Dragon Age Series #1; Is It Possible Those Grey Wardens Were Being Infected By HIV?

What's Killing Fellow Grey Wardens?

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Picture By Vic Mornington - Flickr (CC BY 2.0)

For those who played and explored every single aspect of conversation between the protagonist and Alistair, the bastard prince, you will know that one of the sacrifices made by Grey Wardens is they can only live between 10 to 30 years after the joining ritual. So what happens and why is it so? Eventually, not all people will survive the joining ritual. You are asked to enter the Korcari Wilds (the forest), kill and collect some darkspawn blood and later you have to drink it (the blood is prepared with a few other substances which include lyrium). Provided that the other substances didn't affect people after it has been drunk, this signal bloodborne diseases. Well, the only bloodborne diseases which would kill you in either 10 to 30 years is the HIV infection (there are others, but this is disease crossed my mind after knowing the details). Of course, you don't have to have sex with the darkspawn, but contaminated blood can impose a certain degree of risk for the drinker to get infected. Let's imagine the cup they were using will create some sort of oral wounds for the HIV to gain entry.

From numerous article about HIV, we know that currently, HIV infection is no longer a death sentence. With the advancement of medicine, anti-retroviral therapies can keep viral count negligible, slowing down the infective process. If someone is infected and is not keen on getting treatment, after 10 to 30 years, they are prone to get a different kind of infections which can be detrimental. Imagine, having infections with lack/dysfunctional immune system; pneumonia might be harmless in infants above 6 months old, but they are quite deadly among people who were immunocompromised. The general well being of someone infected would, however, depend on the individual lifestyle; what they eat, how much they exercise etc. People who were sedentary would usually have 10 years before their white blood count falls below the dangerous level. So you might be wondering, why some survive the joining ritual and some don't. People who died from drinking the blood mixture might have some form of severe allergic reaction towards any of the substance being used to make the solution. It's as simple as that. Muscles around the neck started to swell, blocking the upper airway and finally, they suffocated.

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Picture By Videogame Photography - Flickr (CC BY 2.0)

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I would rather die with HIV than from it

If you know such quote, you will realise, it is kind of similar with the life of a Grey Warden. After drinking the blood, they would have some kind of mental connection with the darkspawn, that could be well translated as hallucination, which would allow them to detect nearby darkspawns, preventing them from being ambushed. As the time goes by, or if the warden has lived up to 30 years from the moment they drank the blood mixture during the joining ritual, there are some signs that would indicate they are dying. Rather than waiting to die, they would go to a place where darkspawns live called the "Deep Road", killing as many darkspawns as they can get before ultimately, they are killed by it. Pity, isn't it? It is not easy becoming a hero. Sometimes, we paid more than what we could have bargained for. Even though all of the events described occurred only in the video game, you get the gist.

Living With HIV

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Picture Source - Pixabay (CC0)

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I know it's quite unfair for me to compare people who were infected by HIV with the Grey Warden who is pretty much celebrated by the people in Ferelden/Orlais/Antiva (wherever they might be) but the tune does really make them feel special, isn't it? We know that there are three phases of HIV infection:

• Acute Phase: Seroconversion occurs during this stage which allows the body to produce antibodies against the virus. The interaction between them would cause some physical symptoms resembling the flu. Fever, headache, some generalised body rashes, muscle ache etc. It's really taking tolls on the body. If Grey Wardens are to be affected by these symptoms, would it affect their judgement and ability to fight? Well, maybe but in some occasions, seroconversion doesn't really produce physical symptoms which is why it is impossible to determine whether you are infected or not unless you are screened.

• Asymptomatic phase: People would appear healthy even without treatment if they were in this phase. The HIV would slowly replicate, destroying your immune system bit by bit. Some people with HIV claimed that they were having some kind of physical symptoms that are caused by the HIV itself like rashes, low energy, weight loss etc. The thing is, people who knew they were infected by such virus are subjected to stigma and ostracisation. This would make them more likely to be diagnosed with clinical depression hence the symptoms. People who were depressed, practice a sedentary lifestyle and often experience lack of sleep would accelerate the progression of the virus itself. Some studies have concluded that clinical depression can lead to a reduction in the immune system which would make such an individual prone to infection etc.

• Symptomatic phase: If you adhere to your lifelong treatment of HIV, sometimes, you won't experience this phase. Anti-retroviral therapies, even with all of the side effects have proven to be effective in delaying the onset of AIDS (Acquired Immunodeficiency Syndrome). AIDS is not a disease, it is a collection of diseases. When you were infected by HIV and consequently diagnosed with more than two illnesses as a result of impaired immune systems, you are considered to be in the symptomatic phase of HIV infection, commonly known as the AIDS. Without treatment, the prognosis of such patients are poor; they can live up to three years.

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Picture Source - Pixabay (CC0)

There are currently two strains of HIV which are HIV type I and HIV type II. Both exert a detrimental effect towards our immune system although the difference between them might have been more structural rather than functional. There are a few people in this world who were lucky enough to be infected by a defective strain of HIV (they are up to this point didn't cause any kind of damage to the immune system). If you are curious whether this kind of illness can be cured or not, well, up until now, there are no antiviral that can be found that could have cure viral infection (we can't even cure flu completely). Among others, there is one patient designated as the "Berlin patient" named Timothy Ray Brown who are cured of HIV infection, completely. This is an interesting development. When he was diagnosed with HIV infection, he was also found to have a form of blood cancer called leukaemia. People might have pitied him for having both of the diseases without knowing that the leukaemia was actually a blessing in disguise.

Before performing an operative procedure called the bone marrow transplant (for the leukaemia), the treating doctor purposely chose a donor who exhibits a rare form receptor produced by a gene called the CCR5-delta 32. Let me explain a bit; to exert its infective property, an HIV needs to latch itself onto cells through a receptor produced by a specific gene called the CCR-5. CCR5-delta 32 is a mutated form of CCR-5 gene which would allow it to produce receptors that are resistant to HIV attachment. After the procedure, they do all sort of test, including brain biopsy to detect HIV (since this is the favourite spot for HIV to lie dormant) but none of it could ever detect the virus. It was a successful yet dangerous treatment.

The Calling

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Picture Source - Pixabay (CC0)

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After 30 years of being tainted by darkspawn blood, Grey Wardens may lose their capability to think clearly and end up becoming the thing that they were vowed to kill instead. This is why people who were willing to put down their life for the sake of peace in the realm would rather die being killed by the darkspawn before their sanity being taken over by such consequences. We know that people who were infected by HIV will have a significant number of such virus, lying dormant in the brain. If you think they won't affect the brain, then you are gravely mistaken. In March 2018, a paper which was written by Phillip M et al found that the concentration of an enzyme called tyrosine hydroxylase which is essential in the production of dopamine in an HIV-positive patient was low. This will reduce the amount of dopamine produce which would affect patients in a different way depending on which side of the brain which is affected; if it affects the nigrostriatal pathway, patients will show some symptoms resembling Parkinson's disease and if it affects the mesolimbic pathway, clinical depression can be expected.

This is why treating HIV with anti-retroviral drugs is important which is to avoid terrible consequences which can be caused by such virus. Patients who are diagnosed with HIV are prone to get some form of neuropathological consequences. Pity for those Wardens; they can't get their hands on medication that could have possibly treated their own diseases provided the diagnosis is right. Who am I kidding? HIV might not have even existed in such worlds. If you are exposed to any situations which might have predisposed you to HIV infection, get tested and treated. You might have to abide by a lifelong treatment, but if you are determined enough to fight off, you can live similarly with people who are HIV-negative; anti-retroviral therapies made it so.

References And Further Reading Materials

• HIV/AIDS epidemiology, pathogenesis, prevention, and treatment. Retrieved on July 15th, 2018.
• Symptoms And Stages of HIV Infection. Retrieved on July 15th, 2018.
• HIV Can Lie Dormant in the Brain. Here's What That Means.. Retrieved on July 15th, 2018.
• Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Retrieved on July 15th, 2018.
• The dopamine transporter: An unrecognized nexus for dysfunctional peripheral immunity and signaling in Parkinson’s Disease. Retrieved on July 15th, 2018.
• The Only Man Cured Of HIV, Timothy Ray Brown, Speaks. Retrieved on July 15th, 2018.

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