Recognize the Early Signs and Symptoms of HIV - AIDS Discovered in Los Angeles

                 What are the early signs and symptoms of HIV? Do you know? If you don’t you need to learn them. There are two separate stages when HIV shows its early signs. First is when you are just infected. When first infected most people experience flu-like symptoms – body-aches, fever, chills, night sweats, day sweats and extreme fatigue. Often they are laid out, sick in bed. This happened to me when I was first infected with HIV. If you have not been taking ARVs, these same signs show up almost a decade later when the disease turns into Aids. That is when similar symptoms will again alert you that something is seriously wrong with your health.   

            In October 1983, about a week after having sex and after not having had any intercourse for several months before that, I suddenly became desperately ill. I lay prostrate on the mattress on the floor of my upstairs bedroom sweating, sweating, sweating - feverish like never before. I thought I was going to die - I almost wanted to. I was living in West Hollywood, a revolver shaped Los Angeles suburb at the bottom of the Hollywood Hills, wedged between Hollywood and Beverley Hills. West Hollywood with its bars, restaurants and clubs stretched along the Sunset Strip and La Cienega Boulevard was once and still is the playground of movie stars, rock-and-roll rogues, cinema moguls, and other assorted glitterati and hangers on in the entertainment industry. The four-plex apartment where I lived was a block away from the real Melrose Place and a block down from Santa Monica Boulevard - Route 66 - made famous by the song from the Sixties by The Rolling Stones. The biggest male star of the 1930s, Mickie Rooney, once came by and paid everyone in the building a hundred bucks plus for the day so he could shoot the front of the building as the fictional setting for a pilot he was making. It was going to be about the lives of friends who lived together in a small apartment block. The same situational comedy premise that the shows “Friends” and “Melrose Place” turned into television gold…. Great show biz minds think alike. Someone stole Mickie’s idea, or he tried to steal theirs. As the Danish doctor who once stole my scientific clinical trial protocol and put her name to it said to me, “Ideas are free.” Some TV pilots make it…. Most crash and burn…. Mickie’s plan to return to the industry didn’t make the studio cut…. But THAT’s HOLLYWOOD for you!       

            As I was saying…. I was sick as a dog. Flu-like symptoms? No. There was nothing “like” about them. These were double the normal flu symptoms, way beyond any influenza I had ever had. “Double flu” is the best way I can describe them. Normally influenza puts a person in bed for three or four days and usually there is at least enough energy to prop yourself up and watch television. But this was intense. I was flat on my back for seven days and seven nights – turning and sweating …. sweating and turning – with absolutely zero energy. My sheets were soaked. It was the worst I had ever felt in my life….      

            That flu-like illness is what scientists call the “sero-conversion phenomenon” – when the most primitive part of the immune system tries to burn the invader away. “B” white blood cells furiously produce antibodies to tag viruses for destruction by macrophage “big eater” cells. The existence of those antibodies is what changes the blood from being HIV negative to HIV positive. And part of the problem with HIV is that the virus infects the very macrophage cells that are sent to destroy them. It is an insidious disease.

Flu-like symptoms are the common harbinger of many diseases. Some like Ebola kill quickly, while others are suppressed by the immune system, only to resurface some years later - like HIV. HIV “double flu” is anything but pleasant. Luckily or perhaps unluckily, only about 80% of people who become infected experience this dramatic foreshadowing of illness. Sometimes the symptoms are less severe than I experienced, and 20% of people infected never recall having any initial symptoms. However if a person misses this primary illness they have absolutely no sign that gives them a clue they have been infected.

…. From the start of that hot sweaty fever I had a strong suspicion I might be – that I probably had been infected. I had tried so hard to avoid this new virus – even going a year without kissing anyone when no one knew what actually caused the disease or how it might be spread. By the time I was infected in 1983 people had already been dying for over two years from this slowly emerging epidemic. But there was still no test I could take to let me know if I had this novel infection or not. It would be two more years before they developed the HIV test – now commonly used worldwide.

            The early symptoms I had are usually the very first sign of infection for others as well. HIV-flu can be extreme, as in my case, or it can be much less severe. Some people never experience it at all. If there is no severe flu, then there is no warning sign you might have been infected.  If you have had unprotected sexual intercourse at any point in the previous ten years you never know for sure if you are infected or not. You need to get tested. If YOU have never tested, NOW is the time to do it…. Yes…. right now. Ignorance is not bliss…. Ignorance is deceptively dangerous and NO ONE should be so careless or deceitful as to pass on a disease they don’t even know they have. Endangering someone else’s life is not just wrong, it is evil, and in some states it is a crime. Don’t do it. If you are HIV positive you should never ever infect another person. If you are starting up a new relationship discuss this issue and both get tested, just to be safe. Better safe than sorry!

            After infection, depending on the strain of virus, it takes between five to ten years for HIV to cause the CD4 count to decline to the 200 level. Below 200 indicates an Aids diagnosis - when the first signs and symptoms of advanced disease begin to show up. A few may appear when the CD4 count falls below three hundred but most only begin to show up at or about 200 CD4 count. Often the first signs may be something as innocuous as “jock itch” or other minor skin problems. The early signs and symptoms of late stage HIV disease - Aids - years after initial infection include 1) severe or frequent headaches 2) repeated bouts of flu-like or malaria-like symptoms 3) unusual skin problems including fungal infection and 4) more regular eruption of herpes sores, or shingles. They can also include extreme fatigue, constant tiredness, night sweats, and skin sores that won’t heal. Those are the signs you should be on the lookout for and if you notice any of them get tested immediately. If necessary see a doctor. While all of these symptoms can occur in the absence of HIV and can often be the sign of other diseases, don’t ignore them – especially if you experience more than one. Ignoring the signs of HIV infection may be the death of you.

            The first person I ever knew who had Aids was Tom Vanderpool. Tom started work at the Department of Defence (DoD) Defence Logistics Agency (DLA) in Inglewood, California the same day I did in September 1977. We were both trainee aerospace-manufacturing cost-analysts, hired off the roster after scoring highly on the US professional civil service exam. Tom was a native Californian. I was originally from a small town in Virginia but graduated from high school in Honolulu Hawaii. I returned to Virginia for four years of college and one year at the University of Virginia studying to be a diplomat. Instead of the Department of State I ended up in the Department of Defence. But I was happy enough to be on the West Coast in the big city of LA with the beach scene close by - half-way between my two home states.

            Tom and I were new recruits working in a ten person group of cost-analysts, most of whom were military veterans from several wars back – half nearing retirement. The DCASMA office was on the eleventh floor of the Imperial Bank Building at the corner of La Cienega and Century Boulevards, overlooking the 405 San Diego Freeway. Working in regulation government open office cubicles, our cost-analyst section enjoyed the slight diversion of watching jets coming in to land at Los Angeles International Airport (LAX) on the north and south runways every three or four minutes all day long. The planes glided in smoothly for their perfect touchdowns, on either side of our building, coming in just a little above eye level from our office. After a day or two we learned to ignore this distraction. That is except on the rare occasion when a golden oldie World War II or Korean War relic flew in the couple of crusty old veterans in our section who had once flown them took notice and called them out by their exact model numbers. “Oh look, that’s a P3-X4”…. or whatever. “I served as an engineer on one of those in Guam.”…. That was our job after all. Analysing and negotiating prices on contracts for spare parts to keep the planes of the US Air Force flying – heat exchangers and such. Every part had a number as did every plane.

Under the supervision of a former Army master sergeant drill instructor Mr Smook, we had to keep our noses to the grindstone. Me more so than Tom. He seems able to cut a few corners and get away with more than I would dream of. “GET TO WORK!” Mr Smook would bark from right behind my chair if he caught my nose in the LA Times one minute after starting time - 7:15.  One day Tom dropped a small white tablet of speed, benzadrine maybe. The big black lady who served as our section typist, Mary, quietly pointed it out to him, “Tom…. I think you dropped a whitey.” As a native Angeleno Tom fit in better. I was new…. just a little wet behind the ears… and my fingers had never touched a calculator before. For the next seven years as a cost-analyst for the military and later for four military prime subcontractors like Northrop and Hughes Aircraft, my fingers were never far from a calculator again.    

            I moved to California to accept a job offer with the federal government, just days after completing my master’s degree studies in international relations at the University of Virginia. I had been interviewed by phone and that was it. I first landed in Long Beach where I slept on the sofa in the living room of a friend from undergraduate school in Virginia. Four years before at the end of the school year, Brett and I had driven his Camero cross country on the way home to California and Hawaii. We choose the northern route, via Chicago, Minneapolis, Mt Rushmore, Yellowstone National Park, Montana, Seattle, and down scenic Route 101 twisting back and forth through the giant redwood forests along the Pacific north-west coast, all the way down to Los Angeles. An unforgettable road-trip. After almost three months bunking on his couch I moved to Westwood near UCLA, and two months later to the old Jewish neighbourhood of Fairfax, half a block from CBS Television City and Farmers’ Market.  

Twelve months later I found my dream beach apartment in the surfer enclave of Hermosa Beach where I could sit on my sofa and gaze out the window to the broad sandy beach, clean blue ocean, and perfect sets of four foot waves rolling in one after another. No wonder the surfboys talked about Hermosa Beach, even in Hawaii. My apartment building was set back a block from the beach on the first rise of the hill. From the wide wooden deck in front of the apartment, you could see a panoramic view stretching from the Palos Verde Peninsula in the south to the tip of Malibu in the north. Most days you could see Catalina Island twenty nautical miles off Long Beach. I vividly recall the 1979 Malibu Fire. The mountain ridges above Malibu were trimmed with line after line of raging yellow-red flames. Neil Young lost the house on his Malibu ranch in that fire. But California doesn’t burst into flames on a nightly basis. On less dramatic evenings the sun setting slowly into the ocean behind brilliantly colored cloud formations was a phenomenally natural inspiration.

Twice a week after work I walked down the wooden stairs, crossed Beach Front Ave and crossed the clean wide sandy beach to reach the berm, the hard packed part of the beach that lies between the high and low tide marks. I jogged in my bare feet on the packed sand beach as the water sometimes washed up around them. I always started just a little slow until the oxygen and adrenaline kicked in. Up to the Manhattan Beach pier, back past the Hermosa pier, down to the Redondo Beach breakwater and back again. The four-plus miles felt good. At the extreme western edge of the great North American landmass and the eastern edge of the vast Pacific Ocean, with the late afternoon sun lowering in the sky and the sea-misty air pumping in and out of my lungs, I spread my arms to imitate the seagulls gliding above and waved the occasional pod of porpoises plying their way north or south, in the deep water fifty meters out beyond the breakers. As I threw my hand up to greet the few runners passing in the opposite direction I thought to myself what a spiritual experience it was to be exercising in the sea freshened air at the nexus of the four classical elements of nature - fire, water, earth and air. I felt at one with myself, nature and the elements.   

            ….For the first three years as a G-man – a representative of the federal government - my pay wasn’t great. But since I had been hired into a program to develop professional level government staff they guaranteed to double my salary over those three years of service – GS-7 – GS-9 – GS-11. However even that GS-11 salary was no great shakes. Most of the professional people I compared myself to seemed to be making much more. It was government work. At least it was a secure job and it moved me to sunny Southern California, halfway between my home state of Virginia and my adopted state of Hawaii where my mother now lived. And I had the beach life at my doorstep.

            Tom Vanderpool, myself and seven other young professional-track recruits had been hired to work at DCASMA-LA, the contracting service for the US military. District Contract Administration Services Management Area Los Angeles, otherwise known as DCASMA-LA had just over a hundred employees spread over two floors. DCAA, the government auditing agency occupied the floor below. As new civilian recruits we joked about the acronym soup of military abbreviations…. We were all fresh-faced, young, smartly educated civilians in their twenties gleaned off the roster of the professional civil service exam - a four hour intelligence test I had taken in the basement of the Department of Commerce in Washington D.C. the year before. We had signed on to work in military contract administration. We oversaw the purchase of spare parts for military equipment, especially aircraft.

            Tom was bright, clever and charming in a sly, mischievous sort of way. He claimed he had majored in math at UCLA but ended up working in an aerospace machine tool shop somewhere near Hawthorne. His job at DCASMA was a decided step up for him. For me, it was a step sideways or maybe a half step down from my career goal as a diplomat. But it was a job – my first professional job. Vanderpool was twenty-nine – two years older than me – my height, just short of six feet, with a medium slim build. His face looked like an exact cross between a young Vladimir Lenin and Vincent van Gogh – angular facial features, short clipped reddish hair, a receding hairline and a goatee beard. With a sharp, wry wit and a cacklely, high-pitched laugh, Tom was a unique character. He was also a sex addict.

            When I arrived in California in 1977 it was the height of the OPEC inspired fuel crisis. Cars were lined half a block down the road just to get petrol. Because the government ordered DCASMA employees to carpool and we both lived in Long Beach, for the first three months, I was forced to pick Tom up every morning for the forty minute drive up the Long Beach Freeway and the chock-a-block “rush” hour traffic of the 405. He didn’t have a car and I did. A brand new, golden-bronze Chevrolet Camaro I had bought to pull a U-Haul trailer across country from Virginia to LA – that time the southern route Interstate 10 all the way from Florida. As I had descended the hills into the LA basin late at night The Eagles, “Welcome to the Hotel California blasted from my tape deck as the lights of LA glittered before me like a carpet of diamonds. Now as the car pool chauffer, every Monday morning at 6:30, along with talk radio I got a full retelling of Tom’s weekend exploits. He was a real chatterbox and held nothing back. There was no pause button.

            Most people have hobbies or pastimes. Some like to play football, shop at the mall, watch TV, play video games, exercise at the gym or go surfing. Tom’s favorite hobby was…. s-e-x. He was a true libertine. On weekends he would go to a sex club in Long Beach and do his thing. His thing was taking drugs and having sex with three or four men on both Friday and Saturday night if he could. The book And the Band Played On by Randy Schults stands out as a singular witness to the early days of the HIV epidemic and the Aids crisis in California where awareness of this disease first unfolded. Shilts names one of his real life characters Patient Zero - an extremely good looking airline steward who supposedly helped spread the disease in different cities he visited. In truth, Tom Vanderpool comes just as close as any other to being the real Patient Zero – at least for Long Beach, one of the early epicenters of Aids in California.

            One Monday morning in the spring of 1980 Tom arrived at the DCASMA office looking paler than usual. His face had always had a ruddiness about it. His skin a bit dry and flaky. Slim already, he was beginning to lose weight. His face had always shown deep lines in his forehead, aged well beyond his years. Tom informed our section manager Mr. Smook he would have to take the week off on sick leave because his doctor had referred him for some tests and admittance to the hospital – Harbor-UCLA Hospital – about twelve miles away in Wilmington, next to LA harbor. Before he left Tom pulled up his trousers and showed us some unusual raised bumps on his legs – the size of small beetles – purplish lesions. He explained, “The doctors don’t know exactly what it is - but it is extremely rare. They say maybe something from Africa. All the doctors told me was that it has something to do with the blood and it goes all the way down to the bone.” Tom was in the hospital for almost two weeks. After a few weeks back at work he had to be readmitted for almost a month. Tom was sick a full year before Dr Michael Gottlieb first reported a cohort of five men with this unknown new syndrome to the Center for Disease Control (CDC) in Atlanta in June 1981. The first ever report of the Aids epidemic. Dr Gottlieb reported the start of the epidemic from the same hospital Tom Vanderpool had been in – Harbor-UCLA in Wilmington. All five of those first index patients had the then very rare lung condition pneumocystis pneumonia. But many other early Aids patients had the same symptoms as Tom, the unmistakable dark purplish lesions of Kaposi sarcoma (KS). These were the first two primary defining symptoms for an Aids diagnosis. Two viruses were circulating on the sex club circuit – not just one. Tom Vanderpool might have been one of the first five cases of HIV reported by Dr Gottlieb to the CDC. Or he might have been the canary in the coal mine that was missed. The one first patient with the disease that was overlooked because the syndrome had not yet become widespread enough for it to be noticed. He was a patient in the same hospital a full year before Michael Gottleib reported it, so Tom could be considered the index case, the true Patient Zero. But by that time Tom was no longer in the Harbor-UCLA hospital. He was probably not among those first five cases. By that time he had moved to San Francisco….

Yes, I was there at the very beginning of the Aids Crisis in America. I was there at the beginning of the epidemic living in the original epicenter where it was first noticed. Like a big game animal tracker I followed the international pandemic as the real epicenter shifted back to Africa from whence the virus had come. I lived to tell the story of this tragedy and the scientific achievements that eventually triumphed over it. Sadly…. Tom did not.

            No one wants to be un-expectantly surprised by sudden illness. Today no one has to be by HIV because we now have a quick, easy test to prevent having to find out the hard way - only after becoming sick. Tom didn’t have the advantage of an early warning system. But he may not have taken heed of it anyway. He came from the “live fast, die young” school of thought. He did live too fast and he did die too young. Over lunch one day, well before he got sick, Tom told me he didn’t think he would live to be forty. I was shocked. I couldn’t comprehend that. Tom never made it to thirty-five. But that was his choice.                        

            Tom’s story is extreme but it highlights the point that HIV disease is often first seen as a skin condition. There are numerous skin problems associated with HIV including herpes, shingles, KS, candidiasis (thrush), fungal infections, and severe inflamed acne, among others. Tom had just one of the more obvious and distinctive ones. Kaposi’s sarcoma – KS – is a rare form of skin cancer caused by the HHV-8 virus. HHV-8 – human herpes virus-eight - is a herpes virus that is entirely different from HIV. But it is also transmitted sexually. Like so many health problems associated with Aids, Kaposi sarcoma is an opportunistic infection – an “OI”. A person infected with KS can carry the virus for years, but KS lesions don’t show up until the immune system declines. Like shingles, caused by the chicken pox herpes virus raising its previously suppressed state from deep down in the nerve endings, HHV-8 takes the opportunity to come out only when the immune system as measured by CD4 count declines to deficiency.

            Many diseases exhibit “flu-like” symptoms – fever, chills, sweats and fatigue – especially in their initial phase. Flu-like symptoms are the familiar sign that the immune system is fighting disease – many diseases including influenza, HIV and malaria.

            It is important to know and recognize the symptoms of HIV infection. This is in order to prevent being un-expectantly run over by the mega-truck of illness we call Aids. When full blown Aids hits you when you don’t expect it and knocks you down, it may be too late. Don’t ignore flu-like symptoms. If you have had unprotected sex outside a 100% faithful monogamous relationship, flu-like symptoms may not just be the flu. It may be HIV, or if you live in the tropics, malaria. Be careful not to mistake one for the other. Flu-like symptoms may be either the initial sign of HIV infection or the onset some years later of advanced late-stage HIV disease turning to Aids. If you are sexually active and think you are HIV negative, it would be a good idea to take an HIV test two or three weeks after every time you experience flu-like symptoms. By that time the HIV antibodies that the test looks for should have formed. But don’t confuse a simple cold with the flu. A cold – caused by one of about fifty-six different rhino-viruses - will give you sneezing, coughing, runny nose and a temperature. But you won’t have body pain, and the kind of severe fatigue that puts you in bed for several days. Besides flu-like symptoms, look out for the other early signs of late stage HIV disease - especially repeated or unusually severe headaches and new, unusual or more intense skin problems or frequent herpes eruptions. Severe fatigue may be another symptom. But severe fatigue is also a symptom of some other conditions; most notably, mononucleosis - Epstein-Barr disease – caused by another herpes family virus.

Many diseases are sexually transmitted. To protect yourself from infections be safe and smart with your sex life. If you are already HIV positive be careful not to get re-infected. Get tested for HIV on a regular basis, especially if you are having relations with several different sexual partners or you come down with “the flu” a few weeks after having sex with someone you are not absolutely sure is HIV negative. Practice safer sex by using a condom every time. But be aware that one in a hundred condoms break…. and condoms can come off in the passionate heat of sex. Thus condoms are only 99% fully protective. Discuss HIV with your sexual partners…. But be aware - sometimes lovers lie. Safest yet, try abstinence for a while. It won’t kill you. I was abstinent for seven years and it didn’t kill me. Abstinence not only protects you from HIV, but from other sexually transmitted diseases as well. Self-control is a good thing - especially in the time of a killer pandemic.              

            Like me, you can beat this disease, but only if you know you have it. If it sneaks up on you without you knowing your health outcomes will not be as good. Knowledge is power. Get tested so you have the benefit of knowing your status. Then use your knowledge to protect yourself and stay safe, or to make the right moves in consultation with your physician to conquer your disease with the wisest choice of anti-viral medications. Don’t let HIV defeat you when modern medicine now has the power to defeat it. Don’t be the big loser when you can just as easily be the winner against this disease.

            Be a winner. Get tested. And know how to recognize the early signs and symptoms of HIV infection.