The Human Immuno-deficiency Virus kills a white blood cell called T4 (CD4) lymphocyte. These T4 cells are immune managers and without them the system doesn’t know what to do.

Mr. Bartlett discussed HIV as a long term, chronic illness with three recognizable stages: Stage I - HIV Positive, Stage II - Early Symptomatic HIV Disease, formerly -”Aids Related Complex (ARC)”, and Stage III - AIDS.

During Stage I (HIV Positive) although the individual is infected, there are no symptom.

In Stage II (Early Symptomatic HIV Disease), the individual exhibits the characteristics of the early mild symptoms of fever, sweats, chills, fatigue, myalgia, headaches, appetite loss, diarrhea, weight loss and lymphadenopathy. As the disease advances the symptoms become worse and last longer. It was noted here that Disability is not the norm at this early stage, but is not unheard of, as certain symptoms become more severe and constant. In Stage III (AIDS), we find characteristics of serious “opportunistic illness” (OIs) that are the actual cause of disability and death. The OIs include unusual pneumonia, odd cancers, fungus infections, and central nervous system infections. They are not the diseases of the general public, but of immune-suppressed people and come from the germs we are routinely exposed to everyday in the environment. AIDS may also be technically diagnosed by having T4/CD4 cells equal to or less than 200.

The incubation period or time from infection (Stage I) to AIDS (Stage III) is 10-12 years without effective treatment, however with successful treatment the likelihood and time required for disease progression is unknown.

Anti-HIV drugs don’t kill the virus, but slows the reproduction rates and/or stops the immune damage. The “drug cocktail” may suppress the viral load to below the measurable level, but undetectable does not mean zero, or HIV-negative or cured. HIV develops resistance to the drugs, which may become toxic and cause side effects of nausea, diarrhea, neuropathy, liver damage, diabetes, and lipodystrophy, some of which may result in disabling conditions.

A discussion of the physical and psychosocial issues of disability and the drug side effects relating to the HIV infected persons found many infected individuals wonder if the health condition is permanent or temporary. Can the condition be resolved with medication, dosage adjustment, other therapy, or will it self-resolve? Can the condition be adequately accommodated to enable the person to engage in the activity desired?

The HIV infected individual is on a “health roller coaster” caused by the infection, opportunistic disease/inflammation, and side effects of medication. The condition is similar to other chronic health conditions and some cancers. The individual has good days, bad days, good six months, bad three months. The physiological problems include persistent and severe fatigue, neuropathy including pain, tingling, burning sensation or numbness usually in the peripheral areas (feet, legs, hands and forearms), aching muscles and joints, diarrhea, nausea, and wasting (dramatic weight loss and loss of muscle mass). The person may have an impaired respiratory capacity, impaired vision, and central nervous system involvement with dementia and physiological manifestations of impaired fine motor skills and coordination.

The individual may develop metabolic disorders such as diabetes or hypoglycemia or lipid dystrophies. The lipid dystrophies present as inappropriate placement of fats. A simultaneous loss of fat in the face, neck, arms; with fatty accumulation at the waist, between shoulder blades (“buffalo hump”), or breasts (women). Regular Lung Cancer as well as Degenerative Bone Disorders such as Osteopenia, Osteoporosis and/or Osteonecrosis may develop.

The psychological issues for the HIV infected individual are depression, which as with other serious illnesses may become severe and the “Lazarus effect” that have HIV infected people, especially those with AIDS, coming back from anticipated death. But coping with having to live, especially if certain shorter-term choices were made, carries its own unfamiliar stresses that may be psychologically debilitating.