharmacy can provide

If you have difficulty with adherence, identify the barriers that prevent you from taking your pills regularly and try to figure out ways to overcome them.

Barrier: You don’t feel compelled to take pills because you are not feeling sick.
Solution: Read up on HIV and how medication can help you from becoming ill.

Barrier: Substance abuse or mental health issues are effecting your ability to be adherent.
Solution: Talk your pastor, your church support group or doctor and ask for a referral to a therapist or counselor.

As you become accustomed to it, your new regimen will become second nature, and you will to take your medication without prompts, again…“On time! Every time!”

What you eat can have a huge effect on your health. It is even more important to eat healthily if you are living with HIV. Often a lifestyle change is necessary to ensure you remain healthy.

Nutrition Tips:

Eat 5–6 servings of fruits and vegetables per day or approximately 3 cups. Eat a variety of colors for a full range of nutrients.

Remember to eat plenty whole grains. Fifty percent of your carbohydrates come from whole grains. Lean protein sources are optimal such as skinless chicken breast, fish, extra-lean cuts of pork and beef, and low-fat dairy products.

Limit added sugar, sweets, and soft drinks; they are low in nutrient density and cause spikes in glucose levels.

Eat at least one serving or more of nuts, seeds, or legumes per day.

Include all 3 macronutrients: protein, carbohydrates, and a little fat in both meals and snacks.

And remember, some people supplement all of the above with a high quality protein drink or gel.

Diet and exercise can help with symptoms of HIV and antiretroviral side effects, such as loss of energy, diarrhea and nausea. They can also help with the challenge of fat redistribution and metabolic abnormalities such as high blood sugar, high bad cholesterol and high counts in triglycerides.

Exercise decreases fat and total cholesterol while increasing HDL (good cholesterol). It also increases the lungs’ abilities to absorb oxygen and decreases the incidence of some cancers as well. Very importantly, exercise relieves general anxiety, tension and depression.

Before you start exercising, consult with your doctor and learn to distinguish the general loss of energy from severe fatigue or growing illness. If you suddenly feel excessively tired in the middle of a workout, you should stop for the day. Talk to your doctor; tell him/her concerns regarding your exercise routine; discuss amendments to your exercise routine; and make recommended adjustments to it.

An HIV co-infection is a second disease that accompanies, but is not the result of, an HIV infection. The two most common HIV co-infections are Hepatitis C and Tuberculosis.

Tuberculosis (TB)

Tuberculosis is a disease which is transmitted through contact with sputum (spit) or secretions (of bodily fluids). TB can occur in any part of the body but is most common in the lungs. TB can be passed from a person with active TB of the lungs or throat to a non-infected person through coughing, sneezing, speaking or singing. Anyone can be exposed to TB, and it can lay dormant for years or for a lifetime. However, TB often becomes active when the immune system becomes weakened and is unable to control it. People living with HIV are 20-30 times more likely to develop active TB.

Worldwide, TB is the leading cause of death in people with HIV. In the United States, 4.2% of all Americans, living with or without HIV, are infected with TB bacteria. The CDC recommends that all people living with HIV be tested for TB, both as soon as possible and at least once a year.

A TB test and chest x-ray is necessary to diagnose TB. Symptoms of active TB infection include:

• Cough with a progressive increase in production of mucus
• Coughing up blood
• Fever
• Loss of appetite
• Weight loss
• Night sweats

Assuring that a non-TB infected HIV+ person does not contract the disease is difficult. All people with active TB should be immediately placed on medication and should take care to cover their mouth and nose when coughing or sneezing. So, what can a person living with HIV do to prevent contracting TB?

When the immune system is weakened in an HIV+ individual, it is beneficial for family and close friends of an HIV positive person to be routinely checked for TB during annual physicals. It can also be helpful to avoid close contact with strangers, particularly in countries with high rates of TB.

Hepatitis C (HCV)

Hepatitis C is a common co-infection in people living with HIV. HCV is contracted mainly through contaminated intravenous needles. HCV can also be spread through tattoo needles and razors. HCV transmission is possible through sexual intercourse and mother to child contact (before or during birth). However, this type of transmission is uncommon.

HCV can remain inactive for decades with no side effects. There are medications that can be taken to control HCV and even possibly eliminate the disease. Approximately 25-30% of people living with HIV in the U.S. are HIV and HCV co-infected.

If you are HIV positive and also have HCV there are ways to help stay healthier. You should:

• Avoid alcohol
• Ask your HIV specialist doctor to recommend an HCV specialist.
• Make certain that the medications you take for HIV and HCV, as well as herbs and supplements, do not conflict with each other
• Get vaccinated against hepatitis A and hepatitis B
• Avoid exposure to environmental toxins such as solvents, paint thinners, and pesticides. If it is necessary to use such chemicals, work in a well-ventilated area and wear gloves and a protective face mask.
• Eat a healthy, well-balanced diet
• Get regular, moderate exercise
• Sleep enough at night and rest during the day as needed to help manage fatigue
• Have your doctor monitor your liver enzymes and blood cell counts

The third measurement of health is whether you have any opportunistic infections, (OIs). Opportunistic infections are illnesses that occur when your immune system is weak. OIs generally occur once your CD4+ cell count falls below 200 cells/mm3.

Opportunistic infections, or to give it its shortened name, OIs, are infections that may occur when your immune system is weakened. OIs can generally occur once your CD4 count falls below 200 cells/mm3.

OIs are the foremost cause of HIV&AIDS-related deaths.

With the introduction of HAART in the mid-1990’s, the number of deaths from OIs has fallen due to HAART’s ability to reduce the amount of HIV in a person’s body, thus somewhat restoring their immune system. With a healthier immune system a person’s CD4+ cell count remains higher, reducing their susceptibility to OIs in general.

Listed here are some of the OIs which affect people living with HIV:

• Histoplasmosis
• Cytomegalovirus
• Cryptosporidiosis and isosporiasis
• Cryptococcosis
• Candidiasis
• Bacterial pneumonia
• Herpes simplex and Herpes zoster
• Histoplasmosis
• Kaposi's sarcoma
• Leishmaniasis
• MAC
• PCP
• Toxoplasmosis
• Tuberculosis

For more information on Opportunistic Infection:
www.aids.gov