Stuff You Should Know - How HIV/AIDS Works, Part I

Episode Date: December 1, 2015

AIDS is one of the most well-known and most misunderstood diseases humans are susceptible to. In part one of this two-part series, Josh and Chuck explain how the disease is contracted and how it works. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. Welcome to Stuff You Should Know from HowStuffWorks.com. Hey, and welcome to the podcast. I'm Josh Clark, there's Charles W. Chuck Bryant, and this is Stuff You Should Know, the podcast.

That's right. Greetings, sir. Two-part podcast, huh? Yeah, today, release day, not the day we were recording. We're not that good. But today is December 1st. It is World AIDS Day. And we were gonna record this a while ago,

and then I noticed it was World AIDS Day coming up. I was like, well, why don't we wait and record it later and release it then. And then there was so much stuff. Right. That it became clear it was a two-parter. And I still don't think we're gonna even, well, we'll scratch the surface.

That's selling it short. But you could have an entire podcast series about HIV and AIDS. For sure. There's so much information. There really is. It's like daunting. It is, but it's luckily because it's such a huge,

massive topic, an important topic, there's a lot of information out there. So usually we do pretty well with those. Don't be daunted is what I'm trying to say. Well, I'm just nervous, you know. I don't wanna mess this one up. Well, we'll mess something up here there, I guarantee it. But yeah, how about this then?

We pledge, we often read corrections, but we super pledge to correct anything on this. Sure. Because we're bound to mess something up. This is a lot of stuff. Yeah. You wanna start from the beginning, don't be nervous. That's fine.

Everybody tell Chuck it'll be fine. It'll be fine, Chuck. So it's a collective sound of our audience. Like high-pitched audience voice. So Chuck, when you think of HIV AIDS, you typically tend to like go back to the late 70s, early 80s, when like the real panic first started.

But later research, and that's about the time it arrived in the United States. But later research found that HIV, the first case of it came in 1959, actually. And that they think that it goes back even earlier than that. But this is the first documented case. They had blood work of this guy who died

mysteriously in Kinshasa and Congo, right? Yes. And he had the first documented case of HIV. That's right, HIV one. There are two HIVs, HIV one and HIV two. The one that has been responsible for the global pandemic is HIV one. Right.

And there's been a lot of debate over the years about where it actually came from. Most people agreed that it was primates in Africa. Right, that it started as SIV. Yes, Simeon Immunodeficiency Virus. Right, HIV we should say is human immunodeficiency virus. Yes, and AIDS is acquired immune deficiency syndrome.

Yes, they're not separate things. It's actually been very much confused in the media. We're gonna set the record straight. Yeah, and at the end, boy how about this for a tease, at the end of the second episode. There's a big musical number. No, three days from now there is an argument that we should not even call it AIDS any longer.

Yeah. So how's that for a setup? People are gonna be waiting or they could just Google it. Or it's fast forward. Well, but they can't fast forward in time, my friend. No, but by the time these come out they'll have been done and they can fast forward. Yes, that's true.

So what scientists believe this is the most current agreed upon theory is that a type of chimpanzee in West Africa is the source of HIV-1, which was transmitted to humans. They don't know for sure how, because they weren't there. Probably Bushmi, undercooked Bushmi. Exactly, wanting to eat a chimpanzee and there's blood

and all of a sudden it spreads to humans and mutates. Chimpanzees fight back. They do, that's what I've heard. Yeah, but yeah, if you ingest blood that was infected with SIV and then the SIV virus evolved into HIV in humans, that's the likeliest version of what happened. It's somewhere in West Africa

and probably the 30s or 40s. Yeah, and they, I saw one article that said that they think that it could have originally started in primates even in the 1920s, which is just crazy to think about like the roaring 20s somewhere in the depths of Africa, SIV was brewing, you know? It seems like such a modern thing.

For sure. And then in the late 70s and early 80s is when these normally healthy people in Los Angeles and New York started getting sick, didn't make any sense. And in 1982, they first started using the term AIDS. Right, and before that, they had a really clumsy name for it. Oh, for HIV?

Yeah, yeah. Are you ready? Yeah, yeah. So just the abbreviation is clumsy, H-T-L-V-3 slash L-A-V. That's just the abbreviation. The full name of what was originally the term for, was it, is it AIDS or HIV?

No, for HIV. Human T-cell lymphotropic virus type three slash, lymphidinopathy associated virus. Yeah, and I think they all looked around the room, whoever proposed that and said, guys, if we wanna ever get this in the news, let's just sweeten that and shorten it to HIV. You, the person who proposed it,

you have to go buy everyone Quiznos for lunch. And actually, we should say Chuck, that this definitely just kind of, we're giving the fairest overview of this, but there's a really, really interesting movie based on what I understand is an equally interesting book called And The Band Played On. Yeah, my brother worked on that movie.

That was a great, great movie. I watched it again in the last few months and it's just as good as ever. Yeah, that's where he got to work with Alan Alda and Lily Tomlin and like some real legends. So yeah, there's a lot of people in it. Phil Collins does a great job. Oh, is he in it?

Yeah, he plays a bathhouse owner who's reluctant to close down. Interesting. But it basically chronicles the early investigation into what the heck was going on, what was suddenly killing gay men in San Francisco and Los Angeles and New York. And it seemed like it was just targeting gay men so much

so that early on, like the non-clinical term for this was gay cancer is what people called it. And all of a sudden, doctors were reporting that otherwise healthy men were suddenly getting really, really rare cancers, rare types of pneumonia, stuff that people who have like zero immune systems die from. All of a sudden, they were just turning up with this stuff.

And it was very curious and very scary, especially in the gay community. And then it wasn't until, what was it, 1982 or 83, 1983, where they identified the virus and there were competing teams, this French team, who most likely did discover the HIV virus on their own. And Alan Alda, the American team, who may or may not have ripped off their findings

and unfairly taking credit for it. But it's- I've never seen that movie. Fascinating. It's fascinating. It's moving. It's got it all. It's really good.

It's like epidemiological detective stories threaded throughout a lot of cultural history. It's really, really worth watching. Well, in episode two, we're also gonna get to that book in the so-called Patient Zero, which will be coming up on Thursday. Yeah. Another tease.

Yeah. All right, so, and we should point out too, the reason these men were dying of cancers and pneumonia and things like that is because, and most people know this by now, a lot of this, we think is just common knowledge, but you never know here in 2015. True.

You don't die of AIDS. You die of complications from AIDS, infections, other sicknesses and diseases because you can't mount any kind of immune response. Right. Okay. I think that was a good move. Excellent.

Yeah. Well, smooth move, excellent. You never know. Some of this stuff, I'm like, do we really in 2015 have to say this stuff? But you do. Well, the weird thing is, you do especially in 2015 is compared to say like 1990.

Right. Because there's become this idea that AIDS has been, as being largely conquered, it doesn't have to be worried about as much. Not true. And I think the education on HIV and AIDS is not nearly as widespread as it once was, like when we were like teenagers.

Yeah. You know, like everybody knew everything about AIDS basically, at least had a working knowledge of what AIDS was, how you got it, how widespread it was. And it seems like today, it's that kind of public information isn't nearly as widespread.

Yeah, I think that's one of the issues now is that a large segment of the public is like, yeah, they have the AIDS cocktail. Look at Magic Johnson, it's all great. Sure. And it is great when we're gonna talk about why he's still with us, but it's still a very big problem. Here's a stat for you.

And these are the most recent stats I could find. 78 million HIV infected people worldwide to date. 39 million people dead. Compared to World War II, which killed 40 million people, that helps put it into perspective a little bit. Right. And Sub-Saharan South Africa,

which is where AIDS and HIV are most threatening. This is a scary stat, dude. One in 20 people have HIV. What? And Sub-Saharan South Africa, and they account for 71% of all cases worldwide of HIV. Man alive. I know, it's a very dire situation over there,

to say the least. Wow, that's especially chilling because if you look at the statistics in the United States, like it's slowing, and it's definitely, if you look at the statistics, it seems like it's being figured out. Well, yeah, well, depends on what demographic though, it's rising in some demos.

Right, yeah, for sure. If you take the United States as a whole, the picture seems okay, but yeah, if you start to break it down into specific subgroups, then some are definitely doing better than others, as far as new infections, death from infections, that kind of stuff goes. Absolutely.

So HIV is a scary disease, and it was super scary before we knew much about it, because it's still technically incurable, although we're gonna get to that. There are some rare cases where it's, what do they call it, functionally cured? Yes, it does seem like there's at least one person who is widely considered to be fully cured,

and he is a proof of concept that you can cure AIDS. And that's coming in part two. What are we gonna do in part one? We're just, yeah, Janet, we're just talking, basically. This is all one big setup for part two, apparently. No, it's not. So one reason AIDS is so deadly is, it's sort of a conundrum,

because AIDS, you can't catch it through the air, it's not airborne, you can't catch it from a kitchen counter, you can only catch it through very specific ways. Intimate contact. Intimate contacts, you would think, hey, it's not gonna be that widespread, because intimate contact is something you can avoid,

and so it should be a pretty slow spreading disease. Right, and not all intimate contact includes like whips and chains and stuff like that. Intimate contact is basically any situation where, you know. Sure. Love. Intimate contact is basically any situation

where blood is transferred or semen is transferred. Right. So it doesn't necessarily just mean inner course of any sort, it can also mean sharing needles. Yeah, absolutely. And it definitely does mean sharing needles too, that's a very high risk subgroup. For sure.

But the reason, and here's the key, that AIDS has spread in HIV so widely and quickly is because it can, you can have HIV for more than 10 years without knowing it. Right. And if you are a promiscuous individual, I did a little math, let's say you have, let's say you're considered highly promiscuous.

What do you rate that as? 100 partners a year. Okay. Which apparently also, so I wanna say this too, AIDS being associated with gay people, gay men especially, is hit at precisely the worst possible time in the history of homosexuality in the world because it came right after Stonewall

when men were just starting to be like, it's all about gay pride. Right. And we are loving life and having more sex than we've ever had ever as a community and having a hundred or a couple hundred sexual partners in the late 70s among gay men was pretty standard.

Yeah, I don't, it definitely, I don't think it made you an outlier. No. You know. So please continue. So, and I caveat all this with, I'm assuming, well, let me just get into it. Okay.

Let's say a hundred partners in a year, let's say 25% of those partners are promiscuous. And then this is, you just broke my brain mathematically already. Then they have a hundred partners. So that's 2,500 people. Okay. And this is not 2,500 people who are infected.

This is assuming, let's say, that there's a smaller percentage that don't use condoms. And even if you don't use a condom, it's not like every time you have sex, you're going to transmit AIDS. But this is a possibility is what I'm saying. Let's say 25% of that group, 2,500, are promiscuous. You end up from that one single person,

62,500 people who could possibly potentially be exposed if nobody wore condoms at all. And of course that number goes way down because people are smarter now and use condoms. But in the late seventies, I mean that number could be accurate, you know? Oh yeah, easily. So-

Because I mean, what are you gonna wear a condom back then for? Nobody's getting pregnant, you know? Yeah, I mean, there was no reason to. Right. So you can see how it can spread so quickly. And that is also the reason why it stays latent, or the fact that it stays latent for so long.

That's the- The single reason why you need to get tested regularly. Gay, straight, black, brown, candy-striped. It doesn't matter, get tested because you may have it and not know it. And HIV, AIDS is an outlier as far as diseases go in that there's no vaccine against it. There is no way to easily treat it.

It spreads quickly and because it has what's called late onset symptoms, like you said, people go 10 years after being infected before they realize they're sick. Especially if they're not getting tested in the meantime. And so it just keeps spreading and spreading and spreading among people who think they're healthy but who actually have the virus.

Yeah, and if you're promiscuous, it's not like you can name the partners you've had over the last decade to tell them maybe you wanna get tested. Right. Yeah. And then even more than that, and again, so with the gay community, it's such a at risk subgroup.

We'll explain why in a second. But one of the reasons why it spreads quickly in the gay community is because it's a relatively small community. So that means that the pool you have to draw from for sexual partners, statistically speaking, you're at higher risk. Yeah, because it's smaller.

Because it is a smaller community. But even beyond that, biologically speaking, they're at higher risk as well, gay men are. Yeah, well, we should go ahead and talk about that. Let's do it. The main reason is it's easier to get HIV from anal sex. And that is men and women. Yeah.

Because, well, there's a few reasons for that. One, the lining of the rectum is very fragile. It tears very easily in intercourse. Lots of blood vessels. Lots of blood vessels. The cells that line the rectum are more susceptible to HIV than cells of the vagina. Right.

And then semen and rectal mucosa, which is the lining of the rectum, carry more HIV than vaginal fluid. Right. So boom, right there, you're, I think, 18%. 18 times. 18, oh yeah, 18 times more risky. With anal intercourse than just regular vaginal intercourse.

Right, and you are, yes. And gay men and straight women are at equal risk of AIDS through unprotected sex, anal-ly. Yes. Because it doesn't matter that you're a man or not. No, a man's rectum is the same as a woman's. Right, exactly. As far as I know.

I'm pretty sure you're right about that. Yeah, I mean, it says in here, the risk, yeah, that's exactly right. Another reason is role versatility is what they call it. Whether or not you're a top or a bottom, you can get it either way by giving anal sex or receiving anal sex. So you're kind of in a lose-lose situation.

Precisely. So I never knew that until I studied this. That switching back and forth. No, no, no, like why do gay men get AIDS, HIV more? Than straight people. If it's passed through intercourse, and now it all makes sense. All right, going back to why AIDS is so scary and HIV,

I feel like we're interchanging those when we shouldn't be. No, let's lay this out right here right now. You ready? Yeah. Because I didn't realize this fully until we started researching this episode. So HIV is a, it's called a progressive disease.

Yes. And that it goes through stages. So technically, an HIV infection has zero, stage zero to stage three. And all of this is based on the number of T helper cells you have in a milliliter of blood. A normal healthy person has about a million T helper cells called CD plus four cells in one milliliter of their blood.

As you, as the HIV infection progresses, it diminishes the number of these helper cells. And as it goes down, you go to certain stages. So like stage three HIV is, I think, 500,000 per milliliter of blood or less. And then once you reach 200,000 CD plus four cells in your blood, you have AIDS. So AIDS is not a separate disease.

It's not a new condition that arises out of HIV. Yeah, it's just part of a classification system. Yeah, it's basically end stage HIV. It's stage four HIV. And it's really bizarre that they have a whole different name for it if you think about it. But AIDS is just basically the end category of HIV. And it used to be, that was a death sentence.

Yeah. Once you had AIDS, you were basically dead. And in the 80s and 90s, especially before I think 1995 when the AIDS cocktail, which we'll talk about, came out, it was, you basically were diagnosed and you were dead in 12 to 18 months. That was that. Now it can keep going.

I mean, people just live for decades now with AIDS. But once you have AIDS, once you have that designation, you have that for the rest of your life unless you're cured, which has only happened a handful of times. Yeah, and there's a guy named Todd Haywood that wrote this great article saying it's time to retire the medical category of AIDS.

And he makes a lot of good reasons why we should just call it HIV disease. Like you would say heart disease. Right. So we're not gonna say HIV disease in this show. We're not that big a trendsetters. Well, I just wanna go with traditional terms because some people learn, but I think there is a good case

to be made for that is what I'm saying. Yeah. I mean, this is also another, another mark in that guys in favor of that argument is that AIDS was named in like 1983. And we've learned so much about this disease since then. And one of the things we've learned is this is a progressive disease that goes through stages.

AIDS is just the end stage of it. Why have a different name for it? Yeah. You know, it's not the same in any two people. And HIV disease is just more all-encompassing, I think. Yeah. So we're not gonna use it. Are we, that's gonna be tough.

What to not say HIV disease? Oh, AIDS, I thought you were saying. I was gonna, yeah. And the final reason, boy this took like 20 minutes to get back to this. Wait, what are we talking about? The final reason that HIV is super scary is because of its very unique way it manifests itself,

which is it invades and destroys the immune system. The very system that is supposed to protect you from disease is ruined. It's, yeah, HIV is a virus. So it behaves like a virus, but other viruses attack say like your fat cell that you could care less about. So who cares? AIDS or HIV attacks your immune system directly.

The cells, a specific type of cell in your immune system. And that's what eventually leads to your death. Or it used to definitely lead to your death, when you know back in the day. Yeah. All right, I think we should take a break and we will talk a little bit about how it is and is not transmitted right after this.

On the podcast, HeyDude the 90s called David Lasher and Christine Taylor, stars of the cult classic show HeyDude bring you back to the days of slip dresses and choker necklaces. We're going to use HeyDude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it, and now we're calling on all of our friends

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Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple podcasts, or wherever you listen to podcasts. All right, Josh, it's 1984. George Orwell is in charge. I'm in elementary school. OK. And AIDS is a scary thing.

And you can get it from toilet seats and mosquitoes. Skittles. And kissing. Yep. And shaking hands. Shaking hands. Looking. Yeah.

Being too near to somebody. It was very scary as far as times go to be a kid. None of that stuff is true. Think about it, man. We were raised during that horrible little Venn diagram where the Cold War and the AIDS scare overlapped. Yeah. Like we just basically didn't want to leave our houses.

We missed out on the days where free sex and drugs was like didn't hurt anybody. Right. And just sprinkle in a little stranger danger in there too. Why not? Yeah, a little satanic panic. Sure. Man, the 80s.

What a crazy time. Now that we've got a little distance from it. They were crazy. Parachute pants. What was that all about? Culture club was actually great. Yeah. That's the only good thing about the 80s.

The ways that you can get HIV, sexual contact, sharing needles, intravenous needles, breastfeeding, mother to baby, infected mother to fetus during pregnancy at birth, and blood transversions, which used to happen a lot and doesn't happen that much anymore. No, it's another thing for me and the band played on was this big to do about whether or not blood donation centers, say like the Red Cross,

should have to test blood for this new disease. They were like, do you know how much this is going to cost? It's going to completely dent the blood supply. People are going to die because we have to do this. But then as it became very obvious that this stuff spread really easily through blood transfusions, they definitely started to check it. They came up with, I think, a fairly cheap test for it in 1985.

Oh, really? Yeah, the FDA approved something in 1985 to test it. But I mean, without these tests, Chuck, you have a 9,250 chance out of 10,000 of acquiring HIV from a blood transfusion that's a lot of HIV. Really? Yeah.

Man. Yeah, those are pretty high chances. Yeah, totally. Because think about it, for unprotected anal sex, if you are receiving, you have a 138 out of 10,000 chance. OK. This is 9,250 out of 10,000 chance from a blood transfusion.

I tried to find those stats, actually. I couldn't find that one. Oh, I got some more for you, buddy, if you want to. Well, I was trying to find when I was doing my stupid mathematical equation earlier, I was trying to find out the possibility or percentage rate of having unprotected anal sex. Like, what are your chances of getting HIV?

If you are giving, you have an 11 out of 10,000 chance. So 1.1 out of every 1,000 encounters. OK. So even if my, yeah, that 62,000 number goes way, way down, thankfully. But I think it's still, you know, the worst mention. This is based on, and I should say, this is based on the distribution of HIV

infected people across the United States as of, like, I think, 2010. Oh, OK. So, I mean, it's all statistics, man. It depends on where you are, who you're hanging out with. I mean, if you're, like, sharing needles with, like, addicts in the street, your risk is probably going to be a little higher than the national average

across the United States, you know what I mean? Absolutely. So it definitely is contextual. It's almost to the point where it's like these stats are meaningless, really. Yeah, true. But they do put a, I think, stats help people put, like, a face to things.

For sure. The blood transfusion one is a tad eye-opening. Yeah, for real. And then finally, we need to mention, and the only reason we mention this is because technically, it is possible. There has been one case of HIV infection through open mouth kissing.

Yes, but. I hesitate to even say that because people like Josh and Chuck said you'd get through kissing. So there has to be bloody gums of an HIV-infected person present. I think both people have to have bleeding gums. And one of the people has to have HIV. And they just make out.

And the HIV is transferred that way. That clearly doesn't happen much. Apparently, it happened at least once, which is pretty crazy. But yes, you're very, it's extraordinarily unlikely that you're going to contract HIV through open mouth kissing. It does not transmit. Well, here's the good news.

This sounds like it's all bad news. The good news is it is not airborne, does not transfer through surface contact. It's very fragile outside the body. Super fragile, which is awesome. Like, once saliva or blood dries up, there's practically zero chance of transmission. Right.

And yeah, it doesn't live very long outside the body, which it sounds bad, but it could be a lot worse. Oh, yeah, super hardy. Transmitted through breathing through the air. That'd be bad. It is not transmitted through saliva, tears, or sweat. And saliva and tears have trace amounts of HIV. They have not detected HIV and sweat at all,

which is good news for me, because I'm a sweaty guy. Yeah, it's good news for us. I guess you're right. Insects, I guess we need to talk about the whole mosquito thing, because I think I talked about this in the virus episode. Was it virus or something? Maybe, I remember.

It might have been just the mosquitoes one. Oh, yeah, maybe so. I remember thinking when I was a kid, and this is before I'd read anything about it, I came up with it on my own. It's like, wow, mosquitoes, those are like little needles. I bet they could transmit AIDS or HIV, and it's not true. So here's why.

There's very, very good scientific reasons why you can't catch HIV from a mosquito. When a mosquito injects its proboscis into your skin. Gross. It uses its own saliva to lubricate this whole thing, right? Gross. And when it draws blood out, it can conceivably draw

the HIV virus out of an HIV-infected person through their blood, right? In theory, yeah. But there's a couple of things that happen after that. One, the mosquito goes and digests its blood meal. Gross. Two, so it doesn't just immediately go to another person and pick up some more blood, usually.

Two, the virus does not replicate within the mosquito. And three, that virus isn't present in the mosquito's saliva. So even if it went and drank the blood of an HIV-infected person, got HIV in it, and then went and injected you and got some of your blood. And then went back and digested its blood meal. You still would not catch HIV from that.

There would be no transfer of HIV from that person's blood into your body. Yeah, and they've even investigated in parts of Africa where AIDS and HIV are rampant and where mosquitoes are rampant and transmit all kinds of diseases. And they've still said, nope, nope, nope. Not happen. Yeah.

Thank God. And then, of course, toilet seats, swimming in a pool with someone, eating at the same restaurant, sharing a fork. Even social kissing, closed-mouth kissing. Did you know there was a name for that? Closed-mouth kissing? Yeah, I call it no fun.

Social kissing. What, like the French do? Yeah, like Frenchies, yeah. Yeah. Or I call that a wedding ceremony kissing. You don't often see people when they say you may kiss the bride. Just like, go full-time. Oh, it's gross.

I think I saw one guy do that once at a wedding. I was like, oh, man. You just do, like, a nice, respectful kiss on the lips. You and I went to a friend's wedding recently, and they had a nice kiss. Tony and Wendy, congratulations, by the way, guys. Well, it was nice about it. It was not social kissing, but it was not, like, gross.

It was a good wedding kiss. A good romantic but tasteful kiss. Perfect. Perfectly put. Well, that's nice. I hate that I missed that. Do you? Maybe I can get my hands on video of it or something else.

Yeah, show me later. Yeah, virus talk with Josh and Chuck, by the way, October 2014. Yeah, but I really think it was the Mosquitoes episode that you talked about it in. No, no, no. I mean, we're about to talk about viruses because HIV is a virus. Agreed. And as you learned in virus talk, viruses require a host cell because viruses are basically not their own thing.

Like they just are carrying information, basically, to invade another cell and poop it out in there. Right, exactly. I mean, they are the definition of, I guess, what Dawkins would have called the selfish gene. It just, the whole purpose, if there is such a thing as a purpose to the universe, the whole purpose of a virus is to create more viruses. That's it.

And when you think about the effect that a virus like HIV has on human beings and has had on the entire population of humanity over the last few decades, to think that these viruses aren't even thinking that they're not, that all of that is just a byproduct of its... Signular purpose. Yeah, of replicating itself. It's kind of astounding. Yeah.

It's just so... And creepy. Yeah, it is, because it's just like the virus couldn't care less, because the virus couldn't care. Yeah, literally. It doesn't have feelings. It's just, it's bizarre to think of it like that. Yeah, it truly is.

So viruses, including HIV, they don't have cell walls or nucleus. It's just those genetic instructions, and it's got a little protective shell, a virus HIV particle called a virion, a virion. I think both of those are acceptable. All right. It is spherical and one 10,000th of a millimeter in diameter. And it has little buds sticking out of the top of it, where it's basically, it docks with the host cell.

So like you said, it's just some instructions to replicate itself. It's RNA strands wrapped in like a little protective shell made of proteins and lipids, I think. And it enters the body and it goes straight for your lymph nodes, I believe. Yeah, because that's where the T helper cells like to hang out. And of course, because it wants to wreak havoc on your body, it goes straight there. And let's talk a little bit real quick about T helper cells. So basically, you have T cells and they are like these, they're like jaws from James Bond.

Okay. Lurch from the Adams family. You rang. And Jason Voorhees all rolled into one. Wow. As far as like white blood cells in your immune system, they are mindless, bloodthirsty killers. Hey, Lurch wasn't a bad guy. No, but he's scary, intimidating.

Okay. And you do a pretty good Lurch, by the way. That's awesome. Very good. I thought it was a great Lurch. I appreciate it. So it's just vocal fry. These things are just kind of hanging out.

These T cells are just hanging out, waiting to be told what to do. So okay. So there's one more character that they're like. Master Blaster. Oh yeah. But they need the master guy. Right. A little shrimp.

Yeah. And the little shrimp comes in the form of the CD4 plus T cells, the T helper cells. They go to the T cells and say, hey, get ready, get all revved up and go get those guys. So HIV goes right to the CD4 plus T cells, the T helper cells, and that's its preferred cell to attack. Those are the ones that it hijacks and it goes up and it docks with the CD4 plus T cells and it basically takes over. It hijacks it and turns those cells into HIV, Varian factories.

That is correct, sir. And more specifically, there are seven, it's a seven part process in how HIV invades the T cells. And replicates. Yeah. Because I don't know if we said that. The replication is a really big part of HIV and why it's so devastating. Yeah, we did.

Did we mention that? We'll talk about it a little more. Okay. Let's just get to the nitty gritty though. Yeah, and we should point out, too, we're going to talk about the drug cocktail later and then each stage, there's another, there's a corresponding drug in the drug cocktail that helps disrupt this process. Yeah.

It's like a very smart, multi-pronged approach. It really is. Because the HIV virus is like, what the hey, what's going on here? I can't get anything done and it just leaves. All right, so part one binding is when the HIV actually attaches to the immune cell, the T helper cell, and they actually fuse together. Yeah. There's special proteins, there's proteins on the helper cell that allow these things

to dock with it. That's right. It's like a receptor site. Yeah. It's like a couple of rednecks and boats when they tie their boats together out in the lake on 4th of July. I was thinking more like a space capsule in the ISS, but I guess it's a lower tech version of it.

Rednecks tying their boats together. One man's space capsule is another man's party boat. Yeah. Some redneck boater who was listening to this and didn't realize he'd be implicated. He was like, hey, I'm not gay. He just said that to his iPhone. Number two, reverse transcription. Reverse transcriptase, it's a viral enzyme.

It copies, we said that HIV was RNA initially, correct? I don't know if we said that. It's a retro virus, so the genetic instructions that are inside the virus is RNA, not DN. Right. But it goes through the reverse transcription process where the virus's RNA becomes DNA. Right. And it just, when it docks with the helper cell, it does this little bit of work on its own.

It says, it's got this little enzyme. It runs its RNA through it and there's a DNA strand that it just built, right? Correct. Number three, integration. Now you have your DNA and it is carried into the cell's nucleus by something called viral integrase, binds with that cell's DNA, and now you are no longer a retro virus, you are a pro virus. Right.

But then, strangely, the cells DNA, the helper cells DNA, takes this new instruction, these new blueprints, and spits out RNA again. mRNA, correct? Right. It's called messenger RNA, and it is instructions on how to build new HIV virions. Yeah. It all sounds very sinister. It does, because if you think about it, on a cellular level, it is like I'm trying to

kill this thing. Right. But it's very insidious in that it comes up with, it translates its own little instruction manual into the language of the cell, inserts it into the cell's main section, the brain of it, and makes the brain spit out new instructions that are taken to the rest of the cell. So, it almost like it gets the stamp of approval from the cell to go for the other parts of the cell to start building these new parts for the virus. Yeah.

We're totally humanizing it by making it sound like it's nefarious, but it does seem that way. Yeah. You know? It's very interesting. So, that last step was called transcription. Then you have translation. You've got that mRNA at this point, it's carried back out of the cell.

This is like a work order. Yeah. Exactly. So, the brain of the cell and then basically follows a natural progression where these long chains of proteins and enzymes are strung together. By the own cells, own functions, and own components. Yeah. It just starts doing its normal thing.

Right. But it's not doing its normal stuff any longer. What it's doing is using its energy and time to build new HIV virions rather than go-prime T-cells. Exactly. Part six, assembly, the RNA and viral enzymes, they get together at the edge of the cell, and another enzyme called proteins basically cuts. I don't really understand this part.

So, imagine what's more efficient than doing like making one cell at a time, having somebody just spit out a whole bunch of the same parts and then assembling them later. One of the steps of assembly is cutting them into individual bits from these long chains of polypeptides. And then finally, budding is when it actually splits off, it pinches out from the cell membrane, becomes its own thing, and one of the key components there is it doesn't have to destroy the host cell in the process. No, it doesn't.

There's a lot of viruses out there that just keep building and building and building until they literally rupture the cell, and that's how they spread through the body. These like say, hey, thanks for a little bit of that lipid action. I'm now a new HIV virus, but you can keep going on and build some more virions. I don't have to destroy you to spread. It's really a nasty, nasty disease. It really is. And how it works.

So, eventually the helper cell does figure out that there's something terribly wrong, and it self-destructs. But this makes the whole thing even worse. So, the CD4 plus T helper cell is not out there doing what it's supposed to be doing, priming T cells to attack the HIV. Instead it's spending its time making more HIV, and then when it finally is like, this is messed up, something's really wrong, I need to self-destruct, it actually signals other CD4 plus T helper cells to come surround it, and then it basically blows up, taking

them with it. Yeah, it's like a mass suicide. Yeah, it's like a massacre down there on the cellular level. So this is one of the things that makes HIV so insidious. All right, I think we need to take another break because people's minds are exploding at this point, and hopefully expanding. So we'll be right back after this. On the podcast, HeyDude the 90s called David Lasher and Christine Taylor, stars of the

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you listen to podcasts. Chuck, one of the things we also have to mention about HIV and one of the other aspects that makes it so difficult to cure or to even treat. In addition to these cells like being hijacked, some of these virions that are being produced are just going off and accumulating in other cells, but they're not hijacking it, right? Right. So as far as the cell's concerned, there's nothing weird going on. There's nothing worth blowing yourself up over.

It's just, um, there's just some extra little virus hanging out on my surface, but who cares? It's fine. Yeah. But over that decade from infection to the onset of symptoms, they start to spread and accumulate throughout the body in the groin area and your bone marrow and your lymph nodes, like all over your body. Are these the reservoirs? Yes, they form HIV reservoirs, right?

And since these things can just hide out and they're not active and then they can become active whenever, it makes HIV a chronic lifelong disease. And it makes it really, really difficult to eradicate because the body mounts its own defense against the HIV infection initially. It's those reservoirs that become more and more widespread and increase in number to where they finally get to a point where your viral load is what it's called. There's just so many HIV virions infecting so much of your body that when they do start to finally become active, it just totally overloads your CD4 account and your number

just goes down and all of a sudden, you have stage three or four HIV, which is, again, is AIDS. And we, yeah, thanks for pointing that out. I think that one of the also more dangerous parts is those reservoirs are invisible, isn't that right? Like immunologically speaking? Yeah. Yeah.

And you know. It's just like there's a virus on the protein outside and that's it. And we're going to talk about the AIDS cocktail and stuff, but even though it is effective, I think they said it's so slow moving that it would require 60 to 80 years of the cocktail therapy to completely eradicate the virus. Right. In other words, you can't completely eradicate the virus. I mean, you technically could.

It depends. It depends. If you lived to be very old when you were very young. If you acquired it at age 10 and you lived to age 90, then technically you could probably completely eradicate HIV. That's not the way that this goes though, you know? Yeah. Well, no, but there have been plenty of kids who get it through other ways, you know?

Sure. Yeah. I mean, like you can be infected as a fetus and again through breastfeeding, I think are two of the ways you said, right? Yeah. And, you know, with, I think Ryan White got it through a blood transfusion, didn't he? Oh, yeah. It is.

Well, we'll talk about that too. Man, there's so much future goodness coming. All right. Well, we're going to close this episode out with some stats. I went to, and this is for the United States. We've already given some worldwide stats, but, geez, where to start? There's so many. Estimated incidence of HIV has remained stable in recent years.

About 50,000 new HIV infections per year in the United States. But like we said, some groups are worse off than others. If you go by groups, and this is where categorizing sexuality gets so tricky because you can say homosexual men, bisexual men, or this term that was invented in the mid-90s, MSM, men who have sex with men. Which is meant to be a neutral term that's not casting any judgment or anything. Right. It also takes into account dudes who are into like down low stuff, who don't self-identify

as gay. Right. Like I'm not gay or bisexual. It covers everyone. Like men. Exactly. Every Wednesday. Right.

In the park. Yeah. Those people would be counted in this. Correct. We might as well say there's the very people who created that term in the science community. Some of them are now lobbying to have that term removed. Or used more sparingly, I think, is another interpretation. Yeah.

And the thought is, and it makes a lot of sense, and there's also women sleeping with women, WSW. It says, and I'm going to read this directly so I don't goof it up, said MSM and WSW often imply a lack of lesbian or gay identity in an absence of community, networks and relationships in which same gender pairings mean more than merely sexual behavior. Plus, it makes sense. They are also saying that it's overly broad, too, that you're really not taking into account specifically who you're talking about.

You know? Yeah. You're talking in Wednesday download guys with men who have been openly homosexual since age 16, who are now 60. Yeah. Those are two totally different communities in most ways. Absolutely. And to lump them in together, especially if it's an epidemiological paper, for example,

that's doing a disservice to the person you're writing the paper for. Absolutely. So they propose to just be more specific. Right. And you don't have to do away with MSM, but say Wednesday download MSM when you're talking about a specific population. And in your study, cite the type of subgroups that you studied that participated in the study.

Like you had 20 Wednesday download MSMs. You had 30 old gay guys. Right. Surely there's other abbreviations that could come out of this, but they're saying, just be more scientific about this, shall we? Yeah. They're going to get out with a well-meaning, well-intended thing, but this whole thing has evolved.

Everyone's learning how to best deal with terminologies. And in 10 years, there'll be more specific terminology. For sure. What were you about to say? You had a good job. You're like, give everybody a break. We're all learning as we go. Yeah, we are.

We're in this together. But risk group-wise, and of course, it says MSM here right after we said all that, they represent about 4% of the male population as all in the United States. And in 2010, they accounted for 78% of new HIV infections and 54% of all people living with HIV in the United States. So we got to the reasons why that is happening earlier. And then the, let me see here, injection drug users represent 8% of new infections in 2010. Women accounted for 20% of estimated new infections in 2010, and what's scary there

is there's been a rise in HIV infection in women, a 21% increase from 2008 to 2010. You know, that's going in the wrong direction. I didn't see it in my research anywhere, but I didn't specifically look for it, so take it with a grain of salt. But I remember hearing not too many years ago that HIV was on the rise among the elderly population. So really? Thanks to Viagra, that there's a far greater increase in sexual activity in say like retirement

communities or nursing homes even because of Viagra, but they're just not taking precautions because they're like, I'm 80, it's fine. But apparently HIV is on the rise among that population. We need to do one on Viagra. I actually looked at that article the other day to suggest that and it was hard. Oh, was it? Yes. It was dense and difficult, so I put that off, yeah, bad guy.

African-Americans and minorities in general, African-Americans represent 12% of the population, but accounted for 44% of new infections in 2010, and I wish we had more recent stats, but we don't. Apparently that's the most recently available, which is surprising. And the same with Hispanic Latino, a disproportionate affected by HIV compared to their population. So then I was like, well, why is this happening? As far as African-Americans are concerned, there's a lot of debate on what's going on there, but they have found more infections, a shorter survival period, an increased number

of deaths, and the most leading theories are poverty. They may be more likely to be uninsured, go to the doctor to begin with. Injection drug use increases the spread of HIV, and I guess what they're saying is there's less safe injection drug use in the African-American community, or less responsible like getting new clear needles and stuff like that. Plus there's a heroin epidemic going on right now. I don't think just with the black community, as a matter of fact, I think it's even more popular among white kids than black kids right now, but I wonder how much of an effect that's

having on the spread of HIV among everybody. Yeah, good point. And then the last couple, lack of information, you may be HIV positive and you don't even know it. And I know we talked to before about the Tuskegee syphilis experiments and how that has led to a general distrust in some corners of the African-American community against medicine and doctors overall. And then finally, there's a stigma in the black community that still is a gay white

disease and that's why when EZE got AIDS it was such a big deal. Yeah, it was the Illuminati who injected him with it. Was that one of the theories? You're kidding. No. Wow. I mean, that was why he was a really big deal because he put a face to a certain segment of the black population where they're like, wait a minute, if EZE can get it, anybody

can get it. Yeah, it's true. So those are the reasons they think it's spreading more in the minority communities. And are we done with part one? I think so. So do you remember when they would do a very serious two-part different strokes? Oh yeah. At the end, normally they would clap at the end, but at the end of part one it would

just like go quiet. Yeah, I got no listener mail for this. I think we should do that. Okay, so how do we set this up? I think we just stop talking. For more on this and thousands of other topics, visit HowStuffWorks.com.