In a blitz of media frenzy, Charlie Sheen recently announced he is HIV positive.  So, should we care?

Before saying anything else, absolutely and unequivocally: YES!  Raising awareness for disease is always a good thing.  Remember that ALS ice bucket challenge?  Even a disease like HIV, which for the general public is a has-been, benefits from media attention.  To the medical and scientific community, HIV is so much more.  HIV remains the number 1 infectious disease killer and top-funded research area.  Despite not yet having an effective vaccine (the Holy Grail of infectious disease if there ever was one), we’ve made enormous progress in understanding this unwieldy virus.

“I have to admit that I am HIV positive”
“It is a hard 3 letters to absorb”
-Charlie Sheen (1)

The stigma that surrounds an HIV diagnosis–exemplified by Sheen’s use of the verb “admit”–is partially to blame for the fact that 37 million people around the world are HIV-positive (2).  The most important weapon we have in the fight against HIV is knowledge.  Knowledge about how the virus is transmitted (and how it’s not), knowledge about preventing transmission, and knowledge about the importance of antiretroviral medications. However, knowledge about your HIV status (and your partner’s) is arguably the single most important tool in our fight against HIV.  And in order to truly harness this arsenal, we need to talk about HIV openly and without judgement.

In 2013, the Centers for Disease Control (CDC) amended their HIV recommendations to include routine screening for everyone, plus pregnant women and those engaging in risky behaviors including drug use, frequent unprotected sex, prostitution, etc. (3).  These new recommendations now represent “opt-out” screening, replacing the previous “opt-in” screening.  What this means is that the test will be performed unless the patient declines rather than having to request the test.  There are also 2 home tests currently available, but it should be noted that the performance of these tests are inferior to those performed by a physician and false negatives are possible.  Regardless, these new recommendations and home testing kits will undoubtedly increase the number of HIV diagnoses in the U.S. over the next several years, but importantly they will also decrease the number of HIV positive patients unaware of their infections (ie. enhancing knowledge).

“Have you knowingly or even unknowingly transmitted the HIV virus to anybody else?”
-Matt Lauer
“Impossible.”
-Charlie Sheen
“Individuals who are optimally treated, who have undetectable viral loads, who use protection…it is incredibly rare to transmit the virus.  We can’t say that it’s zero.”
-Sheen’s physician Dr. Robert Huizenga

There are currently 3 ways to limit HIV transmission and they work best when used all together.  First, and perhaps most obvious, condoms prevent sexually transmitted infections including HIV.  Second, antiretroviral therapy can reduce the virus to undetectable levels in HIV-infected individuals, as mentioned by Sheen’s doctor above, which reduces the level of virus available to transmit to someone else.  Finally, the newest method of preventing HIV transmission and the one that is currently most misunderstood is called “PreP” or Pre-exposure Prophylaxis.  PreP is a drug taken by an HIV-negative individual that can block HIV from infecting cells in their body.   When taken daily, PreP reduces the chance of HIV infection by more than 90%.  The CDC recommends that PreP be considered for HIV-negative individuals at high risk for HIV infection, including anyone in an ongoing sexual relationship with an HIV-positive partner, those engaging in frequent unprotected sex, and injection drug users (3).  Further, a recent study has shown that for gay men, PreP taken before and for 2 days after sex may confer the same protection as when taken daily.  For a short video of this study, see the New England Journal of Medicine (NEJM) Quick Take on the ANRS IPERGAY Study.  Importantly, knowing your HIV status is the critical information needed in order to take steps to prevent transmission to others.

Sheen told her he did “did not want his child to have his blood type (HIV-positive) and that she should have an abortion,” which, according to the lawsuit, she did.
From the lawsuit filed by Sheen’s ex-fiance Scottine Ross, as reported by CNN

1 in 5 untreated HIV-positive pregnant women give birth to an HIV-positive baby.  This type of infection, called perinatal or vertical transmission, is the most common way children acquire HIV.  However, taking antiretroviral therapy during pregnancy, having a cesarean section, and avoiding breastfeeding can reduce this risk from 20% to under 1% (3).  In Sheen’s situation, an HIV-positive male coupled with an HIV-negative pregnant female, PreP can prevent transmission to the female AND the baby.  Careful monitoring and prescription of antiretrovirals if necessary can eliminate nearly all risk of transmission to the baby.  Again, knowing your HIV status and that of your partner is absolutely critical to avoid perinatal HIV transmission and increase the chance of having a healthy baby.

“In conclusion, I accept this condition not as a curse or scourge, but rather as an opportunity and a challenge. An opportunity to help others. A challenge to better myself.”
Charlie Sheen

Good on you Charlie, and good luck.

References:
1. Today Show – Health & Wellness
2.  World Health Organization HIV/AIDS
3.  Centers for Disease Control HIV/AIDS