HIV and AIDS

What are HIV and AIDS?

HIV (Human immunodeficiency virus) is a type of virus that damages the immune system in human beings. It destroys the immune cells in the body that fight against infections and diseases to the point that it progresses to AIDS (Acquired immunodeficiency syndrome). AIDS is a chronic, life-threatening condition that makes the immune system too weak to fight against infections, making the body more susceptible to various infections and cancers. AIDS is an advanced stage of HIV. An untreated HIV can progress to AIDS within a span of 8 to 10 years. Life expectancy after developing AIDS is three years or even shorter.

Alternate names

• HIV disease
• HIV infection

Transmission of the virus

HIV is a sexually transmitted infection in the majority of cases. It is also transmitted through bodily fluids that include blood, semen, breast milk, and vaginal and rectal fluids. The virus does not spread through the air, water, or through casual contact. A child can share HIV infection from the mother during pregnancy, vaginal birth, or through breast milk.
The virus can be spread from an HIV infected person through:

• Unprotected vaginal, anal, or oral sexual intercourse
• Sharing needles and syringes for the administration of drugs
• Sharing tattoo equipment without sterilizing
• Blood transfusions, organ transplantation, or through a needle stick

HIV spreads only when coming in contact with the blood of an infected person. It does not spread through:

• Air or water
• Skin-to-skin contact through hugging, kissing, or shaking hands
• Saliva, sweat, or tears
• Sharing foods, drinks, towels, bedding, or toilet
• Insect bites like mosquitoes or other insects

Are HIV and AIDS a Medical emergency?

HIV and AIDS is a medical emergency. If left untreated, it will lead to a life-threatening situation and death.

Types

There are two types of Human Immunodeficiency Viruses, they are:

• HIV-1: HIV-1 is the most common type of HIV. The viral load of HIV-1 is high and can spread easily when coming in contact with the infected person’s blood, semen, or vaginal secretions.
• HIV-2: HIV-2 is less common and is mainly present in West Africa. This does not spread as easily as HIV-1. HIV-2 is mainly transmitted through sex. HIV-2 develops slowly than HIV-1. The viral load of HIV-2 is lower than HIV-1.

Causes

HIV is a virus that is found in African chimpanzees. It is believed that it has spread from chimps to humans when the infected chimpanzee’s meat is consumed by humans. HIV spreads through sexual intercourse when the infected person’s blood, semen, and vaginal secretions enter the body.

Risk factors

Individuals who are at an increased risk of developing HIV infection are:

• People who have unprotected sex with multiple sexual partners
• People who have frequent sexually transmitted infections, which can cause genital sores
• People who use IV drugs and share needles and syringes with other people

Signs & symptoms

Signs and symptoms of HIV are as follows:

• Fever
• Muscle aches and joint pains
• Fatigue
• Swollen lymph nodes mainly in the neck
• Cough
• Sore throat
• Mouth sores and oral thrush
• Skin rash
• Diarrhea
• Weight loss
• Shingles
• Pneumonia

Signs and symptoms of HIV after progressing to AIDS are as follows:

• Recurrent fever and chills
• Chronic diarrhea
• Sweats
• Swollen lymph nodes
• Persistent fatigue and weakness
• Persistent oral sores on the tongue and in the mouth
• Skin rashes and lumps
• Weight loss

Investigations

Investigation tests that are performed to diagnose HIV are:

• Antigen/antibody tests: Blood from the vein is collected to check for the presence of HIV antibodies. Saliva can also be checked. These tests include enzyme-linked immunosorbent assay (ELISA).
• Nucleic acid tests (NATs): This test is performed to look for the actual virus in the blood.
• Other tests include polymerase chain reaction (PCR), western blot, and an immunofluorescence assay (IFA).

After the diagnosis of HIV is confirmed to be positive, the following tests are done to stage the disease and plan the treatment:

• CD4 T cell count: The stage of the disease is determined by the number of CD4 T cells present in the body. The virus specifically targets and destroys these cells. If these cells are fewer, the disease is in a chronic stage or advanced state.
• Viral load (HIV RNA) test: This test measures the amount of virus in the blood. This test helps to determine the stage of the disease and plan the treatment accordingly.
• Drug resistance test: Some virus strains are resistant to certain medications. This test helps to determine which drugs are resistant to the virus and helps in planning the treatment.

Diagnosis

The diagnosis of HIV is made by reviewing the signs and symptoms and considering the results of the investigation tests.

Course & Stages

HIV progresses in three stages. Every individual having HIV may not develop AIDS.

The following are the stages of HIV:
Stage 1: Acute HIV. This is the stage of primary infection. The symptoms would be mild and not even noticeable. The symptoms may occur four weeks after the virus has infected.
Stage 2: Chronic HIV. This stage of HIV lasts for many years. If left untreated, this can progress to the final stage of the disease.
Stage 3: AIDS, symptomatic HIV infection, this is the last stage of the disease. The virus multiplies and destroys the immune system to the point that it can no longer fight against infections or diseases. It makes the body more vulnerable to severe opportunistic illnesses, eventually leading to death.

Treatment options

There is no cure for HIV and AIDS. Once infected, it is not possible to get rid of the virus. Treatment primarily focuses on controlling and slowing the progression of the disease.

Medical treatment

HIV is treated with antiretroviral therapy (ART). A combination of two or more drugs is used in this therapy. They include the following:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)such as efavirenz, rilpivirine, and doravirine
• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs)such as abacavir tenofovir, emtricitabine, lamivudine, and zidovudine
• Protease inhibitors (PIs) such as atazanavir, darunavir, and lopinavir/ritonavir
• Integrase inhibitorssuch as bictegravir sodium/emtricitabine/tenofovir alafenamide fumar, raltegravir, and dolutegravir
• Entry or fusion was inhibitor such as enfuvirtide and maraviroc

Compliance with medications is very important to:

• Strengthen the immune system
• Reduce the risks of developing infections
• Reduce the progression of HIV infection
• Reduce the chance of spreading it to other people

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Lifestyle modifications and living with HIV infection:

• Eat healthy foods, fresh fruits, vegetables, whole grains, etc for energy and strength
• Avoid raw meat, eggs, raw seafood, and unpasteurized dairy products
• Be up-to-date on vaccinations
• Avoid pets. Stay away from cat feces or pet litter boxes to avoid any infections

Preventive measures for HIV infection are:

• Perform safe sex by using condoms and lubricants
• Have a single sexual partner
• Avoid sharing needles or other injecting equipment
• Use pre-exposure prophylaxis (PrEP) medication to reduce the risk of getting the virus
• Use post-exposure prophylaxis (PEP) on any suspicion of being exposed to the virus
• A pregnant woman should get HIV screening to prevent transmitting the disease to the fetus
• Male circumcision can reduce the risk of HIV infection
• Being compliant with HIV medications can avoid the virus from spreading to another person

Complications

HIV infection weakens the immune system and can lead to various complications:

• Infections like tuberculosis, candidiasis, meningitis, pneumonia, etc.
• Cancers such as lymphoma, Kaposi's sarcoma
• Neurological complications
• Kidney and liver disorders
• Significant weight loss, chronic muscle wasting, and weakness

Prognosis

The prognosis of HIV depends on compliance with the treatment. An untreated HIV can lead to AIDS in a span of 10 years and eventually lead to death after 3 years. Nevertheless, if treated appropriately, the life span and quality of life of an infected individual can improve.

When to contact the doctor? / How to identify the complications?

Medical consultation is recommended after noticing any signs of HIV symptoms or being at an increased risk of contracting the virus by coming in contact with an infected person.

Indications for hospitalization if required

Hospitalization of HIV-infected patients is recommended during opportunistic infections and opportunistic diseases (they refer to severe infections and diseases that occur in people with a weak immune system).

Screening methods

HIV screening is done by checking the blood samples for the presence of HIV antibodies.

Suggested clinical specialists/ Department to consult for this condition

• Infectious Diseases