(Note: This was initially submitted in academia through the California College of Ayurveda and exists in their archives)

Crossing the Bridge Where East Meets West:

An Ayurvedic and Allopathic Perspective on the Management of HIV and HIV-Related Inflammation

Dr. Antonio (Vishnu) A. Aragona AD

Submitted to the California College of Ayurveda in partial fulfillment of the academic requirements

2018

ABSTRACT

When it comes to the successful treatment of HIV and inflammation there is no one size fits all approach. Nor is it the case that any one medical system alone can be the end all and be all resolution to such a complex condition. Both the Allopathic Medical model and Ayurvedic Medical model can work along each other in supporting an West meets East approach to management. HIV has been around for quite some time and both allopathic medicine and Ayurveda have an understanding of how individuals affected by such a disease can find harmony within themselves and within the balance of ancient medicine and conventional medicine.

Inflammation seems to be a common condition associated with HIV, and from there this situation can affect the overall health on various levels. Allopathy (Conventional/Western Medicine) can support by continuing its scientific studies to “find a cure,” while providing medications that help virologically suppress the virus, manage inflammation, and Ayurveda can provide support by sharing its wisdom of a deeper understanding of inflammation and the effects of such an intense virus, through a body-mind-spirit approach. It is with the intention of this paper to join both Ayurveda and Allopathy in an effort to fully achieve an even more optimal outcome with individuals affected by HIV. What may that outcome be? Possibly the complete resolution or a more balanced way of living with this condition.

INTRODUCTION

HISTORY OF HIV/AIDS:

It is unlikely the case that in 2017 there is anyone who isn’t familiar with HIV. It has had a devastating, worldwide effect since the beginning of the 1980s; the mortality then was high and spread like wildfire in major cities and certain parts of the world.

What is HIV? HIV stands for “Human Immunodeficiency Virus.” This is the virus that can lead to AIDS (Acquired ImmunoDeficiency Syndrome) when left untreated. Once the disease has spread to this stage, mortality increases and the individual can have a short lifespan from that point. With the intervention of medications, HIV can be managed and AIDS prevented.

The CDC (Centers for Disease Control) is a federal agency that supports health promotion, prevention, and education when it comes to public health. According to the CDC, there is no known effective cure for the HIV, but it can be controlled.1 AVERT is an international group geared towards the education and prevention around HIV. Here’s a general timeline of the progression of this disease according to AVERT: 2

Pre-1980

It is widely believed that HIV originated in Kinshasa, in the Democratic Republic of Congo around 1920 when HIV crossed species from chimpanzees to humans. Up until the 1980s, we do not know how many people were infected with HIV or developed AIDS. HIV was unknown and transmission was not accompanied by noticeable signs or symptoms.

While sporadic cases of AIDS were documented prior to 1970, available data suggests that the current epidemic started in the mid- to late 1970s. By 1980, HIV may have already spread to five continents (North America, South America, Europe, Africa and Australia). In this period, between 100,000 and 300,000 people could have already been infected.

1980s

1981

In 1981, cases of a rare lung infection called Pneumocystis carinii pneumonia (PCP) were found in five young, previously healthy gay men in Los Angeles. At the same time, there were reports of a group of men in New York and California with an unusually aggressive cancer named Kaposi’s Sarcoma.

In December 1981, the first cases of PCP were reported in people who inject drugs.

By the end of the year, there were 270 reported cases of severe immune deficiency among gay men - 121 of them had died.

1982

In June 1982, a group of cases among gay men in Southern California suggested that the cause of the immune deficiency was sexual and the syndrome was initially called gay-related immune deficiency (or GRID).

Later that month, the disease was reported in haemophiliacs and Haitians leading many to believe it had originated in Haiti.

In September, the CDC used the term 'AIDS' (acquired immune deficiency syndrome) for the first time, describing it as AIDS cases were also being reported in a number of European countries.

In Uganda, doctors reported cases of a new, fatal wasting disease locally known as 'slim'.

By this point, a number of AIDS-specific organizations had been set up including the San Francisco AIDS Foundation (SFAF) in the USA and the Terrence Higgins Trust in the UK.

1983

In January 1983, AIDS was reported among the female partners of men who had the disease suggesting it could be passed on via heterosexual sex.

In May, doctors at the Pasteur Institute in France reported the discovery of a new retrovirus called Lymphadenopathy-Associated Virus (or LAV) that could be the cause of AIDS.

In June, the first reports of AIDS in children hinted that it could be passed via casual contact, but this was later ruled out, and it was concluded that they had probably directly acquired AIDS from their mothers before, during or shortly after birth.

By September, the CDC identified all major routes of transmission and ruled out transmission by casual contact, food, water, air or surfaces.

The CDC also published their first set of recommended precautions for healthcare workers and allied health professionals to prevent "AIDS transmission.”

In November, the World Health Organization (WHO) held its first meeting to assess the global AIDS situation and began international surveillance.

By the end of the year the number of AIDS cases in the USA had risen to 3,064 - of this number, 1,292 had died.

1984

In April 1984, the National Cancer Institute announced they had found the cause of AIDS, the retrovirus HTLV-III. In a joint conference with the Pasteur Institute they announced that LAV and HTLV-III are identical and the likely cause of AIDS. A blood test was created to screen for the virus with the hope that a vaccine would be developed in two years.

In July, the CDC states that avoiding injecting drug use and sharing needles "should also be effective in preventing transmission of the virus."

In October, bath houses and private sex clubs in San Francisco were closed due to high-risk sexual activity. New York and Los Angeles followed suit within a year.

By the end of 1984, there had been 7,699 AIDS cases and 3,665 AIDS deaths in the USA with 762 cases reported in Europe.

In Amsterdam, the Netherlands, the first needle and syringe program was set up with growing concerns about HTLV-III/LAV.

1985

In March 1985, the U.S Food and Drug Administration (FDA) licensed the first commercial blood test, ELISA, to detect antibodies to the virus. Blood banks began to screen the USA blood supply.

In April, the U.S. Department of Health and Human Services (HHS) and the World Health Organization (WHO) hosted the first International AIDS Conference in Atlanta Georgia.

Ryan White, a teenager from Indiana, USA who acquired AIDS through contaminated blood products used to treat his hemophilia was banned from school.

On 2 October, the actor Rock Hudson dies from AIDS - the first high profile fatality. He left $250,000 to set up the American Foundation for AIDS Research (amfAR).

In December, the U.S. Public Health Service issued the first recommendations for preventing mother to child transmission of the virus.

By the end of 1985, every region in the world had reported at least one case of AIDS, with 20,303 cases in total.

1986

In May 1986, the International Committee on the Taxonomy of Viruses said that the virus that causes AIDS will officially be called HIV (human immunodeficiency virus) instead of HTLV-III/LAV.

By the end of the year, 85 countries had reported 38,401 cases of AIDS to the World Health Organization. By region these were: Africa 2,323; Americas 31,741; Asia 84; Europe 3,858, and Oceania 395.

1987

In February 1987, the WHO launched The Global Program on AIDS to raise awareness; generate evidence-based policies; provide technical and financial support to countries; conduct research; promote participation by NGOs; and promote the rights of people living with HIV.

In March, the FDA approved the first antiretroviral drug, zidovudine (AZT), as treatment for HIV.

In April, the FDA approved the western blot blood test kit, a more specific HIV antibody test.

In July, the WHO confirmed that HIV could be passed from mother to child during breastfeeding.

In October, AIDS became the first illness debated in the United Nations (UN) General Assembly.

By December, 71,751 cases of AIDS had been reported to the WHO, with 47,022 of these in the USA. The WHO estimated that 5-10 million people were living with HIV worldwide.

1988

In 1988, the WHO declared 1st December as the first World AIDS Day.

The groundwork was laid for a nationwide HIV and AIDS care system in the USA that was later funded by the Ryan White CARE Act.

1989

In March 1989, 145 countries had reported 142,000 AIDS cases. However, the WHO estimated there were up to 400,000 cases worldwide.

In June, the CDC released the first guidelines to prevent PCP - an opportunistic infection that was a major cause of death among people with AIDS.

The number of reported AIDS cases in the USA reached 100,000.

1990s

1990

On 8 April 1990, Ryan White died of an AIDS-related illness aged 18.

In June, the 6th International AIDS Conference in San Francisco protested against the USA's immigration policy, which stopped people with HIV from entering the country. NGOs boycotted the conference.

In July, the USA enacted the Americans with Disabilities Act (ADA), which prohibits discrimination against those with disabilities including people living with HIV.

In October, the FDA approved the use of zidovudine (AZT) to treat children with AIDS.

By the end of 1990, over 307,000 AIDS cases had been officially reported with the actual number estimated to be closer to a million. Between 8-10 million people were thought to be living with HIV worldwide.

1991

In 1991, the Visual AIDS Artists Caucus launched the Red Ribbon Project to create a symbol of compassion for people living with HIV and their carers. The red ribbon became an international symbol of AIDS awareness.

On 7 November, professional basketball player Earvin (Magic) Johnson announced he had HIV and retired from the sport, planning to educate young people about the virus. This announcement helped begin to dispel the stereotype, still widely held in the US and elsewhere, of HIV as a ‘gay’ disease.

A couple of weeks later, Freddie Mercury, lead singer of rock group Queen, announced he had AIDS and died a day later.

1992

The 1992 International AIDS Conference scheduled to be held in Boston, USA was moved to Amsterdam due to USA immigration rules on people living with HIV.

Tennis star Arthur Ashe revealed he became infected with HIV as the result of a blood transfusion in 1983.

In May, the FDA licensed a 10 minute testing kit which could be used by healthcare professionals to detect HIV-1.

1993

In March 1993, the USA Congress voted overwhelmingly to retain the ban on entry into the country for people living with HIV.

The CDC added pulmonary tuberculosis, recurrent pneumonia and invasive cervical cancer to the list of AIDS indicators.

Over 700,000 people were thought to have the virus in Asia and the Pacific.

By the end of 1993, there were an estimated 2.5 million AIDS cases globally.

1994

In August 1994, the USA Public Health Service recommended the use of AZT to prevent the mother-to-child transmission of HIV.

In December, the FDA approved an oral HIV test - the first non-blood HIV test.

1995

In June 1995, the FDA approved the first protease inhibitor beginning a new era of highly active antiretroviral treatment (HAART). Once incorporated into clinical practice HAART brought about an immediate decline of between 60% and 80% in rates of AIDS-related deaths and hospitalization in those countries that could afford it.

By the end of the year, there were an estimated 4.7 million new HIV infections - 2.5 million in southeast Asia and 1.9 million in sub-Saharan Africa.

1996

In 1996, the Joint United Nations Programme on AIDS (UNAIDS) was established to advocate for global action on the epidemic and coordinate the response to HIV and AIDS across the UN.

The 11th International AIDS Conference in Vancouver highlighted the effectiveness of HAART leading to a period of optimism.

The FDA approved the first home testing kit; a viral load test to measure the level of HIV in the blood; the first non-nucleoside transcriptase inhibitor (NNRTI) drug (nevirapine); and the first HIV urine test.

New HIV outbreaks were detected in Eastern Europe, the former Soviet Union, India, Vietnam, Cambodia and China among others.

By the end of 1996, the estimated number of people living with HIV was 23 million.

1997

In September 1997, the FDA approved Combivir, a combination of two antiretroviral drugs, taken as a single daily tablet, making it easier for people living with HIV to take their medication.

UNAIDS estimated that 30 million people had HIV worldwide equating to 16,000 new infections a day.

1999

In 1999, the WHO announced that AIDS was the fourth biggest cause of death worldwide and number one killer in Africa. An estimated 33 million people were living with HIV and 14 million people had died from AIDS since the start of the epidemic.

2000s

2000

In July, UNAIDS negotiated with five pharmaceutical companies to reduce antiretroviral drug prices for developing countries.

In September, the United Nations adopted the Millennium Development Goals which included a specific goal to reverse the spread of HIV, malaria and TB.

2001

In June 2001, the United Nations (UN) General Assembly called for the creation of a "global fund" to support efforts by countries and organizations to combat the spread of HIV through prevention, treatment and care including buying medication.

After generic drug manufacturers, such as Cipla in India, began producing discounted, generic forms of HIV medicines for developing countries, several major pharmaceutical manufacturers agreed to further reduce drug prices.

In November, the World Trade Organization (WTO) announced the Doha Declaration which allowed developing countries to manufacture generic medications to combat public health crises like HIV.

2002

In April 2002, the Global Fund approved its first round of grants totaling $600 million.

In July, UNAIDS reported that AIDS was now by far the leading cause of death in sub-Saharan Africa.

Also in July, South Africa’s Constitutional Court orders the government to make the HIV drug nevirapine available to all HIV-positive pregnant women and their newborn children following a legal challenge by the Treatment Action Campaign.

In November, the FDA approved the first rapid HIV test with 99.6% accuracy and a result in 20 minutes.

2003

In January 2003, President George W. Bush announced the creation of the United States President’s Emergency Plan For AIDS Relief (PEPFAR), a $15 billion, five-year plan to combat AIDS, primarily in countries with a high number of HIV infections.

In December, the WHO announced the “3 by 5” initiative to bring HIV treatment to 3 million people by 2005.

2006

In 2006, male circumcision was found to reduce the risk of female-to-male HIV transmission by 60%. Since then, the WHO and UNAIDS have emphasized that male circumcision should be considered in areas with high HIV and low male circumcision prevalence.

2007

In May 2007, the WHO and UNAIDS issued new guidance recommending “provider-initiated” HIV testing in healthcare settings. This aimed to widen knowledge of HIV status and greatly increase access to HIV treatment and prevention.

2010s

2010

In January 2010, the travel ban preventing HIV-positive people from entering the USA was lifted.

In July, the CAPRISA 004 microbicide trial was hailed a success after results showed that the microbicide gel reduces the risk of HIV infection in women by 40%.

Results from the iPrEx trial showed a reduction in HIV acquisition of 44% among men who have sex with men who took pre-exposure prophylaxis (PrEP).

2011

In 2011, results from the HPTN 052 trial showed that early initiation of antiretroviral treatment reduced the risk of HIV transmission by 96% among serodiscordant couples.

In August, the FDA approved Complera, the second all-in-one fixed dose combination tablet, expanding the treatment options available for people living with HIV.

2012

In July 2012, the FDA approved PrEP for HIV-negative people to prevent the sexual transmission of HIV.

For the first time, the majority of people eligible for treatment were receiving it (54%).

2013

In 2013, UNAIDS reported that AIDS-related deaths had fallen 30% since their peak in 2005.

An estimated 35 million people were living with HIV.

2014

In September 2014, new UNAIDS “Fast Track” targets called for the dramatic scaling-up of HIV prevention and treatment programs to avert 28 million new infections and end the epidemic as a public health issue by 2030.

UNAIDS also launched the ambitious 90-90-90 targets which aim for 90% of people living with HIV to be diagnosed, 90% of those diagnosed to be accessing antiretroviral treatment, and 90% of those accessing treatment to achieve viral suppression by 2020.

2015

In July 2015, UNAIDS announced that the Millennium Development Goal (MDG) relating to HIV and AIDS had been reached six months ahead of schedule. The target of MDG 6 – halting and reversing the spread of HIV – saw 15 million people receive treatment.

In September, the WHO launched new treatment guidelines recommending that all people living with HIV should receive antiretroviral treatment, regardless of their CD4 count, and as soon as possible after their diagnosis.

In October, UNAIDS released their 2016-2021 strategy in line with the new Sustainable Development Goals (SDGs), that called for an acceleration in the global HIV response to reach critical HIV prevention and treatment targets and achieve zero discrimination.

2016

The number of people in Russia living with HIV reached one million. Newly released figures also showed 64% of all new HIV diagnoses in Europe occurred in Russia.

UNAIDS announced that 18.2 million people were on ART, including 910,000 children, double the number five years earlier. However, achieving increased ART access also means a greater risk of drug resistance; the WHO released a report on dealing with this growing issue.

2017

CDC officially announces that HIV Undetectable individuals have zero capacity for transmission of HIV in individuals without a condom.3

In viewing the timeline, one can clearly see the progression and advancements in management of HIV. This current model is supported by scientific research based on western methodology. The continuation of this paper will share both the Western perspective and Eastern perspective, specifically Ayurveda, and management of HIV.

WESTERN PATHOLOGY

Bio-physiology of HIV: How does HIV work?

According to the CDC, AVERT, and the overall medical community, HIV is a virus that is spread through bodily fluids such as blood and semen that then attacks a cell called the T-Helper Cell (CD4.) Over time, the virus affects the immune system so much so that it makes it harder for the body to fight off infections, and diseases such as cancer, among many others. 4, 5 HIV virus cannot multiply on its own. The virus enters the immune host cell and forces the cell to replicate infected strands of itself, and continues this cycle of replication and destruction of immunity by infiltrating other cells. The process of the destruction of the T-helper cell multiplication of virus is called the HIV Life Cycle. AVERT has delineated clearly the stages of infection. 6

Stage One: First, the virus attaches to a T-helper cell and inserts itself.

Stage Two: Once the virus has entered into the cell it enters into the nucleus, changes the genetic material at this level and forces control over the nucleus.

Stage Three: The virus has taken control and then it causes the cell to replicate itself.

Stage Four: New HIV particles are released into the body to find other cells and continue this replication process, until the whole body is infected.

Here’s an image of what the virus looks like in comparison to the T-Helper Cell.7

What does the actual manifestation of HIV infection look like outwardly? That generally depends on the individual and their level of immunity prior to infection. Some individuals may develop beginning stage symptoms immediately while others may not have any symptoms for quite some time; meanwhile, there may be a slow and steady decline of immune function that causes significant alarm often prompting an individual to get tested. We will discuss testing below in the next section under Western Management.

The CDC outlines the general stages of infection as such:8

Stage One: ACUTE HIV INFECTION. Within 2-4 weeks of viral exposure, a person may experience flu-like symptoms, which may last a few weeks.

Stage Two: CLINICAL LATENCY (HIV Inactivity or Dormancy.) It is during this phase that there may not be any symptoms. This duration of how long the latency period varies, lasting anywhere up to several years. It is possible and likely that without the (ART) medications, an individual is considered to be infectious. Whether symptoms develop or remain latent during this stage depends on the level of the individual’s immune response. This stage applies to even if the virus is present and dormant, or what is known as ‘virally suppressed’ due to ART/HIV medications. If/when unmanaged, the virus will increase as the CD4 response decreases. Immunity is compromised and a whole domino effect of health issues can ensue.

Stage Three: ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). It is at this stage that the immune system has broken down and an individual develops varying symptoms ranging from swollen lymph nodes, weakness, weight loss, and other symptoms. CD4 cells are measured according to whether the cells reached below 200 cells/mm. When CD4 reaches below this number and the individual has two or more opportunistic infections, this is defined as AIDS. People at this level are very contagious and the average life span, from this point, tends to be up to three years after the AIDS diagnosis. Meaning, that within this time frame of the AIDS diagnosis the individual can die.

WESTERN MANGEMENT

Prevention

It is pretty well understood in today’s society that HIV can be prevented any number of ways. In fact, when the HIV virus was understood in the 1980s the primary means of prevention was the usage of condoms. Then, in the 1990s PEP was introduced. PEP stands for “Post Exposure Prophylactic,” which is a medication regimen administered within the first 72 hours to any individual who may have been exposed to the virus. This medication can be obtained through a primary physician or the emergency room. PEP prevents the virus from infiltrating the cells of the body.9

In 2012, PrEP (Pre-Exposure Prophylactic) was introduced into the public after scientific evidence indicated that PrEP can be used to prevent the exposure to HIV. PrEP is used as a preventative means for those who would like to be proactive in eliminating the chance of becoming infected. The CDC supports the usage of this medication in the efforts of reducing HIV infections by more than 90%.10 Individuals are recommended to take a pill called Truvada, once a day. This has been one of the greatest breakthroughs in the field of HIV, and across the world, in order to finally prevent HIV from spreading as quickly.

Lastly, in 2017 what has finally come to scientific recognition across the board is that engaging sexually with an individual who is HIV positive and is Undetectable, is another concrete means to preventing the perpetuation of HIV. The CDC released a statement on their HIV page stating “The goals of HIV treatment are to improve health and prevent transmission of HIV. The best marker of successful treatment is reducing the amount of HIV in the blood and elsewhere in the body to very low levels. This is called viral suppression. Three different studies of the prevention effectiveness of viral suppression to reduce the risk for sexual HIV transmission have shown similar results: across thousands of couples and many thousand acts of sex without a condom or PrEP, no HIV transmissions were observed when the HIV-positive person was virally suppressed. This means that getting and staying virally suppressed is not only the best thing people living with HIV can do to maintain their health, but also one of the best ways to prevent new infections through sex. CDC is working with other federal agencies to ensure that we consistently and accurately describe the prevention effectiveness of HIV treatment and viral suppression for sexual transmission of HIV. We will update our messages accordingly.”11 A study of serodiscordant couples (couples where one partner is HIV positive and the other is HIV negative) has also shown that HIV cannot be transmitted as long as the HIV-positive individual remains under ART.12

What public health forums, medical, and scientific authorities continue to support is that education around such matters is a fundamental necessity in addressing public health concerns. Getting educated and knowing these details can significantly help with navigating HIV, and other STI’s (Sexually Transmitted Infections/formerly STD’s, Sexually Transmitted Diseases.) Therefore, being educated, knowing your partner, taking precautions such as condoms and/or PrEp are keys to preventing the spread of HIV.

Testing

Testing is available through various means. An individual can meet with their primary care physician, or they can go to a general testing site in their local area. There is also an HIV testing kit that can be purchased through a local pharmacy called OraQuick. This test kit can even be purchased through Amazon.com.

The home test kit is easy to follow with instructions. Within 20-30 minutes a general reading can be obtained determining whether someone has been exposed to the virus. If a test result shows positive, this is when the individual is suggested to contact a doctor to follow up with further testing and obtain the necessary treatment. Should an individual not use the home test kit and visit a local testing site, the same rule can be applied. If they find their result to be positive, they are encouraged to meet with the appropriate medical authority to follow up. Finally, if an individual simply asks their physician to be tested, the physician sends the blood for analysis. Once an outcome is obtained, and if the individual is found to be HIV-positive or “reactive to HIV antibodies,” another test is done to definitively confirm their positive result, or not. It is a rare situation that there are “false positives;” in these cases a retest is recommended within a certain period of time. Should the test be conclusive and the individual is HIV-positive (Poz) then treatment is the next step. If the individual is HIV-negative or “non-reactive,” they are asked to return in a few months for a retest if there is an indication that the individual is a high risk. Additionally, they are usually encouraged to use the necessary precautions to prevent exposure through prophylactic means such as the use of condoms.

How does the blood test work? According to the CDC, there are three main tests implemented to determine someone’s HIV status. NAT’s (Nucleic Acid Tests), Antigen/Antibody Tests, and Antibody tests. NAT’s look for the actual virus in the system. This test is expensive and is typically used if the individual is aware that they were in high risk exposure and showing early signs and symptoms. The Antigen/Antibody Test look for both antigens (foreign substances that show up in the blood and the body shows an immune reaction to) and antibodies (is the immune response/defense to something foreign.)13

It is important to emphasize that an essential component to prevention of spreading HIV is through testing. When someone knows their status they are usually able to obtain the necessary medical assistance to ensure the management of the virus. The lack of testing is one of the reasons why HIV continues to spread because there are individuals who do not know their status. Therefore, the first step is to get tested.

Medications

While it may be suggested that individuals pursue a healthier lifestyle with diet, exercise and relaxation, medical intervention via pharmaceuticals is the primary means of treatment for individuals with HIV. It is understood within the medical community that medications are the key aspect to maintaining health and prolonging the life of someone living with HIV. Once an individual begins a medication regimen they are encouraged to remain compliant and follow up with their physician as necessary. Coming off the medications is discouraged for the entire lifespan of the individual.

Medications have come a very long way since the 1980s where the primary medication administered consisted of concentrations of AZT, which had numerous side effects. The medications were called “cocktails” because there could be any number of pills prescribed in any one sitting, and multiple times a day. Some individuals could easily take eight to ten pills, two to four times a day. In modern times, many medications consist of single dosages. Simply one pill a day. Although an HIV positive individual may take one pill a day, the science behind formulations continues to advance because in one pill there could be three different medications addressing different entry points in support of immunity within the cell and following the stages mentioned below.

As mentioned in the section on Bio-Physiology of HIV and the stages of infection, according to AVERT drug treatment is designed to counter the effects at the various stages.14

Stage One: This is where the various medications, designed to support immunity, involve what is called the “Infusion or Entry Inhibitors.”

Stage Two: Drugs that are administered for this stage are called NRTI’s, meaning “Nucleoside Reverse Transcriptase Inhibitors.”

Stage Three: There hasn’t been any drug indicated for this level of development.

Stage Four: Drugs that are designed to stop this stage are called “Protease Inhibitors.”

According to the CDC and National Institute of Health, the earlier someone tests HIV positive and begins adherence to medication, the better the long-term outcome for health.15 This is the next step, after testing, that is a crucial component to the prevention and management of HIV. Medication adherence/compliance increases an individual’s capacity to become HIV Undetectable. With this, it is known that Undetectable = Un-transmittable.16, 17, 18, 19, 20

HIV and Inflammation

A critical point in understanding HIV is that it involves inflammation, —not only as a byproduct of the initial infection of the virus—, but also the domino effect the virus has over time. This is a huge area currently under research showing many possible insights to prevention and well-being.

The term inflammation is a generic term, to indicate some process/progression of pathology, and an emerging field and a fairly new concept for medicine within the past seven years. Dr. Axe states that “modern medicine focuses on treating symptoms, not addressing the root cause of an issue. Arthritis is inflammation in the joints. Heart disease is inflammation of the arteries. Instead of taking a medication to reduce joint pain or lower cholesterol, we would be better served by reducing inflammation in the body.”21 Inflammation has been linked to many conditions such as cancer, heart disease, liver failure, dementia and autoimmune disease. This understanding of inflammation can be applied to the process around the HIV virus.

What is inflammation? First, it is safe to say that inflammation is not always a bad thing. Known as Pyroptosis, it is the body’s natural response to damaged cells that have been afflicted by exogenous causes such as viruses and other causes of infections or trauma to the body. When the body suspects that it has been exposed to some trauma or pathogen/foreign invader chemical messengers act locally, causing blood vessels to dilate so that more blood rich in oxygen and immune-chemicals are brought to the area. When the white blood cells, which include Helper T-cells (CD4) and Killer T-cells (CD8 cells), antibodies, clotting factors and pro-inflammatory cytokines, and many others arrive they send out their own chemical signals, to invite other cells within the immune system to respond to the injury/infection.22 The end result is healing of the tissue.

According to Dr. Axe, there are two different types of inflammation. “One type is Acute Inflammation, and the other is Chronic Inflammation. Acute inflammation lasts only for a short term as part of the body’s immediate immunological response. When the threat has been addressed the body turns the signals off and harmony is returned to. Whereas, chronic inflammation lasts for months and years as a result of failure to eliminate the cause and minor, repeated exposure to the agent.”23 Tissue damage typically occurs as a result of infection along with scarring. The body remains in a constant state of arousal and defense, and within this state antibodies are produced that end up attacking healthy cells.

In HIV-positive individuals, it can be understood that “Pyroptosis,” which is this process of inflammation associated with the infection of the HIV virus, causes CD4 Helper T-cell depletion. Gilad Dotil, et al. and Tessa Bergsbaken, et al. state “Pyroptosis corresponds to an intensely inflammatory form of programmed cell death where cytoplasmic contents and pro-inflammatory cytokines including IL-1β, are released. This death pathway thus links the two signature events in HIV infection––CD4 T-cell depletion and chronic inflammation––and creates a vicious pathogenic cycle where dying CD4 T-cells release inflammatory signals that attract more cells to die.”24, 25 In understanding how inflammation is associated with the HIV virus in its host, insight can be gained in determining the potential towards increased longevity and health within the HIV-positive individual. Inflammation is commonly associated with regard to the natural aging process due to deterioration and diminishing immunity, which is commonly seen in the elderly and the multiple health issues they express. When it comes to HIV, the individual infected with the virus has an acceleration of deterioration due to the heightened quality of inflammation based on the immune-response to the viral infection over time. Inflammation has been shown to be higher in HIV-positive individuals versus HIV-negative, exhibiting increased rates of heart disease, neurocognitive diseases, liver disease, liver failure, opportunistic infections, and cancers.26, 27

Below is an image showing the HIV Pathogenic Cycle and process of inflammation.28

Leaky Gut Connection, Immunity, and Inflammation

Research has shown that the gut possesses 70% of the body’s immune cells a high concentration of CD4 cells.29 This immunity within the gut is called GALT (Gut-Associated Lymphoid Tissue.) It protects the body from germs in food and has been shown to incur damage from the HIV virus. When inflammation occurs in the gut, it weakens the immune response and allows germs to pass through and “leak” into circulation. This is one of the main means in which inflammation can spread systemically. This process is generally known as “Leaky Gut Syndrome.”30, 31 Studies will continue to investigate this and its application to the health of individuals who are affected by HIV.

Management of HIV-related inflammation

As previously mentioned, there are several studies currently supporting the conclusion that while it is known that HIV-positive individuals show not only an increase in inflammation, but also an acceleration of the aging process, compared to HIV-negative individuals that age and display the natural course of aging. Because of this, research is seeking out methods in reducing inflammation. According to Benjamin Ryan, who quotes Deeks stating: “the long-term damage caused by HIV-related chronic inflammation may be easier to prevent when people are younger, as opposed to reversing the damage once people are elderly.”32

There is an overall approach in management of inflammation that involves:

*Healthy eating: anti-inflammatory foods, eating more vegetables, fruits, eliminating refined/excess/process sugars and foods

*Staying active: exercise

*Quitting smoking: since this is known to increase inflammation

*Maintaining a healthy weight: since being overweight contributes to inflammation

*Keeping the HIV virus managed with the appropriate ART medications: getting on ART earlier supports the reduction of inflammation, since science has shown that letting the virus increase in the body causes a higher rate of inflammation.33

Barriers

The topic of barriers is a topic worthy of much attention. A barrier in prevention around HIV involves the fears associated with getting it, some fears around how someone contracts it whether sexually or through drugs like needle sharing, or other direct blood contact from a detectable HIV-positive individual. Additionally, when HIV was first observed in the early 1980s it took the world by storm. Most individuals who were exposed to the virus were dying, seemingly quickly, and AIDS had become a fast growing epidemic. So much loss and devastation, to so many communities, left an intense imprint upon society. Since then science has prevailed in working on a “cure for the virus,” and managed to take AIDS to a simply managed condition considering it a chronic but manageable condition similar to diabetes; as for HIV, the impression left from the 1980s is slowly dying, but not completely gone. Clearly AIDS still exists in places such as Africa and Asia/South Asia. This is because there is a lack in medical care for many reasons ranging from fear of seeking medical support, fear from finding out so getting tested isn’t an option, fear from getting tested but not wanting families/friends/communities finding out, or just that the medications are not available. Here in the USA, HIV is still higher in the African American and Latin American Communities.

Discrimination and stigma still circulate, creating fear for individuals in becoming more proactive in the management and reduction of HIV. Discrimination and stigma are the main reasons why people are apprehensive about getting tested, disclosing their status, and taking the medications.34, 35, 36 But it is hopeful that there are organizations such as the WHO (World Health Organization), Positive Alliance, Action AIDS, Matthew Shepard Foundation, Ryan White, GMHC (Gay Men’s Health Crisis), AVERT, and many more, designed to counter discrimination and stigma, with the intention of reducing HIV in the world.

If society can be more open-minded, and see HIV for what it is today versus what it was back when it was profoundly activating AIDS, and if communities could dissolve their judgments around anyone who is HIV-positive, and see them as people who are living with a condition that is manageable and easy, like diabetes, then this would make the overall intent of reducing HIV more effective.

AYURVEDIC PERSPECTIVE

Ayurveda is known as the “Science of Life” and is the oldest most complete system of integrated health and medicine. Ayurveda has its roots in nature and the five elements: Space, Air, Fire, Water and Earth. In configuring these elements into categories, the ancient Ayurvedic masters/doctors classified them into what is called Dosha, or “Biological Humor.” Therefore, there are three doshas and they are as follows: The combination of Space and Air elements fall under the principle of Vata. Vata is the term that refers to the nervous system and catabolism. Pitta, is the term that encompasses the fire and water elements and governs hormones, digestion and metabolism. Kapha, is the final principle that involves the water and earth elements, governing immunity and anabolism.

When Ayurveda considers inflammation, there is the understanding that many systems can be affected because eventually all the elements are affected. Health is considered ideal when there is balance within these five elements, and when one is affected, the others will surely follow. According to Ayurveda, there are the concepts of Prakriti and Vikriti. Prakriti is defined as the baseline constitution or primary constitution that is determined by birth, environmental factors, and karma. Vikriti is the deviation from the natural state of balance that is inherently designed per the individual. This is why Ayurveda is such a unique system of medicine because it shows that not every person can be treated the same and that optimal care is when individuals are uniquely understood for who they are, how they feel and think. Everything is connected!

In Ayurveda, 80% of diseases are considered a result of Vata imbalance because Vata oversees, primarily, the mind/brain and nervous system. What stresses the mind will eventually stress the body; some examples of symptomology that are common in Vata predominant individuals (Ectomorphic) include insomnia, constipation, anxiety, fear, breathlessness, ADD/ADHD, Multiple Sclerosis, involuntary tremors, alzheimers. Next, Ayurveda says that 40% of diseases are a result of Pitta imbalances, which shows up as inflammation. For Pitta predominant individuals (Mesomorphic) examples of such ailments includes anything and all the symptoms ending in “itis” such as gastritis, conjunctivitis, iritis, diverticulitis, types of cancers and viral infections. Finally, Kapha governs 20% of imbalances, relating to accumulation of sorts. With Kapha predominant individuals (Endomorphic) there are examples including edema, diabetes, depression, sluggishness, fibroids, candida and certain types of tumors. As mentioned previously, that when one of the elements are out of balance so too shall the others be somehow affected. In this case, when all the doshas are afflicted the pathology is considered Sannipatika, meaning the progression has affected Vata, Pitta, and Kapha (all the doshas.) Generally, when pain is experienced the Ayurvedic understanding is that the aspect of Vata is primarily out of balance. When inflammation is present, this is an indicator that Pitta is somehow imbalanced and when swelling is present, Kapha is out of balance.

The ancient texts of Ayurveda, written in the Arthava Veda (one of four Ancient Vedic Texts) and Charak Samhita, Sushruta and Ashtanga Hridayam (some of the classical Ayurvedic Medical Texts) discuss this concepts of HIV and Inflammation extensively through its content. Where the term inflammation is newer and within recent years in the context of disease pathology and health, Ayurveda has a different perspective and understanding of Inflammation. According to Dr. Sanjay Pisharodi, an Ayurvedic Physician, Ayurveda has a similar understanding of inflammation compared to the modern medical concept, but that Ayurveda does not view it the same way overall and has specified it under a different category known as Jvara or “fever.”37 Additionally, a condition such as HIV and Inflammation is assessed and treated according to the concepts of Agni, Ama, and Ojas.38 It is safe to say that Ayurvedic practitioners determine health and any necessary protocol based on the state of an individual’s balance and health to their Agni, Ama, and Ojas.

AYURVEDIC PATHOLOGY

JVARA

It is interesting to learn that although Ayurveda and Allopathic Medicine have a similar understanding of what Jvara (fever) is, Ayurveda has an expanded perspective of its totality. According to Dr. Marc Halpern, a practitioner of Ayurveda, he refers to Charak Samhita and states ““Jvara means ‘miseries or disease.’” It is synonymous with roga; however, the term is used specifically to indicate fever. In the Madhava Nidanam, fever is listed as the first disease because “man is born and dies with fever, it affects the whole body, the organs of the senses and the mind and is so severe that only man and Gods can survive it and by which other diseases are produced.” In each of the classical texts, more pages are devoted to fever than any other condition. This is partly because there are so many types of fevers and their understanding, and the vaidya’s ability to manage them is so important””39 Additionally, Dr. Marc Halpern states “that the causes of fever are many; however, the most important is simply living out of harmony with nature and thus, improper daily regimens. Fever is how the body tries to correct the disturbance that has been created. By causing an individual to be bedridden, fever puts an end to all unhealthy regimens and when fever goes away, the individual is able to begin anew, free from the unhealthy habits. Fever is produced by those factors that lead to poor digestion and ama formation, as well as a lack of rest. Exogenous causes to fevers include those that are caused by trauma (injuries) ….”40

This serves as a powerful understanding of Ayurveda’s application and relevance to HIV and HIV-related inflammation. Typically, when an individual is affected by the HIV virus, it is an exogenous cause due to the introduction of the virus to the system. Consequently, it is common that once the virus has had a chance to enter the body, sometime after exposure, the individual is known to develop a fever of sorts, even a cold, which is a sign of an immune compromise. Charak states, “Amongst the disease, fever is described first because of its being the earliest (in appearance) of the somatic diseases. Fever is originated by the anger of Maheswara, it takes away the life of all living beings, causes disturbances in body, sense organs and mind, diminishes intellect, strength, complexion, pleasure and enthusiasm. Produces tiredness, exhaustion, confusion and difficulty in intake of food; it is called as jwara because it brings about unhappiness in the person, no other disease is so severe, complicated and difficult in management as this.”41, 42 In the consideration of HIV and how jvara relates, it can be understood that at any point when the virus is not managed adequately any of these aforementioned symptoms are possible and tend to express, but Ayurveda shares that the presentation of symptoms will also be based on the dominance of an individual’s constitution. It is safe to say that regardless of dosha, should the virus progress to later stages and into AIDS then not only will fever be present, but consumption since AIDS is an auto-immune disease and essentially the body is breaking down from the inside. Fever can be correlated to the medical understanding of inflammation, but inflammation does not always produce fever, or at least not right away. In some chronic conditions, intermittent fevers are possible (Vata type), or consistent high fevers (Pitta type), or even low grade dull fevers (Kapha type.) Professor K.R. Srikantha Murthy states in the Ashtanga Hridayam (Classical Ayurvedic Medical Text) “Jvara (fever) is the lord of diseases, born from sin, causing death, feeds on ojas (essence of tissue), leads to final end (death), originated from the upper eyes of Rudra (Lord Shiva) who destroyed the sacrifice of Daksha, by wrath (of being insulted); it is producer of delusion at the time of birth and death (of living beings) characterized by (producing) santapa (discomfort by heat), arising from improper conduct, (regarding food, activities, etc.) a cruel one, affecting all the species of living beings and called by different names.”43 For clarification regarding the usage of the term “sin” it can be interpreted in the modern sense as committing any sort of harm to the mind and body due to usually making choices that may not be the most optimal for health. It is important to note this because there has been too much stigma in the past around the infection of HIV as being a result of some sort of situation that invited a punishment or consequences related as being an unwholesome person. Quite often, mentioning the word sin has a negative connotation and implication, which does not support nor is it conducive to the possibility of achieving an optimal state of health as an individual experiences this judgment.

AGNI, AMA, OJAS

Agni

Agni is an important concept in Ayurvedic medicine because it is understood in Ayurveda that the primary cause of disease originates in the digestive system, which includes the physical digestive system and the mental processes of digesting information. Agni is generally described as fire, and resides in Pitta which is the governing principle for metabolism. More specifically when agni is being addressed as part of the digestive system this is known as ‘Jatharagni.’ According to Charak “there are four categories of bodily fire (agni) according to intensity – such as intense, mild, regular and irregular. Amongst them, the intense fire can tolerate all sorts of improper regimen while the mild one has got the contrary character. The regular fire gets affected by improper regimen but otherwise remains normal, the irregular fire has got the character contrary to that of the regular fire. These four types of fire are found in four types of person.”44

It is known in Ayurveda the balanced fire or what Charak refers to as regular is called Sama Agni; Vata-related agni is called Vishama Agni for its variable/unstable qualities; Pitta-related agni is known as Tikshna (sharp), and Kapha-related agni is Manda (slow/sluggish.) What does this have to do with HIV? Indirectly, agni plays a significant role because as previously mentioned Ayurveda teaches that health is contingent upon the state of digestion. If digestion is healthy and balanced in an individual, then the overall state of health and immunity are amplified making the body impenetrable for pathogens to enter the body. Digestion feeds into health and has its connection to Ojas, which is later discussed. Charak states, “By the word ‘sariresu’ all the types of agni are intended but the description given is only for jatharagni which only shows its utmost importance. Jatharagni is the root of all the agnis.”45 When Charak suggests the “types of agni” he is referring to the Ayurvedic understanding that there are 13 types of agni in the body but jatharagni is the most important. The other agnis are in the mind (1), five in the liver, seven representing each of the the dhatus (tissues).

According to Ayurveda, when agni (which refers to jatharagni but essentially all the agnis in the body) is balanced/high, ama is low. When ama is low, agni is balanced. Ama does not exist in the body when digestion is up and running optimally. Dr. Vasant Lad elaborates, “Agni maintains immunity, so low agni creates ama that can affect cellular immunity by coating and clogging cell membranes (a micro srotas.) Because of this, cellular communication is affected and the immune cells do not receive correct signals from the body’s other living cells. Those cells send out messages that are blocked by ama, so there is no response. The immune cells then attack the neighboring cells as if they were a foreign body. This is the mechanism for the development of autoimmune diseases.”46 In relationship to HIV, the health of the individual will be dependent upon the quality of the immunity which is rooted in the relationship between digestion and the degree to which toxicity (ama) is present.

Ama

What is ama? According to Charak, “Ama means undigested food or immature annarasa (chyle.)47 Dr. Vasanat Lad defines Ama as: “Ama can be created in the mind due to mental stress, negative thinking, repressed emotions and mental fatigue. It can also be due to parasites, viruses, bacteria and worms, which may produce cytotoxic ama at the cellular level. Ama is a good medium for bacteria and viruses and can create repeated infections and a bed for a future disease. Certain drugs also produce ama. Ama is the root cause of all diseases; therefore, disease is called Amaya, which means ‘that which is born out of ama’” and adds that “low jathar agni causes undigested food to be improperly digested, which creates toxins.”48

Therefore, to manage ama, agni is supported through various means of proper diet, and proper mental practices that support a more balanced and peaceful mind. Agni is the key to ensuring the optimization of health and reduction/elimination of ama in the body and mind. When agni is adequate, then ojas, which is the key factor to immunity, is created and health can be achieved.

Ojas

What is Ojas? According to the Ayurvedic Physician Dr. Vasant Lad, “Ojas is the superfine essence of all bodily tissues…For optimal health, an individual needs a constant, fixed amount of ojas that is stabilized in the heart and other tissues. This ojas maintains the immune mechanism and the span of the person’s life.”49 Ojas disorders such as Ojaskshaya is defined as “decreased immunity.” Ojaskshaya, according to Dr. Vasant Lad, “shows as an extremely high Vata disorder that is so dangerous that a person can die.”50 As stated previously, Vata related diseases are those diseases that oversee the whole body and govern about 80% of diseases. The nervous system includes the brain and all the nerve tissue in the body, being the information pathway and communication system for the body and mind connection.

Ayurveda categorizes HIV/AIDS under Ojaskshaya, otherwise known as a weakness of ojas which is immunity/immune compromise and chronic disease. When an individual has arrived at a level of chronic infection, Ojaskshaya is one of the main roots which this inevitably translates into AIDS, the fullest expression of the HIV virus when it has become unmanaged or mismanaged. Dr. Vasant Lad states that AIDS is classified as “Rakta Dushti”51 which is an imbalance of the blood tissue in the body that has been affected by a dosha and immunity is compromised. Dr. Vasant Lad states that “AIDS begins with Pitta.”52 At this advanced stage, jvara can be observed along with an increase in inflammation of the tissue, which is what the virus of HIV is known for: inflammatory expression in the tissues of the body.

In the Charak Samhita (Collections of teachings of Charak who is considered the “Founder of Ayurveda”) Charak states that “Ojas, which maintains the living beings by its saturation without which no life of creatures exists, which is the initial essence of embroyo and also the essence of its nourishing material, which enters into the cardiac cycle first, which destroyed, leads to destruction, which is the sustainer and located in heart, which is the cream of the nutrient fluid in the body, and where vital factors are established.”53 Charak is describing ojas from a multi-faceted perspective, but for the purposes of Western understanding, ojas can be considered similar to the immune system and the cells it produces. Charak states, “Ojas is the essence of all the dhatus and is located in the heart.”54 The dhatus refers to the main tissues of the body and according to Ayurveda there are seven of them. These dhatus are Plasma (Rasa), Blood (Rakta), Muscle (Mamsa), Fat (Medas), Bone (Asthi), Nerve (Majja), and Reproductive fluids (Shukra.) Ojas is sometimes noted as the “eighth tissue” because the final product of metabolism in a healthy individual is ojas, but it is in fact the essence of all these seven tissus. Ojas contains the qualities of “white and slightly red and yellow.”55 This would be consistent with the qualities associated with plasma described in Western physiology.

Dr. David Frawley discusses ojas and the disease process when he states, “Ojas is the essential energy of the body. It literally means ‘vigor.’ It is the subtle essence of the reproductive system and of all the vital secretions. It is the special Ayurvedic concept of a source fluid underlying all our physical capacities. Ojas is not a physical substance. It is the sap of our life energy and exists on a subtle level in the heart chakra. When it is sufficient, there is health. When it is deficient, there is disease. Disease strikes at the locations where it is weak. In modern terms, we could say it is something like the essential energy of the immune system.”56

The proper treatment of ojasksaya and AIDS is dependent upon thorough investigation and assessment. Dr. Gyanendra Panday quotes Charak stating that “Charak speaks of diseases that are curable and incurable, manageable and unmanageable HIV would fall under the category of incurable but manageable.”57 AIDS was initially considered unmanageable in the 1980s, yet now it is possible for AIDS to become manageable depending on how chronic an individual’s condition is and based on the adequate support of immunity (Ojas.)

AYURVEDIC MANAGEMENT

Mind-Body

In order to properly comprehend Ayurveda and its healthcare system, it is essential to consider the role of mind, its relationship to the body, and its interactions with diseases such as HIV and HIV-related Inflammation. This is due to the strong understanding that mind and body have an intimate relationship; this relationship also invites in the perspective that there is a spiritual component that everything is connected to.

There is a fascinating story that describes the "Summary of The Process of Disease Formation," according to Dr. Marc Halpern.58 First, disease begins when we forget our true nature. This is known as the "Primordial Cause" of disease. We forget how we as spirit are spiritualizing through the human experience. According to Marisa Laursen, a professor at the California College of Ayurveda, "the mind is a place of purity and clarity. The thought comes along and disturbs the mind. Thought is part of ego and the chatter becomes the smoke screen that disturbs us from the true self."59 The ego creates stories and draws upon attachments to the past and projections of the future, constantly shape-shifting and vacillating between the two; preventing us from being absolutely absorbed in the present moment because it fears its cessation. There is a sacred text called the Yoga Sutras of Patanjali and the first line of the yoga sutras states "yoga chitta vritti nirodha," which means that "Yoga (union/merging) involves the cessation of the disturbances of the mind." There are 195 sutras or verses and of the 195 versus the 194 verses show us how to accomplish verse number one.60

The process and movement of time, which is known as "Parinama" or that which relates to things that change, is the next cause and contributing factor. There are two aspects to time. One relates to linear time, which is out of our control because this involves the cycles of the Earth revolving around the sun and the changes of season. The second form of time consists of biological time, which, though is in our control, is dynamic. This is because the pacing of biological time changes with response to our motion and as motion increases, the rate of biological time increases. With this, the body either ages faster when we are moving faster and more slowly when we slow down. A busy mind causes us to perceive time as moving quickly; while with a mind that is still and more anchored in the present moment, time slows down. When the mind moves quickly, the body will reflect this and as the mind moves slower, the body will reflect this too.

Once we experience a busy and chaotic/distracted mind, we come to the next step where disease develops. This experience is called "Prajnaparadha" or "crimes against wisdom/failure of intelligence." What happens here is that on some deep level we know what is right for us, but we allow our minds to convince us otherwise and we make opposite choices. Our intellect is constantly being used to make decisions and it prefers to choose between pleasure and harmony. Somehow as the ego pursues outer pleasures to satisfy itself and perpetuate its own existence through separation/division, the ego feeds off the senses and uses the senses to support its own happiness. Dr. Marc Halpern, says "While the ego and the senses speak loudly within the great hall of the mind, the soul speaks in whispers." Therefore, when we allow our inner wisdom to be ignored, we give our power away to our senses; this leads to the next stage where the five senses, the eyes, ears, mouth, the skin, and smell dictate our interaction with the world.

This is called "Asatmendryartha Samyoga" or "unwholesome conjunction of the senses with their objects of their affection." Dr. Marc Halpern further explains: "When people take into their body that which does not match their constitution, they are considered misusing their senses. In addition to taking in what is not harmonious, a person may also take in too much or too little of what is energetically harmonious for that person. This too will cause disease."

What is amazing is that of all the healthcare systems in the world, only Ayurveda has come up with an adequate and full definition of what is health. Other systems, like Allopathy, define health as the "absence of disease" but Ayurveda says this: "Sama Dosha Sama Agnis ca Sama Dhatu Mala kriya Prasannatmendriya Manah Svasta itiabhidyate" which means "balanced constitution (Vata/Pitta/Kapha), balanced digestion, balanced tissues, balanced waste products (urine, feces, sweat), balanced senses (eyes, ears, nose, mouth and skin), balanced mind (sattva, rajas, tamas), and alignment with spirit is what healthy is." Any disturbance or abnormality in any of these is an indication of disease.

Additionally, an important Ayurvedic contribution to modern medicine is that it has broken down disease pathology into six stages, known as "Samprapti." Each of the stages can be understood as such: Accumulation, Aggravation, Overflow, Relocation, Manifestation and Diversification. There is an image that helps to grasp these concepts more easily. Imagine a tree and the roots are the doshas (tendencies towards imbalances based on constitutional determinants, of Vata, Pitta and Kapha), and these roots are below the surface. What is above the surface is the trunk of the tree and this represents Overflow, where the blood and plasma exist as part of the circulatory system. As the tree progresses upward, the branches form and this is known as the Relocation Phase. From the branch, we have a bud and this budding is the Manifestation of the disease. After it starts to bloom, and this blooming is the full-fledged experience of the disease, known as Diversification.61 According to Ayurvedic prevention and management of disease, there is a natural cycle that happens throughout the year and within each season. As one season is present, that is the Aggravated Phase, and the season that just left has now been Alleviated, but while we are in the Aggravated Phase the next season is already Accumulating.

As each Dosha (biological constitution that is prone to decay) undergoes this experience of time/season change, the natural Alleviation of particular symptoms occurs. IF or WHEN, for some reason or another, this cycle is then interrupted, and Alleviation is prevented, we enter into Overflow and this is when a disease is really progressing. In other words, it is during the Accumulation and Aggravation phases that the development of pathology actually begins, which is in the digestive system. Appearing subtle or overt, commonly ignored disturbances would be: sluggish digestion (weak/low digestive fire = Manda Agni), gas/dry stools (variable digestion = Vishama Agni), and/or burning indigestion (sharp digestion = Tikshna Agni). Low digestion relates to Kapha. Variable digestion relates to Vata and sharp digestion relates to Pitta. Balanced digestion is called Sama Agni where there are no digestive disturbances. It is during the Accumulation and Aggravation phases that we can catch a disease from further progressing, but we are usually too busy and less sensitive to notice, and we keep pushing ahead until other symptoms develop and scream for attention. It is at these early stages, according to Ayurveda, that we can simply balance our diet and lifestyle, making better choices, preventing diseases from increasing. However, when the symptoms have progressed and have entered into the circulatory system then we have to intervene with herbs/medications and other therapies. Regardless of what stage a disease is at, diet and lifestyle must be adjusted in order to secure the optimization of health. This is the holistic approach and effort. Herbs/medications alone are not meant to do the job as we are whole beings and not just treating parts of a body/mind; thus, diet and lifestyle provisions are made to ensure success or at least marked improvements.

Prognosis is about the likelihood of improvement and/or correction of a condition. Disease, depending on what stage of development it is at can always be managed. There are diseases that are “Easy to cure, Difficult to cure, Incurable but not terminal and Terminal.” Disease starts out as "dis-ease," picking up momentum until it has completely manifested itself as disease. By returning ease through our diet and lifestyles, we can encourage disease to return back to ease. Importantly, this ease also involves supporting the well-being of a person through their state of mind. I've said for many years now, that it's about the little things that build up to the big things.

There are of course extenuating circumstances that are to be factored into all this, circumstances such as external factors like accidents and other outside variations of trauma that can influence health and disease pathology. Karma falls into this, and it is important to remember that karma is not about blame or judgment but about balance. Karma is not about punishment or reward, it is about balance. In Ayurveda and Yoga, the concept of karma is a result of selfish acts and by being selfless there is a release from the cumulative effects and experiences of karma. This is a discussion that requires further exploration at another time and escapes the main purpose of this present article, which is meant to give a general understanding and summary of the cause of disease. This previous statement is meant to share a perspective and expand to the possibilities that surround dis-ease leading to disease. Simply, disease can always either be prevented or managed.

The Ayurvedic management of HIV involves this body-mind-spirit approach; it is the most comprehensive and elaborate of all available systems. There are many parts that create wholeness for any given individual, including their relationship to nature as a key factor in the optimization of health. Dr. Claudia Welch states that the mind and heart have a profound connection to one another. Through this, it can be understood how the body and mind interact and that the state of ojas depends on the mental and heart relationship. It is such an intricate system that in order to truly address the idea of achieving optimal health it is crucial to embrace how they co-operate together. She states, “In short, what we see is that the overlap of mind, prana (energy), heart, doshas, ojas and basic bodily nutrition channels are so integrated that it is impossible to affect one without affecting the others.”62 This suggests an amazing way to help individuals who are living with HIV to live longer and healthier lives. This integrated holistic approach would truly serve the HIV positive individual.

Another recent perspective that requires further study, especially with its potential implication towards HIV, examines the relationship between the gut flora, lymphatic system, and the mind. A discussion with Dr. John Douillard, who has written several articles on the lymphatic system and the linking of the mesentery organ to the lymphatic system, and its connection aging, has also suggested that inflammation is more of an allopathic term that is currently being studied and understood, but within the Ayurvedic system of medicine it is an indication of an underlying pathology that deserves more attention and the term is not as commonly used as it is within Western medicine. Dr. Douillard has suggested that when assessing and treating inflammation that it should be viewed in terms of digestion and the functionality of the lymphatic system.63, 64, 65 According to Dr. John Douillard, “Persistently high levels of cortisol have been linked to suppressed immune system function and reduced circulation of the antibodies the body desperately needs to fight off foreign invaders.”66 As previously noted in the section of Ama and how it affects the health of the body through the manifestation of its symptoms, this can be connected to the lymphatic system; in particular if agni is low and ama is high, then toxins enter into the drainage system of the body which involves the lymphatic tissue, which is also responsible for the vitality of the immune system. Dr. Douillard states, “The biggest drain we have in the body is the lymphatic system, which can stay clogged for many years. This forces us to adapt to an environment of toxins that stress and weaken immunity and other important pathways of detoxification.”67 Additionally, as mentioned earlier in the section of how inflammation can accelerate the aging process, the mesentery organ, linked to the lymphatic system, is located as connective tissue, connecting the intestines to the wall of the abdomen. According to Dr. Douillard, “the mesentery that lines the entire intestinal tract from top to bottom was found to be a major site for lymphatic-based immunity. As an organ, the mesentery is loaded with lymphatic, anatomical, vascular, neurological and connective tissue structures that are deeply involved in immunity, circulatory-vascular, hormonal and metabolic processes.”68

How To?

First and foremost, it is quintessential to remember and reiterate that as of now there is NO cure for HIV that is scientifically known or proven to be substantial according to modern science. There may be one in the future as various institutions are working on it, but as of now the best measure to take against getting HIV is prevention and the best management for the virus itself is through medication management and adherence. That being said, just taking a pill and going on about one’s day isn’t enough to consider optimal health for an HIV positive individual. In fact, this is where Western medicine is significantly lacking, and where Ayurveda can truly support the individual in their fullest capacity. Ayurveda is a holistic approach. Its foundation is about diet, herbs, exercise for the body (yoga, pranayam) and exercise for the mind (pranayama and meditation). There are also other hands on therapies that Ayurveda can offer in helping to maintain the health of the body through treatments such as oil therapies, and detoxification protocols such as Panchakarma (five cleansing/detoxification actions.) Ayurveda also has a vast understanding of herbs and their classification accordingly. This is all in conjunction with the individual taking their necessary medication to manage the virus itself, which is a brilliant contribution of Western medicine. There are no specific herbs scientifically agreed upon or proven or known to cure the virus itself at this time.

Diet

The topic of diet is a touchy subject for many reasons, one being the direct connection with food and emotions/memories. Dr. Rajesh Kalawadiya suggests that a “nutritious diet, Ayurvedic baseline therapy, timely allopathic treatment of opportunistic infections and regular counseling support appears to be an ideal combination in the management of HIV/AIDS patients.”69 Swami Sadashiva Tirtha uses the basic foundation and principles of Ayurvedic wisdom around food to be an important component to managing the health of an HIV positive individual and their symptoms.70 Ayurveda teaches “We are what we digest” which is different from what has been taught “we are what we eat.” If there is no food, there is no body. If people aren’t eating the best food, then it will not be that possible to have the best body which includes health and immunity. Digestion is two-fold. The first relates to the actual physical digestion of food substances in the GI Tract and the second pertains to the effect of how the mind processes/metabolizes information. With regard to physical digestion, diet plays a vast role in the reduction of diseases, the production of diseases, and the prevention of diseases. General examples of foods that increase inflammation and contribute to all three of the above categories are as such: sugar, processed sugar, excess salt, skipping meals, minimal intake of water, eggs, alcohol, fermented foods (breads, cheeses, pastas, yogurt, cheese, night shades (tomatoes, potatoes, peppers and eggplants), soy/tofu/tempeh, coffee (in excess), beef and especially pork, processed sugar (I.e. candy and soda), and all fast/processed/packaged foods. Highly processed foods, lacking adequate hydration, lend themselves as factors in inflammation. When any of the above conditions are present, they all feed off this previously mentioned list. What can be added to this is Ayurveda's wisdom of “Incompatible Foods” (such as cheese, sauce and bread combined, potatoes and eggs, bread and yogurt (depending on when and who/constitutionally). Lack of vegetables, especially green leafy vegetables and fiber overall can contribute to inflammation. The chlorophyll, which is the blood of the plant, is alkalizing and in alkalizing the “hotness” of the blood and reduces inflammation. The cellulose fibers, from vegetable and legumes, also help to clear toxins and transport them from the digestive system releasing them through our bowel movements. They also encourage bowel movements which is an essential daily function highly required for management of health. Having a healthy colon, encourages a happy mind and healthier body. It is also important to note that water/hydration daily is part of “diet” and is a natural anti-inflammatory.

Exercise

This is an important area worth discussing. Exercise is a fundamental component to supporting health; this is partly due to its effects on stimulating the lymphatic system.71 Engaging in exercise is what moves the body on all levels. Improper exercise can build up lactic acid (remember acid is acidity and a great place for inflammation to grow, along with many other ailments.) Improper breathing effects CO2 in the body and lactic acid. The lymphatic system is a system of drainage of toxins, also an important component of our immunity. If individuals aren’t sweating adequately enough/regularly, then already they can have a sort of “sewage” back up. Exercise supports metabolism and with the biochemical marriage of insulin and glucose. When people exercise, the muscles use glucose as energy molecules and when we don’t exercise enough this sugar accumulates and can cause the typical Type 2 diabetes. When people exercise, insulin and the sugars are metabolized accordingly. If there is an excess of glucose and proteins, known as glycation, then this becomes a breeding ground for inflammation and is a host to many other disease pathologies. Exercise practices can be both stimulating and anti-inflammatory.

Breathing

Pranayam (breathing exercises that cultivate our life energy and vitality) are tools that the ancient system of yoga offers us in order to support our life. Dr. John Douillard encourages stress reduction through meditation, which also involves breathing practices, in managing overall health.72 Breathing properly, regularly/consciously and with intention becomes a natural anti-inflammatory for both mind and body. It is a tool to be used with all forms of exercises that will not only maximize efficiency of the body and mind but also promote longevity. Pranayam is also a tool used in yoga to cross the bridge from the outer experiences of the world and enter into the inner terrain of the body and mind. The respiratory mechanism is both involuntary and voluntary. The breath cannot really be held long enough wherefore it can cease one’s life because the body protects itself from its own extinction, per say. Yet it is still voluntary because the breath can be manipulated in many ways. The breath serves a purpose physiologically and psychologically. The yogis also know that spiritually the breath is a vital tool. Improper breathing decreases the quality of life. The yogis knew that longer, deeper and fuller breaths add on to life and that short, shallow breathing increases degeneration. Dr. Vasant Lad, an internationally known and master yogi and physician, gave an example of life span to breathing. He teaches to observe how a dog breathes. Short, quick bursts of breath; the dog doesn’t have a long lifespan. Yet when the turtle is observed it takes deep full and slow breaths; the turtle can live approximately 100 years. Amazing! Breath is life. No breath, no life. Breathing more deeply, slowly and consciously can support the respiration of not only the body, organs but go as far as the cells and DNA themselves. This is the difference between sympathetic nervous system response (flight or fight) and parasympathetic nervous system response that involves the vagus nerve and allows an individual to feel a deep sense of peace and love. When peace can be felt within, then there is no war. When there is no war, there is no inflammation. Ayurvedic medicine says that even cancer tends to be an example of where we are at war within ourselves because love and peace are somehow hiding. The more an individual can breathe, the more they create a space for peace and love to show up. Pranayam (ones that are soothing and calming, mainly) is also a precursor to meditation. Both pranayama and meditation are natural anti-inflammatories. The more there is focus on breathing techniques and inviting meditation into individual daily lives, the more the individual can notice shifts inwardly and outwardly. Pain management techniques are showing that the usage of meditation and breathing exercises help to reduce pain and other symptoms. Pain can be an indication of inflammation.

Herbs

Swami Sadashiva Tirtha refers to an ancient Ayurvedic text called the Madhava Nidan that “fortells a disease that will come to India and from its description is known as HIV/AIDS; with its cure being and herb called Shilajit.” Swami Sadashiva Tirtha continues to describe the cause of HIV entering into the body “when there is deficient life-sap (ojas), which causes an extremely weakened immune system. When one has sufficient ojas, the HIV virus cannot develop. Ojas is lost or diminished by excess sex, improper diet, junk food, drugs, excess worry, thinking, and insomnia.”73, 74 The main herb for this condition rooted in low Ojas is Shilajit. It is also noted that Shilajit is known for its antiviral properties. With this being said, it is at least clear at this point that the Shilajit is not about eliminating the virus but boosting immunity so that the immune cells can protect the body against the invasion of the HIV virus.

This is one of many herbs that has been described in supporting immunity and increasing ojas. Other herbs include, but are not limited to: Shatavari, Kapikacchu, Bala, Diamond Ash, Mercury Compound (Makaradhwaj), Chywanprash, Ashwagandha, and Guduchi.75, 76 A study in Sri Lanka that conducted a short-term intervention trial on HIV positive patients using a Sri Lankan classical rasayana drug (rejuvenative) called Ranahamsa Rasayanaya showed some promise in stabilizing their patients but this study was only conducted for 90 days and further studies should be followed.77

There are herbs that are also anti-inflammatory such as Guduchi, Turmeric, Sandalwood, Licorice, Brahmi, Gokshura, Coriander, Manjistha, Bhringaraj, Musta, Bhumyamalaki, Katuka, and Purpura. These herbs support not only addressing inflammation but also the function and health of the liver. Some of these herbs also possess properties of anti-bacterial, such as Guduchi and Turmeric.78 As mentioned earlier, Dr. John Douillard has spent time researching the relationship of the lymphatic system to the gut, along with its associative organ the mesentery, and from this he has suggested that herbs of an anti-inflammatory nature along with herbs that encourage the proper health of these systems include: proper hydration, Manjistha, Beets, Turmeric, and Tulsi.79, 80

CONCLUSION

What does all this mean at this point? Western medicine has made tremendous stride in the management of HIV, and prolonging the life of HIV positive individuals through the usage of pharmaceuticals. Inflammation has yet to be a targeted study with the intention of possibly reducing the inflammatory process created by the HIV virus. Western medicine does not have a cure at this point for HIV. It has managed to significantly reduce the exposure to the virus by stabilizing individuals who are already HIV positive and getting them to levels of being undetectable, so that HIV is untransmittable. Reduction has also happened through education, through the ongoing usage of protective methods such as condoms, and through the medication PrEP/PEP that prevents the virus from infecting individuals. There are still parts of the world that struggle with HIV. This is partially due to governmental political issues and economic/affordability/availability issues. It may also be added that general fears and stigma still exist around the world, but there is hope that this too shall pass as the continues to make its way throughout the world and replace the memories of the past with ones of hopefulness.

While western medicine has made tremendous progress in reduction, it fails at addressing an individual’s wholeness; it does not offer much more than the previously mentioned steps to help reduce or caretake other HIV related complications such as inflammation, or even the side effects associated with the medications that HIV positive individuals must take for medical management. This is where Ayurveda can have a great deal to offer. Through Ayurveda, HIV positive individuals can be seen not as afflicted people, but people living with a chronic disease as manageable as diabetes. Ayurveda can help manage the optimization of health by offering a strong dietary foundation, exercise practices to encourage health, breathing/meditation practices to help stabilize the mind and nervous system, and herbs to assist with increasing immunity and decreasing inflammation within the body, while individuals continue to maintain their medication regimen consistently.

One other thought to consider is that a virus is a virus is a virus, but how it manifests and the progression of its pathology, according to Ayurveda, will express itself with some variation as part of an individual’s constitution. In that, an individual who may be Vata or Pitta or Kapha predominant, with a secondary constitution –of whatever the configuration that may be, whether Vata or Pitta or Kapha– will tend to have the virus, as with any disease pattern, vary in its expression. More research should be conducted in determining the accuracy of this statement with regard to HIV and HIV-related Inflammation. If/when an individual arrives at the AIDS stage of disease, examination according to Ayurvedic prakriti and vikriti should be conducted in order to confirm how Ayurveda teaches in that as with almost all diseases, they can be broken down according to symptoms based on constitutional configuration of Vata, Pitta, Kapha. For instance, an individual who has a cold and is Vata predominant will have clear, scanty mucous with a dry cough, but a Pitta predominant individual who has a cold will have more productivity in cold and cough and the mucus will be yellow/green; a Kapha predominant individual with a cold will create copious amounts of white, thick mucous and a productive cough. The same may hold true as per HIV and its manifestation based on prakriti/vikriti concepts.

A reminder with regard to medically managed HIV is that once HIV is at the Undetectable level of status, the individual is considered equal to an individual who is HIV negative; however, eventhough the virus has been virologically suppressed the inflammation due to the virus itself is an essential aspect of an individual’s health that should still be managed appropriately. For it is with this inflammation that the body is still susceptible to other ailments and potential diseases.

Based on this research, it is clear that both Allopathic medicine and Ayurvedic Medicine can serve the community together as allies. Further studies should be conducted measuring the quality of life in an HIV positive individual involved in a holistic approach that involves both Ayurveda and Allopathic Medicine. A holistic approach can benefit not only individuals living with HIV, but anyone else with a condition, such as cancer, diabetes and any other ailment. Western medicine has come a long way, and with its relationship to Ayurveda it may be able to deepen further and increase its success rates. The West can learn so much from the East, and in doing so thrive significantly. Ayurveda recognizes the importance and necessity of Western medicine as needed, and it is understood in Ayurveda that everything, every system serves a purpose and can work together.

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19- Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD; Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016;316(2):171-181. doi:10.1001/jama.2016.5148 Last corrected on November 13, 2016.

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ABSTRACTS FOR HIV AND INFLAMMATION

Journal: AIDS

Title: Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward.

Author: Anish P. Mahajan, Jennifer N. Sayles, Vishal A. Patel, Robert H. Remien, Daniel Ortiz, Greg Szekeres, and Thomas J. Coates

Abstract

Although stigma is considered a major barrier to effective responses to the HIV/AIDS epidemic, stigma reduction efforts are relegated to the bottom of AIDS program priorities. The complexity of HIV/AIDS related stigma is often cited as a primary reason for the limited response to this pervasive phenomenon. In this paper, we systematically review the scientific literature on HIV/AIDS related stigma to document the current state of research, identify gaps in the available evidence, and highlight promising strategies to address stigma. We focus on the following key challenges: defining, measuring, and reducing HIV/AIDS related stigma as well as assessing the impact of stigma on the effectiveness of HIV prevention and treatment programs. Based on the literature, we conclude by offering a set of recommendations that may represent important next steps in a multifaceted response to stigma in the HIV/AIDS epidemic.

Journal: JAMA. 2016;316(2):171-181

Title: Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy.

Author: Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD

Abstract:

A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex.

Journal: Ayu. 2010 Apr-Jun; 31(2): 197–204.

Title: A Short-term intervention on HIV positive patients using a Sri Lankan classical rasayana drug- Ranahamsa Rasayanaya.

Author: Somaranthna, KIWK, Chandola, H.M., Ravishankar, B. Pandya, K.N. and Attanayake, A.M.P.

Abstract:

Rational use of Rasayana therapy, in the management of HIV infected individuals, could potentially stabilize the destructive control mechanisms, by modulating the psycho-neuro-endocrine-immune axis. The objective of the present study has been to determine the short-term effects of Ranahamsa Rasayanaya (RR) in HIV infected patients. A total of 27 patients with documented HIV infection were randomly assigned to two groups, Group A – 5 g of RR twice daily with cow's milk and sugar. Group B – Only routine modern therapy was continued, if any they were taking, including highly active anti-retroviral therapy (HAART). Absolute CD4+ T-cell and total lymphocyte counts were measured in these patients, registered under Group A. Only 21 participants completed the study protocol (In Group A, 15 patients and in Group B, 6 patients). Initial mean CD4+ T-cell count was 304.50 ± 43.36 cells/microliter, which increased to 430.44 ± 66.01 cells/microliter by 41.36% (P<0.05), measured among 9 patients out of 15, who received RR in Group A. The RR seemed to be a safer adjuvant in people with HIV infection with respect to absolute CD4+ T-cell count over a 90 days treatment.

Journal: Avert. https://www.avert.org/about-hiv-aids/how-infects-body

Title: How HIV Infects The Body And The Lifecycle of HIV

Author: Avert Staff

Abstract:

Understanding how HIV infects the body is important to help explain how HIV drugs work to treat the virus. The science behind the virus and the HIV life cycle help put wider prevention, treatment, and general HIV awareness into context.

Journal: Nature. 2014 Jan 23; (7484): 509-514

Title: Pyroptosis drives CD4 T-cell depletion in HIV-1 infection.

Author: Gilad Doitsh, Nicole LK Galloway, Xin Geng, Zhiyuan Yang, Kathryn M. Monroe, Orlando Zepeda, Peter W. Hunt, Hiroyu Hatano, Stefanie Sowinski, Isa Muñoz-Arias, and Warner C. Greene..

Abstract:

The pathway causing CD4 T-cell death in HIV-infected hosts remains poorly understood. Apoptosis has been proposed as the key mechanism for CD4 T-cell loss. We now show that caspase-3-mediated apoptosis accounts for the death of only a small fraction of productively infected cells. The remaining >95% of quiescent lymphoid CD4 T-cells die by caspase-1-mediated pyroptosis triggered by abortive viral infection. Pyroptosis corresponds to an intensely inflammatory form of programmed cell death where cytoplasmic contents and pro-inflammatory cytokines including IL-1β, are released. This death pathway thus links the two signature events in HIV infection––CD4 T-cell depletion and chronic inflammation––and creates a vicious pathogenic cycle where dying CD4 T-cells release inflammatory signals that attract more cells to die. This cycle can be broken by caspase-1 inhibitors shown to be safe in humans, raising the possibility of a new class of “anti-AIDS” therapeutics targeting the host rather than the virus.

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