Disease of the Month: HIV/AIDS

A deadly virus emerges in Africa. The virus causes an epidemic across the continent, preying on poor sanitary conditions and poor public-health practices. It kills thousands of people and threatens millions of others. A worldwide pandemic seems imminent.

If this makes you think of Ebola, don't be too hasty in coming to this conclusion, because this description applies more to the history of HIV/AIDS than it does to the Ebola epidemic.

Ebola is a malevolent virus and the fatality rate among those infected is almost 90%. However, in countries with a good healthcare infrastructure, Ebola will be much easier to contain. It is unlikely to cause a worldwide pandemic, or even a sustained outbreak here in the UK.

If you consider how the two viruses, Ebola and HIV, are spread, you will be able to view the threat in perspective. In west Africa now, according to Centers for Disease Control (CDC) statistics, for every person infected with Ebola, two close contacts acquire it.

In the UK, where we are able to identify symptoms rapidly and isolate sick patients, any Ebola outbreak should be quickly contained. Ebola is transmitted when a person is usually very sick, and you have to come into direct contact with bodily fluids, so it is difficult not to know that you have been exposed to it.

The reason HIV can spread more widely is that it is often hard to know someone has it. It can spread silently from one patient to the next via unprotected sex or sharing needles.

What is HIV?

HIV stands for Human Immunodeficiency Virus. It is a virus that attacks the body's immune system: the body's defence against diseases. When someone is described as living with HIV, they have the HIV virus in their body. Without medication, people with HIV can develop AIDS.

HIV can be passed on through infected semen, vaginal fluids, rectal secretions, blood or breast milk.

The most common ways that HIV is passed on are through sex without a condom, or sharing infected needles, syringes or other injecting drug equipment. In the UK, more than 90% of people are infected through unprotected sex.

Although HIV is not as easily transmitted as Ebola, the impact has been far greater because of the large numbers of people involved, and because you can unwittingly get into contact with someone and become infected with the virus. 

Today there are more people than ever before living with HIV in the UK, but many people think they don't know anyone with HIV. However, one in four people living with HIV don't know they have it, and even if someone does know they are HIV positive, they may not feel able to tell you.

What is AIDS?

The Human Immunodeficiency Virus or HIV causes the disease we know as AIDS. AIDS stands for Acquired Immune Deficiency Syndrome. A person with AIDS will have HIV and at least one of a list of ‘AIDS-defining' diseases, including tuberculosis, pneumonia or some types of cancer. With advances in HIV treatment, many people can recover from AIDS, although they will still have HIV.

AIDS is a pandemic. In 2000 alone, 3 million people died of AIDS. Since the AIDS pandemic began in around 1985, almost 22 million people have died from the disease.

HIV now infects more than 36 million people across the world, so the death toll will definitely rise over the next several years. In the UK in 2012, only 390 people were diagnosed with AIDS: 0.39% of the total number of people living with HIV.

How HIV/AIDS affects the body

HIV doesn't kill people itself. Instead, the virus shuts down a person's immune defences: the tools used to fight off invading germs by infecting and destroying important immune cells called T cells.

Once a person loses too many T cells, his or her body can no longer deal with other microbes that cause infections. HIV merely opens the floodgates. Eventually, HIV-infected people become overrun by germs and die of lung infections, skin infections or other diseases.

AIDS is a condition characterised by progressive failure of the immune system. It is caused by the human immunodeficiency virus type 1 (HIV-1).

When HIV-1 or any virus infects a cell, it replicates and spreads to other cells. HIV-1 attacks cells that are vital to the body's immune system, such as T cells. These white blood cells play an important role in the body's response to infection, but HIV-1 disrupts the cells' ability to fight back against infection.

One type of cellular protein, T cell immunoglobulin and mucin domain (TIM-1), has been shown previously to promote entry of some highly pathogenic viruses into host cells. Now, researchers have found that the same protein possesses a unique ability to block the release of HIV-1 and Ebola virus.

A study of several important enveloped viruses, including HIV and Ebola, undertaken by the Harvard Medical School's Dana-Farber Cancer Institute showed that TIM proteins keep viral particles from being released by the infected cell and instead keep them tethered to the cell surface.

A series of experiments revealed the protein's ability to inhibit HIV-1 release, resulting in diminished viral production and replication. This may be used to slow the production of these viruses.

CD4 count is a measure of immune function. Measuring someone's CD4 levels, will show how HIV has affected their immune system, revealing the progression of the virus.

Most people in the UK start treatment when their CD4 count is at 350. Viral load measures how active HIV is in someone's body. The higher the viral load the more infectious someone would be.

Effective HIV medication can keep people's CD4 count high and their viral load so low it is undetectable. However, the CD4 count and viral load can go up and down depending on factors such as the medication taken by the person infected with HIV, whether they have another sexually transmitted disease and their general health.

Although there is no cure for HIV, treatment can keep the virus under control and the immune system healthy. There are now have several drugs that fight HIV. They cannot cure the infection, but they can keep it in check. People infected with HIV are able to live full lives with the help of anti-retroviral drugs. 

They have to take several of these drugs every day for life, and the drugs are very expensive. They may also experience some side-effects from the treatment. If HIV is diagnosed late, treatment is likely to be
less effective.

A sizeable number of people in the UK are living with HIV, many of these living normal lives. However, only some insurers recognise these individuals have a need
for insurance.

Underwriting implications

Most insurance companies request an HIV test as part of the standard non-medical limit. A number of insurers will now offer life cover to individuals who have responded favourably to treatment. 

The key underwriting factors: are mode of transmission, CD4 count and viral load. This is deemed to be a step in the right direction that the industry welcomed.

Global case numbers

The numbers of those contracting and living with HIV globally goes up every year. Thousands of new cases are reported in the UK each year and it is an infection that can affect anyone, regardless of age, race or sexual orientation.

• One-quarter of people with HIV in the UK don't know they are infected
• The average age at diagnosis of HIV in the UK is 35, and life expectancy is older than 72 years
• The most common treatment today for someone diagnosed with HIV early is daily anti-retroviral medication
• Many people with HIV work, and their HIV does not affect their working life
• With the right medical help, 99% of HIV positive women give birth to healthy babies without passing on HIV
• HIV affects all ages: one in four people living with HIV in the UK are over 50, while last year one in ten people diagnosed were aged between 16 and 24

David Jones is strategic claims manager at VitalityLife