On Nov. 17, Charlie Sheen disclosed his HIV status on the Today show. He sat down to speak with Matt Lauer, and was later joined by his doctor Robert Huizenga, M.D. In the interview, Sheen discusses his journey from diagnosis to achieving an undetectable viral load. To help make sense of the claims made in Sheen's disclosure interview, here are some quotes from the interview and analysis of their scientific accuracy.
Sheen: "It started with what I thought -- based on this series of cluster headaches and insane migraines and sweating the bed, completely drenched, two, three nights in a row -- that I was emergency hospitalized."
PLAUSIBLE: What Sheen is describing could be acute retroviral syndrome, which has flu-like symptoms that can appear during acute HIV infection. The symptoms can include fever, headache, fatigue and swollen nymph nodes, appear about one to four weeks after infection and can last for one to four weeks before subsiding. However, not everyone who contracts HIV experiences acute retroviral syndrome. It is also worth pointing out that these symptoms are common for other diseases and are not specific to HIV.
Sheen: "I was so depressed by the condition that I was in that I wasn't -- I was doing a lot of drugs, I was drinking way too much and I was making really bad decisions."
PLAUSIBLE: Many people experience depression when they are first diagnosed. The best way to cope is through education and hearing others' stories about living well with HIV.
When discussing Sheen's disclosure, it's important not to take his quote out of context and imply that his HIV status is a result of drugs, drinking and bad decisions. While it's unknown how Sheen contracted the virus, what he's saying here is that the drugs, drinking and bad decisions came after his diagnosis because of depression.
Lauer: "Have you knowingly or even perhaps unknowingly transmitted the HIV virus to someone else since your diagnosis?" Sheen: "Impossible." (Though he has had unprotected sex, he says he's disclosed beforehand every time.)
PLAUSIBLE: As long as Sheen kept up with (adhered to) his HIV medications every day and maintained an undetectable viral load (meaning the level of HIV in his blood was so low that standard tests cannot detect it, which is usually below 50 copies/mL), then the likelihood of him transmitting HIV through condomless sex is almost zero. Technically, it's not impossible, but it's as close as you can get.
In fact, two major studies on mixed-status couples -- the PARTNER study and HPTN 052 -- found zero HIV transmissions through condomless sex when the HIV-positive partner was on treatment and had an undetectable viral load.
Lauer: "People live long, normal, productive lives while they carry the virus."
TRUE: In the HIV community, we wouldn't say that people "carry" the virus because that can be stigmatizing. Instead, we say people live with the virus. Nevertheless, Lauer's sentiment is correct. People living with HIV live long, healthy, productive lives that are just as "normal" (whatever that means to you) as everyone else's. You can find many inspiring personal stories from people living with HIV.
Huizenga: "He was immediately put on treatment -- strong antiviral drugs, which have suppressed the virus; unfortunately, we don't have a cure yet -- it suppressed the virus to the point that he is absolutely healthy from that vantage."
TRUE: Assuming Sheen adhered to his medications, the meds would indeed suppress the virus and lead to an undetectable viral load.
There is such a thing as drug resistance, which can develop if a person's HIV mutates and grows resistant to specific classes of HIV drugs. This usually happens with sub-par treatment adherence and would require a switch in treatment regimen.
We do not have a "sterilizing cure" for HIV -- that is, a treatment to completely eradicate HIV from the body. However, we do have cases of functional cure and long-term HIV remission, where people living with HIV were able to maintain undetectable viral loads for long periods without treatment.
The only person who is cured of HIV is Timothy Brown, who received a never-before-attempted stem cell transplant in which the donor had a rare mutation making him essentially immune to most forms of HIV. This was a very risky procedure that was done to treat Brown's leukemia at the time.
Huizenga: "My biggest concern with Charlie as a patient is substance abuse and depression from the disease more than what the HIV virus could do in terms of shortening his life, because it's not going to."
SOMEWHAT TRUE: The life expectancy of someone living with HIV who is on effective treatment continues to draw closer to that of HIV-negative people, but is still slightly lower. Still, the sentiment is correct: Having HIV is not itself the biggest concern as long as Sheen adheres to his medications, has regular doctor's visits and lives healthily.
But as Huizenga implies, everything else that can come along with HIV deserves focus, including harm reduction (reducing harm caused by a potentially dangerous behavior), mental health, inflammation (or what's sometimes called accelerated aging) and comorbidities (other diseases people living with HIV can be susceptible to). This is especially important for Sheen, 50, who joins a growing group of people over 50 who are aging with HIV.
Huizenga: "Charlie does not have AIDS. AIDS is a condition when the HIV virus markedly suppresses the immune system and you're susceptible to rare, difficult cancers and infections. Charlie has none of those. He is healthy. He does not have AIDS."
TRUE: HIV and AIDS are not the same thing. HIV is a virus. AIDS is a syndrome, or a condition, defined by either having a CD4 cell count below 200 (whereas a normal CD4 count is between 500 and 1600) or having one or more opportunistic infections. This will usually happen if a person's HIV is left untreated for years.
Huizenga: "Individuals who are optimally treated, who have undetectable viral loads, who responsibly use protection, have an incredibly low -- it's incredibly rare to transmit the virus. We can't say that that's zero, but it's a very, very low number."
TRUE: Even without condom use, people having an undetectable viral load are incredibly unlikely to transmit HIV. As mentioned above, two major studies on mixed-status couples found zero HIV transmissions through condomless sex when the HIV-positive partner was on treatment and had an undetectable viral load. However, not using a condom is something to be discussed between partners before sex.
Note that I tend not to use the term "protection" because it can be confused with methods of protection against pregnancy, which is not the same as protection against HIV and sexually transmitted infections.
Lauer: "The virus can still hide in genital fluids and the level of virus can go up and down between testing. Is that fair to say?" Huizenga: "That's fair to say. However, if someone's conscientious -- and we have done repeated labs every several months over the last four years -- then the odds of variation between drug tests and lab tests would have to also be expected to be very, very low."
As for viral load fluctuations, this can happen, but as Huizenga alludes, proper treatment adherence will keep these fluctuations to a minimum.
Lauer: "Are you taking the so-called triple cocktail? Is that what medication you're on?" Sheen: "Every day." Lauer: "How many pills are you taking each day?" Sheen: "Four."
PLAUSIBLE: A "triple cocktail" refers to three antiretroviral drugs taken together. The practice of taking three drugs together started in 1996, the year after the first protease inhibitor was introduced, and it drastically reduced HIV-related deaths. More recently, we have HIV treatment regimens that include four drugs. Sometimes these drugs are coformulated into one pill. So it's unclear whether Sheen misspoke, or if the four pills are not all HIV related; however, he has no obligation to reveal his specific regimen. The main point is that Sheen is on treatment and adhering every day.
Lauer: "Can [Sheen] be trusted to continue to take that medicine on a regular basis if he continues to drink and perhaps do drugs?" Huizenga: "Worried isn't the right word. We're petrified about Charlie. We're so, so anxious that if he was overly depressed, if he was abusing substances, he would forget these pills and that's been an incredible worry and magically somehow in the midst of incredible personal mayhem he's managed to continue to take these medications."
TRUE: Adherence is one of the biggest issues for people living with HIV. Missing doses can happen to anyone -- and not just because of drinking or drugs. Even simple forgetfulness or feeling pill burden can cause one to miss doses. And as Huizenga points out, depression is a major cause of adherence troubles.