How to make HIV disappear

One in 139 women in the United States will be diagnosed in her lifetime with HIV, the virus that causes AIDS, says the director of the Mayo Clinic HIV clinic.

"Every single adult in the United States should be tested for HIV," said Dr. Stacey Rizza, chair of the Mayo Clinic HIV Clinic . Mayo is updating its record system so that health providers will be prompted to prescribe an HIV test for any patient who hasn't already had one.

Rizza said health professionals can include the HIV test as part of normal blood screening, unless a patient specifically asks not to be tested.

Think you're too old to get HIV?

The Mayo HIV Clinic has newly diagnosed patients as old as their 80s.

"This phenomenon is being called 'the graying of AIDS,'" Rizza said.

Think you won't get HIV because you're heterosexual?

Anyone who is sexually active can get HIV, which is caught from bodily fluids like blood or semen, and about 25 percent of people living with HIV in the U.S. are women.

To put HIV in context, it's not as common as many sexually transmitted ailments.

For example, most people, according to the CDC, will get at least one type of human papilloma virus — the sexually transmitted virus that causes cervical cancer in women and genital warts in both genders — at some point in life.

Rizza recently spoke about HIV/AIDS research at Rochester Civic Theatre's first "Science at the Cinema" presentation.

Rizza told an audience of about 40 people, who attended to view the movie "Dallas Buyers Club," that HIV differs from other diseases because "there is politics, there is religion, there is socioeconomic policy" mixed in with the need for patient care, education and research.

'Virtually impossible to eliminate'

To get into the body's cells, HIV needs two cellular receptors.

Essentially, if HIV's key is looking to unlock a cell, it needs to find those specific keyholes in order to succeed.

Once HIV gets into a cell, it replicates and eventually kills that cell. Some cells, though, go into a resting state and hide within the body "and that is why it is virtually impossible to eliminate HIV."

Early in a person's infection, Rizza said, HIV "replicates like crazy." Eventually, though, the human immune system kicks in and moderates the infection enough that the person might feel like he or she has a cold or the flu and then goes back to feeling OK.

It might be years or decades later when HIV has had enough time to chip away at the immune system, leaving the person open to opportunistic infections. That's often when people who haven't sought testing get diagnosed.

The CDC got its first HIV-related reports in 1981, although the condition likely began to infect humans in Africa exposed to primate blood during the late 1800s.

Drug treatments effective

For HIV, Rizza said, the "magic number" is currently three. It takes three medications, preferably from different drug types, to keep HIV at bay. But, in recent years, that has become increasingly possible to do so.

Three drugs, from two different classes, first became possible in 1996. Within eight months, Rizza said, the Bay Area Reporter newspaper reached the first week in years when it had no AIDS-related obituaries to report.

All these years later people have taken the drug regimens long-term, it's become possible using mathematical models to predict that "people could have a near-normal life expectancy" even with HIV.

Research has also helped prove public-health efforts that could make a dramatic difference.

For example, Rizza said, "the data is undeniable that male circumcision decreases HIV transmission by over 50 percent."

The CDC, in 2006, recommended universal circumcision, Rizza said.

A 2011 study of couples with one partner infected and the other not (half male, half female) found that treating the partner with HIV aggressively produces a "96 percent reduction in HIV transmission."

"If we knew every person with HIV and treated every person with HIV aggressively, it would be gone in one generation," Rizza said.

That might be easier today than one might expect. In 1996, patients had to take a handful of pills daily. Today, a patient often has to take only one pill daily.

Potentially curable disease

Researchers have learned that untreated HIV — the time before diagnosis and any time when treatment is stopped for any reason — leads to damage of the body's bones, tissues and organs. People with HIV have higher rates of heart attacks, strokes and osteoporosis.

That's why HIV health providers continue to proactively watch for heart disease, kidney damage and other health problems "as we wait for research to catch up and teach us why this is happening."

A patient in Berlin was functionally cured of HIV, though it's possible some cells with HIV still exist in his body. He was treated for leukemia and the treatment included a transplant with cells that lacked HIV receptors.

It's been tried a couple more times elsewhere without success.

But the exciting thing, Rizza said, is that it worked once, meaning HIV is a potentially curable disease.

Now, she said, research efforts are focusing on how to make that happen. The idea is to prime cells that keep HIV hidden so they won't be resistant to cell death, shock the body's HIV cells into awakening so they will die and to develop a drug that will kill them.

Rizza said it's important to diagnose early to avoid HIV's damage to the body by treating early.

It's also important for everyone to get tested, to know HIV is treatable if you do have it, to use condoms to prevent getting HIV or transmitting it to someone, and for males to get circumcised while research is ongoing toward a cure.

"We're actually much closer now than you can imagine, than ever before," Rizza said.