HIV+ : Gay & Black Glossary

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HIV+

carrying the HIV (Human Imumuno-deficiency Virus) in the bloodstream. HIV is believed to be the major cause of AIDS (Acquired Immuno-Deficiency Syndrome). When you get a positive result on your HIV test, it is not something to celebrate, since it means you are infected. HIV is passed most commonly by screwing/being screwed without a condom or via needles. Very rarely it is passed by oral sex, and only then when there are bleeding gums. The following map distorts the size of countries relative to how prevalent HIV is there. It seems the more a country denies it has a problem, the bigger the problem actually is.

HIV prevalence

© Copyright SASI Group (University of Sheffield) and Mark Newman (University of Michigan)

HIVDrug Immunity

I have had HIV since 1985. Every few years my personal strain of HIV develops an immunity to the drugs that I am taking, and I have to flip to a new cocktail of 3 or so drugs. The theory is it should be much harder for my personal strain of HIV to simultaneously evolve resistance to three drugs than to one. But they do it! Doctors refer to the drugs as chemotherapy. The drugs tend to have nasty side effects such as nausea, diarrhoea, low energy, neuropathy, nightmares and death (abacavir allergy). So it is quite a trick to find a combination that I can tolerate. The process is not always successful.

Genetic sequencing has greatly improved the process of finding a good combo. Everyone in BC with HIV has had their personal strain of HIV repeatedly genetically sequenced and all its mutations mapped. The mutation map is a nucleotide number followed by a letter for the freak nucleotide. From this map, they know which mutations give resistance to what degree to all the various drugs. So they can tell which drugs will fail even if I have never tried them. There are roughly half a dozen families of drugs. If your personal strain evolves immunity to one drug in a family, it will likely already be resistant (or soon will be resistant) to the others in the family. There must be thousands and thousands of mutations for my strain to fluke out and find a way around almost the entire HIV pharmacopoeia.

I am in an awkward position in that there is no suitable drug cocktail left. I am awaiting the release of a new drug (dolutegravir) to fill in the third drug of the cocktail. In the meantime I am not taking any drugs, least I aid the HIV to develop immunity to the still-useful drugs in an incomplete cocktail.

Danes have been working on an HIV cure, where they trick the HIV to come out of hiding deep inside cells. Then it can be completely eradicated by the patient’s immune system. I have to hang in there until that works out.

I want to whack creationists over the head with an umbrella when they assure me animals of any sort never evolve. Tell that to my amazingly capable personal strain of HIV evolutionists! I have to admire their evolving/computing power, even if they are trying to kill me.

Don’t Miss A Dose

Doctors tell HIV patients that is it extremely important never to miss a dose of your HIV medication, but they don’t explain why. Here is my Darwinian explanation:

  1. Let us say there is zero drug X in your body. Some of your HIV might spontaneously develop an immunity to it, but they have no advantage. There is probably a slight disadvantage to the mutation. So the strain quickly dies out.
  2. Let’s say you have a therapeutic dose of X in your body. If some of your HIV develop 25% immunity to it, they are killed off anyway, and the strain quickly dies out.
  3. Let’s say you have skipped a dose of X, and you have only a 10% dose in your body, if some of your HIV evolve 25% immunity to it, many of them will thrive, and perhaps later develop 50% and 100% immunity. In this case you have produced an efficient gradient favouring HIV with immunity. This means drug X will soon lose its effectiveness.
  4. Let’s say you have a cocktail of three drugs. If HIV evolves immunity to one of the drugs, the other two can still kill off the strain. However, if you skip a dose, it can reproduce and the mutation can get a toehold.

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