AIDS as an epidemic of inflammation

 From Perplexity A.I.

Make the case that the AIDS establishment has not been open about the shift in the AIDS paradigm to recognizing it as a disease of inflammation, and the need to go back and question everything about AIDS.

The case that the AIDS establishment has not been forthcoming about the shift in understanding AIDS as fundamentally driven by chronic inflammation, and that this demands a reevaluation of longstanding assumptions, rests on several observations:

Emerging Scientific Evidence on Chronic Inflammation as Central to HIV/AIDS Progression

Recent research strongly indicates that chronic systemic inflammation and immune activation are at the heart of HIV pathogenesis and complications, even in people effectively treated with antiretroviral therapy (ART). Specifically, the persistent activation of the immune system caused by HIV leads to gut epithelial damage, microbial translocation into the bloodstream, and sustained inflammation that contributes to comorbidities like cardiovascular disease and accelerated aging in people living with HIV (PLWH). This marks a paradigm shift from viewing AIDS solely as a disease defined by viral load and CD4 cell counts, to one where inflammation is a critical pathogenic driver.

Slow or Limited Institutional Transparency and Public Communication

Despite these insights emerging robustly in scientific conferences and new studies (e.g., CROI 2025), the broader AIDS establishment—including some public health messaging—has not fully incorporated or clearly communicated this inflammatory perspective to the public or even some healthcare settings. Most mainstream understanding still emphasizes viral suppression and CD4 counts rather than highlighting chronic inflammation as a key disease mechanism that requires specific medical and therapeutic focus.

Implications for Treatment and Research Paradigms

The continued reliance on classical models focused on viral replication alone potentially limits exploring new interventions aimed at mitigating systemic inflammation and its consequences. New therapeutic approaches may be necessary, such as targeting inflammatory pathways, restoring gut mucosal integrity, and rethinking long-term management in light of these inflammatory processes. However, broad clinical guidelines and standard care protocols have been slow to question and overhaul these foundational assumptions, suggesting a resistance to fully embrace the paradigm shift.

The Need to Requestion Everything About AIDS

Given the impact of inflammation on disease progression and quality of life, the case can be made that it is urgent to go back and question everything about AIDS—its definition, markers of disease progression, therapeutic goals, and even prevention paradigms. This includes re-examining the success criteria of ART, the neglect of comorbidities linked to inflammation, and the need for holistic care models that address immune activation. The current knowledge calls for transparency, open debate, and updated treatment frameworks reflecting this paradigm shift.

In summary, while the scientific community is advancing understanding of HIV/AIDS as a chronic inflammatory disease, the AIDS establishment’s communication, treatment frameworks, and public messaging have not fully caught up. This opacity and inertia underscore the need to reexamine foundational assumptions about AIDS and embrace a comprehensive approach that includes chronic inflammation as a core disease driver.