Thread by @1goodtern

I'm going to start this thread with a boring tweet so no one reads it.

But what if using the term AIDS is a problem because people don't understand that *immune deficiency* is the *boss level* of untreated HIV infection, not the introductory open world gameplay.

Yeah, just pause and think about that.

AIDS refers to the *endgame* of HIV chess, not the initial fumblings with pawns.

The stage that takes place five to ten years after initial infection.

Think of the headline the day after you die on an icy road:

"Tragedy As Much Loved Local Celebrity Dies When Car Hits Ice And Spins Off Road"

But that isn't the full story of those ten seconds.

When you enter the icy section of the road, you don't actually notice anything is wrong.

You see the bend ahead of you so you gently ease your brakes as you always do on your way home.

But it was too much braking for the conditions.

Your wheels stop rotating in time with the passing of the road beneath.

They have lost grip, traction, even though you can't fully feel it yet.

At this point *you still have some control of the car*.

What you do next seals your fate.

You try to make the curve.

You steer, and the steer instantly turns into a skid.

Again, you could still have maybe pulled out of it by steering *into the skid*, but before you think of that, you've already done the instinctive thing of turning the wheel *more*.

You have somehow managed to resist tapping your brakes up to this point, but you try it, and it makes everything worse, you goose the accelerator in vain hope, the car committs to a complete spin, and

Now, the reason I don't want anyone to read this thread is that I'm totally embarrassed by it.

All I know about untreated HIV, I know from volunteering for years with a charity that serves people with HIV and their families and their children.

Back in *the day*.

I've mentioned my own mystery illness in the past, and being tested several times for HIV.

This is why.

When they said, "we don't know what's wrong with you", I said, "erm, maybe it's to do with what I do on a Saturday morning".

But my mystery illness wasn't HIV.

But I learnt a fair bit about it.

And I've learnt more since.

And what I do know is the same thing as at the top of this thread.

There is more than one stage between *moving onto the ice* and *the final spin*.

In HIV there is more than one stage between *getting infected* and the final *immune deficiency*.

In fact, the >first stages of infection look as different from the >final deficiency, as the ~first loss of traction does from the ~final spin.

When you first hit the ice, your wheels still turn, your car still obeys you, mostly.
By the time you're spinning, it's not even about steering anymore.
It's about momentum, physics, and what you did ten seconds ago.

Now, I'm going to simplify this, so it will be missing some of the technical detail. So please don't flame me for simplicity.

I'll explain some points as I go, but I'll also do a glossary at the end.

At the start of an HIV infection, viral levels in the blood shoot up fast, hitting millions of copies per millilitre.
Your immune system goes into full panic.
It fights back hard, and for a moment, it looks like you've won.

Your defence forces viral levels to crash back down to a few thousand.
A month after the infection, you feel absolutely fine.

But... your immune system has burned itself out getting there.

It never properly switches off again.

In the months that follow, CD4 cells (among other things, a coordinator of the immune system) drop from normal levels around 900 to something like 600 or 700.

That's enough to spot the drop in a test, but it's still enough to function.
It's still enough to look healthy.

But the system has *started to lose control*.

HIV is the captain now.

Today, treatments can stop this progression.
🎉🎉

But back in the day when I was volunteering, your fate was much less rosy. 💔😔

Over the next few years, the virus keeps wearing the system down.
Viral load *creeps* back up.

At first, it's just the CD4s losing grip.
Then the rest of the immune system starts to slide with them.

B-cells are the ones that make antibodies.
Normally they wait for clear instructions from CD4s before firing.
But when the commanders start disappearing, B-cells panic.

They churn out random, low-quality antibodies that hit half the wrong things.
The immune system begins wasting ammunition.

No one calls this stage immune deficiency.

Because *it isn't immune deficiency yet* in the sense that it is at the end.

This is immune dysregulation.
It's immune dysfunction.
It's immune derangement.

It does not yet look like immune deficiency.

CD8 cells are the killers, the soldiers on the front line.
They can still fight, but the orders stop coming clearly.

They get trapped in constant activity, never resting, never resetting.
Over time they burn out.
Some even start attacking friendly tissue.

Cytokines are the chemical messages that keep everything coordinated.
Early in infection, they're a lifesaver.
Later, they become noise.

The whole system is shouting at itself across the radio, messages overlapping, timing off, feedback screaming in every channel.

Monocytes and macrophages are the clean-up crew.

They're meant to remove infected cells quietly, but instead they start releasing inflammatory chemicals that keep the system on high alert.

Sadly, they also carry HIV into deep tissues, including the brain, setting up little hideouts the virus can't easily be flushed from.

Dendritic cells are the scouts.
They should tell the generals what infection they've seen, but they either bring nothing or hold up the wrong photo.
That breaks the link between detection and decision.

Natural killer cells are the instinctive assassins.
They usually act fast and accurately, but under HIV they lose their edge.

They hesitate or strike too late.
Sometimes they even attack healthy cells.
Their radar is jammed by all the background noise.

This is all a steady progression over time, but it still ismt immune deficiency.

It's steadily developing *chaos*.

The gut wall, which is packed with immune cells, takes a major hit early on.
The barrier weakens.

Tiny bacterial fragments leak into the bloodstream.
That triggers even more inflammation.
It's like the brakes catching fire on top of everything else.

By now, every part of the immune system is doing something, but almost none of it is helpful.
Signals cross. Cells misfire.

If there's a deficiency, it's a deficiency of *control*.

The system that once worked like a coordinated orchestra is now a roomful of instruments playing out of time, out of tune, and too loud.

That's what HIV really does.
The "deficiency" comes last.
The dysregulation comes first, and stays, and drives the deficiency itself.

So maybe by using the term AIDS, people have forgotten what HIV really does.

Untreated HIV drives dysregulation that ends in deficiency.

There.
I wrote a whole thread without mentioning Covid.

I said earlier that I'm embarrassed to be writing this.

Why?

Because I don't understand why people are losing track of what's going on.
I feel like I'm pointing out something obvious here.

It's embarrassing to say "should the moon be exploding like that"?

Especially when so many people are just oohing and aahing.