Random Thoughts on Sword Art Online II – Konno Yuuki’s Condition (AIDS)

SPOILER WARNING FOR SAO SEASON 2

Today I hope to inform you about AIDS.

This post contain spoilers. If you haven’t finished SAO II please don’t read this yet. But I assume that you have, since you wouldn’t have clicked on the title otherwise.

Mother’s Rosario is a lot better than the first two arcs of SAO. At least this one manages to capture the social implications brought about by VR, especially for the medical industry. In this arc, we have Yuuki, perhaps one of the strongest players known.

And today I will be dissecting the conditions leading to the main conflict in Mother’s Rosario, namely, AIDS.

[UPDATE 7/2020: organize the post, update and clarify some information]

Just some intro

Just from reading the SAO forums, I realized how little the general public understands about AIDS, so I hope this post will be useful.

Also, I’m really late to the party, but I do hope some people come by and read this haha…

What is HIV?

HIV is a virus that attacks your white blood cell. When so much of your white blood cells are killed, the result is that there is very few of them left to protect you from infections. When that happens, the condition is called AIDS: acquired immunodeficiency syndrome. In short: HIV causes AIDS.

HIV mutates very fast, a lot faster than SARS CoV/CoV2. That is why it is difficult to treat, and we don’t have a vaccine for it yet.

Transmission (Getting the virus)

This is the part where I’m most confused about.

What the heck does the doctor mean by ‘the whole family contracted it’? HIV testing after blood transfusion is the normal practice. If mama didn’t run away and the doctors did their jobs properly, they should be able to detect HIV before it spread to other family members… and how could it spread in the first place?

Photo by Anna Shvets on Pexels.com

Let me just get this straight. You can contract HIV by direct contact of bodily fluids: sex, blood transfusion, sharing needles, or open wounds could all result in infection of HIV. You cannot get it by kissing (unless you have an open wound in your mouth), sneezing, coughing, sharing things, or shaking hands with infected persons. You cannot get HIV if a mosquito bites you. The mosquito’s gut digests the virus.

So how (the heck) did the entire family end up contracting HIV from each other?

As for Yuuki and her sister, well… vertical transfer. Alright. Virus went through fetal-placental barrier. (PS there are cases where babies are HIV negative because the virus didn’t manage to get through the barrier.) Reasonable enough….

Wait a damn minute, if Yuuki’s mom got an emergency transfusion during c-sec, how the heck is that enough time for the damn virus to get through all the way to the baby?

Secondly, donated blood is routinely screened for HIV. The tests are highly sensitive. Back in 2010, the year Yuuki was born, the risk of HIV contaminated blood being used in transfusion is 1 in 1.5 million. Translate that into numbers and you get a 0.00006% chance (correct me if my math is wrong).

So I am assuming that some way or the other during c-sec or the following processes, the babies came into contact with contaminated equipment or blood. The contaminated blood enter the babies’ bloodstream. It can happen and it probably has happened. Oh god guys please don’t go to this hospital.

It’s possible to cure HIV if detected early, as far as I know. You can get it below the level where it can transmit to other people and live a normal, happy life.

I’m assuming ‘terminal care’ means that Yuuki has like… zero immune cells left. People who have developed AIDS can continue to live normal lives using drug cocktails, given that they do not contract something like MRSA or VRSA or some other incurable infections.

Yuuki had esophageal candidiasis (esophageal thrush) and pneumocytis pneumonia.

Candidiasis is a fungal infection common in people with AIDS. It causes difficulty or pain in swallowing, and if severe, a feeding tube might be needed. It’s a common infection you get from the hospital or using a catheter for too long. People usually get this infection when they use too much antibiotics, and so when all the good bacteria die the yeast are like ‘hurray!’ Candida infections can be treated by medication, and if detected late can spread to other parts of the body including the lungs and liver (including candidemia, where you get it all over your blood). Yes, this can kill Yuuki if you leave it untreated for too long.

The other one is also a fungal infection and is treatable for most cases, but yeah, if left untreated it can still kill Yuuki.

The aforementioned fungal infection would require stronger medication in people with AIDS than in regular people. As far as I’ve read, there’s not much report on candida being resistant to fungicide, which means the drugs should still work to cure her.

Also, I remembered Yuuki’s doctor saying something about how difficult it was to keep up a regimen in a child with AIDS… well if she didn’t keep up the regimen well as a child that could explain her HIV’s drug resistance.

As I’ve said, HIV mutates very fast, and develops drug resistance quickly. That’s why we use drug cocktails: in case it’s resistant to one drug, the other ones will kill it. We try to kill all virions so that the strongest ones wouldn’t survive and make even stronger baby virus.

The thing is, if you don’t take all your doses (this is the same with antibiotics), the strongest ones that survived the drug will make stronger descendants which will have a chance to be even more resistant. When you start taking drugs again, they don’t work as well anymore because the strong ones have bred so much already.

Bubble boy living in sterile environment

Still, HIV doesn’t kill you. Other infections will. All HIV does is kill your immune system, so that you become vulnerable to other infections like the common flu or candida. I think the true purpose of the medicuboid is so that Yuuki can stay in a sterile environment. The reason her condition got so bad she needed the medicuboid is, I think , Yuuki has some kind of underlying condition that causes her to not take drug cocktails and/or fungicide well. She might not be able to handle the side effects, and so the only thing medical personnel could do was give her enough to not die from either the infection or the side effects. This could get so bad that it leads to Yuuki’s coming and going as seen in the anime.

Any chance of treatment?

Antiretroviral therapy. Basically, give her HIV medications. There are a ton out there, and more are coming. However, if her strain is already resistant, the best thing we can hope for is that the doctors can manage the side effects of medication and cure her fungal infections. Some people experience side effects from ART (which can be genetic) and perhaps Yuuki might be in pain because of the medications that are trying to save her. There are many kinds of antiretroviral drugs and you could switch from one to another if there are adverse side effects… I can only assume that she’s not taking well to any of them. And the drug cocktails. So she became so vulnerable and weak that she eventually lost her life.

This has got me thinking whether or not it was the Medicuboid that actually killed Yuuki, weakening her body systems (uh… anyone talked about pressure sore?) due to immobility, or she’s already in critical condition and thus chose the Medicuboid. Anyhow, it doesn’t really matter.

Final words

Yuuki, you are both a warrior and an inspiration. Thank you for all the motivation you have given us humble weebs.