Common questions about HIV
USA TODAY

Charlie Sheen can expect to live a long and healthy life in spite of having HIV, thanks to medications that have transformed the disease from a death sentence into a chronic disease.

Sheen owes his health to antiretroviral drugs, the HIV cocktails developed in the 1990s that can keep the virus at bay. Sheen announced Tuesday that levels of HIV in his blood are undetectable — meaning that there is too little of the virus in his blood for standard tests to measure. Doctors describe such patients as being “virally suppressed,” a condition that dramatically reduces their risk of developing full-blown AIDS or its complications.

“He’s an example of how if you have HIV and you take medication so that you are suppressed, you can have a normal life,” said Carlos del Rio, professor of global health and medicine at Emory University and co-director of the Emory Center for AIDS Research in Atlanta. “We need to have more people who are suppressed on therapy if we are going to suppress the epidemic.”

When levels of HIV are too low to be detected, it’s almost impossible for infected people to spread the infection to others, such as through sex or by sharing needles, said Elizabeth Montgomery Collins, an associate professor in the section of retrovirology and global health at the Baylor College of Medicine in Houston. Scientists call this phenomenon “treatment as prevention.” Collins said she still advises her HIV-positive patients to use condoms, even if they’re on medication.

The partners of people with HIV have another way to stay healthy. They can take anti-AIDS medications themselves, a regimen called pre-exposure prophylaxis, which has been shown in clinical trials to dramatically reduce their risk of becoming infected.

Taking medication faithfully is important because it prevents the virus from staging a comeback, del Rio said.

Sheen has acknowledged his struggles with depression and substance abuse — two conditions that can make it more difficult for people to stick to a treatment plan, said Oriol Gutierrez, editor in chief of POZ magazine, which addresses the needs of people living with HIV or AIDS. Gutierrez has been HIV positive since 1992.

In having his disease under control, Sheen is luckier than most people with HIV in the USA, del Rio said.

Charlie Sheen says he’s been hiding his HIV diagnosis from the public for 4 years, but he’s been up front with every sexual partner and paid for it dearly.

Only about 30% of the more than 1.3 million HIV-positive patients in the U.S. are virally suppressed — not because drugs don’t work, but because people aren’t taking them, del Rio said.

About 1 in 8 people people with HIV don’t know they’re infected, according to the Centers for Disease Control and Prevention. Others know they’re infected but don’t have access to medical care because they’re poor, uninsured or disabled by other serious conditions, such as addiction or mental illness. Even when HIV-positive people have access to medical care, it’s often inadequate, del Rio said.

The stigma and shame of HIV and AIDS make many people afraid to be tested, Gutierrez said. Many people are in denial about their risk, said Thomas Giordano, an associate professor at Baylor College of Medicine and director of the Thomas Street Clinic, a Houston HIV clinic.

“As a fellow person living with the virus, I have nothing but complete understanding of the shame and stigma that he has faced,” Gutierrez said.

Some health advocates hope that Sheen’s fame will remind Americans of the risks of the disease, the importance of being tested and the need to make life-saving treatment available to everyone.

Sheen’s disclosure has, at least temporarily, refocused the nation’s attention on a disease that once terrified Americans, but which has faded from the limelight in recent years, as better treatments transformed the virus from a death sentence into a chronic condition.

Sheen, 50, is the first major celebrity to acknowledge having HIV since 1991, when basketball great Magic Johnson announced that he was living with the disease. Johnson remains healthy today.

In the early days of the HIV epidemic in the 1980s, the news that Hollywood stars were suffering and dying from AIDS — such as actor Rock Hudson, tennis player Arthur Ashe, dancer Rudolph Nureyev and singer Freddie Mercury — put the virus on the front page and raised awareness of the disease.

“HIV in this country is forgotten but not gone,” del Rio said. “It’s been forgotten, because it it affects minorities and poor people. We forget about HIV the way we forget about everything that affects poor people. Now, you have a rich, white person saying they have HIV and it’s a reminder that HIV can affect everyone.”

About 44% of new HIV infections are in the black community — more than in any other racial group, according to the CDC. About 63% of new infections are in men who have sex with men. More than 13,000 Americans a year die from AIDS.

“We have 50,000 new infections every year in this country,” del Rio said, “so we can’t pretend that everything is fine.”

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