Finding out that you have a serious illness is never easy. Until recently, HIV infection was considered a terminal disease, but with recent advances in treatment, there is new hope. But how much hope? What can you expect if you're diagnosed with HIV infection today?
First, it's important to remember that people react to difficult news in different ways by getting sad, angry, depressed even denying that anything is wrong. There is no single right or wrong approach. However, you should not deal with this news alone - help is available. As a newly infected person, you will have to make important decisions about medical treatment, work, and personal relationships. Talk to your partner, friends, a family member, or get professional counseling.
Under doctor's care
Along with personal support, prompt medical attention is essential. Find a trusted doctor or health care provider who can first determine if you have suffered any serious complications that need immediate, specialized attention. Expert care is readily available throughout North America. Don't delay - you should be able to make a full recovery at this stage with the appropriate medical attention.
Once your condition has been stabilized or if you are generally well, you will undergo a series of tests to determine your state of health and how far the infection has progressed. These tests will include measures of your blood cells (a complete blood count) as well as the function of your liver and kidneys. You will be tested for other infections that might require specific treatment such as viral hepatitis, syphilis, or toxoplasmosis. You will also have a skin test and a chest X-ray to determine if you have been exposed to tuberculosis.
HIV blood tests
The two most important blood tests that you will have are the CD4 cell count (helper count, T helper count) and the HIV plasma viral load (viral load test).
CD4 cell count
The CD4 cell count is a measure of the body's defense system. The HIV virus infects the CD4 cells and slowly destroys them over time. In fact, the problem with HIV is not so much the virus itself, but the fact that it prevents your body from properly defending itself against many common infections. The CD4 cell count helps determine how much risk there is of you becoming unwell in the near future. In general terms, if you have a CD4 cell count below 200, you should be careful and report any new symptoms to your doctor immediately. This is all the more important if your count is below 100. Know your count. It's what your doctor needs to take care of you properly.
Viral load test
The viral load test is a measure of how much HIV is in your blood. It can be very low, or very high (perhaps as many as 40 million copies of the virus in each milliliter of your blood). If your viral load is high, there are effective treatments that could lower it so much that tests show no virus in your blood. This does NOT mean that you can be cured of HIV. It simply reflects the fact that, with proper treatment, it is possible to control the disease, perhaps indefinitely. Generally, the higher the viral load the greater chance the disease has of progressing in the near future.
Together, your CD4 and viral load count will help your doctor to know how soon the disease will be getting worse if you do not receive antiviral drug treatment.
Plan your care
Use the information gathered in this initial evaluation to plan your care. If you've never had hepatitis A or B, get vaccinated against them - they could be particularly severe with HIV. Consider getting a shot to prevent the flu or pneumonia. As well, you may require special medications if you have been exposed to tuberculosis or if you have a low CD4 cell count.
Next, you may want to consider antiviral treatments. Take the time to gather all the information you need to make an informed decision on your treatment. As this is a highly specialized field, your doctor may send you to a specialist with extensive experience in HIV treatments so that the best possible combinations are chosen for you. Although we may never be able to cure HIV, we may be able to control it for many years.
This whole process can be very stressful. Most people find it useful to have a friend or loved one with them every step of the way. There may also be a number of AIDS community groups in your area that offer counseling, support, or just another opinion.
HIV infection is no longer the "automatic death sentence" it once was. If you take control of your care and seek help, you may have many productive years ahead of you. In many ways, the future is in your hands.
Brian Conway, MD
in association with the MediResource Clinical Team