HIV is a virus that affects and alters the immune system, increasing the risk of other infections and diseases and their effects. Until diagnosis, the infection can progress to an advanced stage of illness called AIDS.
Recent advancements in treatment also mean that people living with HIV in countries with good access to health care develop AIDS very rarely until they receive treatment.
The life expectancy of a person carrying the HIV virus is now approaching that of a person tested negative for the virus, as long as they are actively adhering to a combination of drugs called antiretroviral therapy (ART).
A 2016 report by Kaiser Permanente indicated that the difference in life expectancy between HIV-positive people and HIV-negative people narrowed from 44 years to 12 years, between 1996 and 2016.
The World Health Organization (WHO) also advises that a person living with HIV may regain a high quality of life with care, and that as of mid-2017, 20.9 million people worldwide received ART.
In this post, we’re discussing the signs, causes and treatments of HIV and AIDS.
What is HIV?
Human immunodeficiency virus (HIV) is a virus that is a type of T cell that targets immune cells called CD4 cells.
These are white blood cells traveling around the body, identifying cell defects and abnormalities as well as infections. As HIV enters and infiltrates these cells, it diminishes the ability of the body to fight other diseases.
This increases opportunistic infections and cancers ‘ risk and effects. A person will bear HIV for a long time, though, without experiencing symptoms.
HIV is an infection that has lasted for decades. Yet receiving treatment and successfully treating the disease can prevent HIV from reaching a serious level and reduce a person’s risk of transmitting the virus.
What is AIDS?
HIV infection is the most advanced stage of AIDS. When HIV infection progresses into AIDS, it poses a greater risk of cancers and cancer.
Without treatment, as the immune system slowly wears down, HIV infection will likely develop into AIDS. Advances in ART suggest, however, that an ever-decreasing number of people advance to this level.
By the end of 2015, there were around 1,122,900 HIV-positive people. Figures from 2016 reveal, for instance, that medical professionals treated AIDS in an estimated 18,160 men.
Causes
People transmit HIV in bodily fluids, including:
- blood
- semen
- vaginal secretions
- anal fluids
- breast milk
In the United States, the main causes of this transfer of fluids are:
- anal or vaginal intercourse with a person who has HIV while not using a condom or PrEP, a preventive HIV medication for people at high risk of infection
- sharing equipment for injectable illicit drugs, hormones, and steroids with a person who has HIV
A woman who is pregnant or recently born with HIV can pass the disease on to her child during pregnancy, childbirth or breastfeeding.
In countries that have successful screening procedures in place for blood donations, the risk of HIV transmission by blood transfusion is extremely low.
Undetectable = untransmittable
Such fluids must contain enough of the virus to transmit HIV. If an individual has’ undetectable’ HIV, he or she will not transmit HIV to another individual, even after a fluid transfer.
Undetectable HIV is when the level of HIV in the body is so small, that it can not be identified by a blood test. People may be able to achieve undetectable HIV rates by following the recommended course of treatment closely.
It is important to confirm and monitor the undetectable status periodically using a blood test, as this does not indicate that the person is no longer HIV-positive.
Undetectable HIV depends on the person adhering to their treatment and on the effectiveness of the treatment itself.
Progression to AIDS
The risk of HIV progression to AIDS varies widely among people and depends on many factors including:
- the age of the individual
- the body’s ability to defend against HIV
- access to high-quality, sanitary healthcare
- the presence of other infections
- the individual’s genetic inheritance resistance to certain strains of HIV
- drug-resistant strains of HIV
Symptoms
Infections by other bacteria, viruses, fungi, or parasites also cause the more serious HIV symptoms.
For people living with HIV, these disorders appear to develop further than for people with healthy immune systems. A properly functioning immune system will protect the body from more advanced infection symptoms, and this mechanism is compromised by HIV.
Early symptoms of HIV infection
Many individuals with HIV show no symptoms until months or even years after they have contracted the virus.
About 80 percent of people, however, may experience a series of flu-like symptoms known as acute retroviral syndrome about 2–6 weeks after the virus comes in.
The initial symptoms of HIV infection might include:
- fever
- chills
- joint pain
- muscle aches
- sore throat
- sweats. particularly at night
- enlarged glands
- a red rash
- tiredness
- weakness
- unintentional weight loss
- thrush
Such effects may also arise from the misuse of many types of viruses by the immune system.
However, people who experience several of these symptoms and know why they may have been at risk for HIV during the last 6 weeks should take a test.
Asymptomatic HIV
In many cases, symptoms may not arise for many years, despite the signs of acute retroviral syndrome.
The virus continues to develop during this time and causes immune system and organ damage. This slow process will continue for an average of about 10 years without a drug that prevents virus replication.
An HIV-positive person often has no symptoms, feels good, and looks well.
Strictly adhering to an ART course will interrupt the process and completely suppress the virus. Taking effective life-saving antiretroviral medicines can halt ongoing immune system damage.
Late-stage HIV infection
HIV weakens the ability to fight infection without treatment. The patient is vulnerable to serious illnesses. This level is called stage 3 HIV, or AIDS.
Signs of HIV infection at the late stage could include:
- blurred vision
- diarrhea, which is usually persistent or chronic
- dry cough
- a fever of over 100 °F (37 °C) lasting for weeks
- night sweats
- permanent tiredness
- shortness of breath, or dyspnea
- swollen glands lasting for weeks
- unintentional weight loss
- white spots on the tongue or mouth
The risk of developing a life-threatening disease greatly increases during late-stage HIV infection. By taking other medications alongside HIV treatment, a person with late-stage HIV can manage, prevent and treat serious conditions.
Opportunistic infections
HIV care is nowadays usually sufficiently effective to keep many infections at bay.
Late-stage HIV decreases the body’s ability to fight a variety of pathogens, illnesses, and cancers by decreasing immune system function. Infections that caused little or no health problems before AIDS may pose a serious health risk once the immune system has been compromised.
Physicians refer to these as opportunistic infections (OIs). A doctor will treat AIDS if any of those infections arise.
These include:
Candidiasis of the bronchi, trachea, esophagus, and lungs: As a fungal infection that normally occurs in the skin and hair, this often causes serious problems for people with AIDS in the esophagus and the lower respiratory tract.
Invasive cervical cancer: This type of cancer develops in the cervix and spreads through the body to other areas. Daily cancer care team checkups can help prevent cancer or reduce spread.
Coccidioidomycosis: Sometimes, in healthy people, people refer to the self-limited version of this disease as valley fever. The infection is caused by inhalation of the fungus Coccidioides immitis.
Cryptococcosis: Cryptococcus neoformans is a fungus that can infect any part of the body but most often gets into the lungs to cause pneumonia or swelling in the brain.
Cryptosporidiosis: This infection is caused by the protozoan parasite Cryptosporidium which causes severe abdominal cramps and watery diarrhoea.
Cytomegalovirus disease (CMV): CMV can cause a variety of diseases in the body including pneumonia, gastroenteritis, and brain infection, including encephalitis. However, in people with late-stage HIV CMV retinitis is of particular concern, and it can infect the retina at the back of the eye, permanently removing sight. Retinitis from CMV is a medical emergency.
HIV releted encephalopathy: This brain disorder may be triggered by an acute or chronic HIV infection. Although doctors do not fully understand the cause, they consider it to be related to inflammation in the brain after infection.
Herpes simplex (HSV): Normally acquired or transmitted during childbirth, this virus is extremely common and seldom causes health issues or causes self-limiting recurrences in people with strong immune systems. However, in people with HIV, it can reactivate, causing painful cold sores around the mouth and ulcers on non-resolving genitals and anuses. The sores are an example of AIDS, rather than a diagnosis of herpes. HSV can also infect the breathing tube, lungs, or esophagus of people with AIDS.
Histoplasmosis: The Histoplasma capsulatum fungus causes extremely severe symptoms, similar to pneumonia, in people with advanced HIV. This disease can gradually spread histoplasmosis and may affect organs outside the respiratory system.
Chronic intestinal isosporiasis: Isospora belli parasite can enter the body through infected food and water, causing diarrhea, fever, vomiting, weight loss, headaches and abdominal pain.
Kaposi’s sarcoma (KS): Kaposi’s herpesvirus sarcoma (KSHV), also known as the human herpesvirus 8 (HHV-8), causes cancer that causes irregular blood vessels to develop anywhere in the body. It can be extremely dangerous if KS enters tissues, such as the intestines or lymph nodes. KS appears on the skin surface as close lilac or pink dots. We may be level, or elevated.
Lymphoma: People refer to lymphoma as cancer of the lymph nodes and lymph tissues, and many different types of cancer -occur. Hodgkin and non-Hodgkin lymphoma, however, have strong connections to the HIV infection.
Tuberculosis (TB): This disease is caused by the bacteria Mycobacterium tuberculosis, and may be transmitted to droplets if a person with an active infection sneezes, coughs, or talks. Tuberculosis causes severe lung infection, weight loss, fever, and fatigue, as well as infecting the brain, lymph nodes, bones, or kidneys.
Mycobacteria, including Mycobacterium avium and Mycobacterium kansasii: naturally occurring in the environment, these bacteria pose few problems for people with fully functioning immune systems. Nevertheless, they can spread throughout the body and cause life-threatening health problems for HIV-positive people, particularly in their later stages.
Pneumocystis jirovecii pneumonia (PJP): A pneumocystis jirovecii infection induces breathlessness, dry cough and high fever in people with suppressed immune systems including those with HIV.
Recurrent pneumonia: Several different infections can cause pneumonia but one of its most dangerous causes in people with HIV is a bacteria called Streptococcus pneumoniae. Vaccines for this bacteria are available and every person who has HIV will receive Streptococcus pneumoniae vaccination.
Progressive multifocal encephalopathy (PML): The John Cunningham virus (JC) occurs in a large number of people, typically lying dormant in the kidneys. Nonetheless, the JC virus affects the brain of people with compromised immune systems, often due to HIV or drugs such as those for multiple sclerosis (MS), leading to a severe conditon called progressive multifocal leukoencephalopathy (PML). PML can potentially be life-threatening, causing paralysis and cognitive problems.
Recurrent Salmonella septicemia: This type of bacteria also enters the body in contaminated food and water, circulates throughout the body and overpowers the immune system, causing nausea, diarrhea and vomiting.
Toxoplasmosis (toxo): Toxoplasma gondii is a parasite inhabiting warm-blooded animals including cats and rodents and leaving the body in its feces. People acquire the diseases by inhaling infected dust or consuming tainted foods, but this may also occur in commercial meats. T. Gondii causes severe lung, retina, back, liver, pancreas, brain, testicles and colon infections. Be sure to wear protective gloves when changing cat litter and then wash the hands thoroughly afterwards.
Wasting syndrome: It occurs when a person loses 10 percent of their muscle mass involuntarily through diarrhea, fatigue, or fever. Fat loss may also be part of the weight loss.
Prevention
Preventing OIs is essential to improving late-stage HIV life expectancy. A person living with the disease must take precautions apart from controlling the HIV viral load with drugs, including the following steps:
- Wear condoms to prevent other STIs.
- Receive vaccinations for potential OIs. Discuss these with your primary care physician.
- Understand the germs in your surrounding environment that could lead to an OI. A pet cat, for example, could be a source of toxoplasmosis. Limit exposure and take precautions, such as wearing protective gloves while changing litter
- Avoid foods that are at risk of contamination, such as undercooked eggs, unpasteurized dairy and fruit juice, or raw seed sprouts.
- Do not drink water straight from a lake or river or tap water in certain foreign countries. Drink bottled water or use water filters.
- Ask your doctor about work, home, and vacation activities to limit exposure to potential OIs.
Antibiotic, antifungal, or antiparasitic drugs can help treat an OI.
HIV and AIDS myths and facts
Some myths exist about HIV that are harmful to people with the virus and are stigmatizing.
The following cannot transmit the virus:
- shaking hands
- hugging
- kissing
- sneezing
- touching unbroken skin
- using the same toilet
- sharing towels
- sharing cutlery
- mouth-to-mouth resuscitation or other forms of “casual contact”
- the saliva, tears, feces, and urine of a person with HIV
Diagnosis
The Centers for Disease Control and Prevention (CDC) reports that about 1 out of every 7 HIV-positive Americans do not know their HIV status.
Being aware of the HIV status is vital for starting treatment and preventing more severe immune problems and subsequent infections from occurring.
HIV blood tests and results
A doctor can take a specific blood test to check for HIV. A positive outcome means they found HIV antibodies in the bloodstream. Before a positive result is provided the blood is retested.
Early testing and diagnosis is critical following potential exposure to the virus, and greatly improves the likelihood of successful treatment. There are also customized test kits available.
It may take 3-6 months for HIV to appear in the test and re-testing may be required for a definitive diagnosis. People at risk of infection may get an immediate check within the last 6 months. Usually, the test provider will recommend a further test within a few weeks.
Treatment
Apparently there is no treatment for HIV or AIDS.
Therapies, however, may avoid the progression of the disease and give most people living with HIV a chance to live a long and relatively healthy life.
It is important to start ART early on when the virus progresses. According to the WHO recommendations from June 2013, this increases quality of life, extends life expectancy and reduces the transmission risk.
More effective and better tolerated therapies have emerged that, by taking as little as one pill per day, can improve general health and quality of life.
A person living with HIV can reduce his or her viral load to such an extent that it can no longer be detected in a blood test. Upon reviewing a number of large trials, the CDC concluded that individuals without detectable viral load “currently have no chance of sexually transmitting the virus to an HIV-negative partner.”
Medical professionals refer to this as undetectable= untransmittable (U= U).
Antiretroviral drugs
HIV treatment involves antiretroviral medicines that counter the HIV infection and slow down the body’s spread of the virus. People living with HIV typically take a combination of medications called highly active antiretroviral therapy (HAART), or antiretroviral combination therapy (cART).
A variety of antiretroviral subgroups exist, such as:
Protease inhibitors
Protease is an enzyme which must be expressed by HIV. Such drugs bind to, and block, the virus, stopping HIV from making copies of itself.
These include:
- atazanavir/cobicistat (Evotaz)
- lopinavir/ritonavir (Kaletra)
- darunavir/cobicistat (Prezcobix)
Integrase inhibitors
To order to kill T cells, HIV requires integrase, another enzyme, Integrase blocks this drug. These are often the first line of treatment for many people due to their effectiveness and minimal side effects.
Integrase inhibitors include:
- elvitegravir (Vitekta)
- dolutegravir (Tivicay)
- raltegravir (Isentress)
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
Such medications, also known as “nukes,” interact with HIV when attempting to replicate it.
This class of drugs includes:
- abacavir (Ziagen)
- lamivudine/zidovudine (Combivir)
- emtricitabine (Emtriva)
- tenofovir disproxil (Viread)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
NNRTIs work in a similar manner to NRTIs, making replication of HIV harder.
Chemokine co-receptor antagonists
Those drugs block the entry of HIV into cells. Physicians in the U.S., though, often don’t recommend these because other medications are more efficient.
Entry inhibitors
Entry inhibitors hinder the entry of HIV into T cells. HIV can’t replicate without exposure to those cells. As with antagonists of chemokine co-receptors, they aren’t normal in the US.
People use a mixture of these medications often to cure HIV.
A medical team must customize may patient to the exact mix of drugs. HIV care is typically lifelong, effective and dependent on daily dose. A person living with HIV will regularly take pills. May ARV class has different side effects, but may have common side effects including:
- nausea
- fatigue
- diarrhea
- headache
- skin rashes
Complementary or alternative medicine
While many people with HIV seek complementary, alternative, or herbal treatments, such as herbal remedies, there is no evidence to confirm that they are successful.
Mineral or vitamin supplements may offer some benefits in overall health, according to some limited studies. Discussing these options with a health care provider is important because some of those options, including vitamin supplements, that interfere with ARVs.
Prevention
Healthcare professionals suggest measures on the following to avoid contracting HIV.
Sex using a condom or PrEP: having sex without a condom or other preventive measures such as PrEP may raise the risk of transmitting HIV and other sexually transmitted infections (STIs) significantly.
Using condoms or PrEPs during any sexual act with a person outside of a secure relationship in which there is no HIV in either partner.
In its 2019 guideline , the U.S. Preventive Services Task Force recommends that doctors should prescribe PrEP only for people with recent negative HIV test results. They tell people with a high HIV risk who are registered for PrEP should take it once a day.
The Task Force recommends only one PrEP formulation in the Guidelines, which is a combination of tenofovir disoproxil fumarate and emtricitabine.
Drug injection and needle sharing: A key factor for HIV transmission in developed countries is intravenous drug use. Users may be exposed to HIV and other viruses such as hepatitis C while sharing needles and other drug equipment.
Many social interventions may help to reduce infections as a result of drug misuse, such as needle-exchange programmes. Recovering from a substance use disorder can for many reasons improve health quality of life, but it can dramatically reduce future HIV exposure.
People who take drugs using a needle should use a new, unused, unshared needle.
Body fluid exposure: By taking precautions to reduce the risk of exposure to contaminated blood, a person can limit their potential exposure to HIV;
In circumstances where exposure to body fluids is a possibility, health care workers should use gloves, masks, protective eyewear, shields and gowns.
The risk of infection can be minimized by regular and thorough washing of the skin immediately following contact with blood or other body fluids. Healthcare functions should follow a set of protocols for avoiding transmission known as universal precautions.
Pregnancy: Many antiretrovirals during pregnancy can cause harm to an unborn fetus.
Nevertheless, a successful, well-managed treatment plan will prevent transmission of HIV from mother to fetus. Delivery may be possible by Caesarean section.
Women who are pregnant but suffer from HIV may also transmit the virus by breast milk. However, taking the right medication regimen on a regular basis significantly reduces the risk of virus transmission.
Consult with a health care provider about all choices.
Education: It is important to teach people about known risk factors so they can be prepared with the resources to prevent HIV.
Living with HIV
Because of the additional risk of other illnesses and diseases, people living with HIV must make adjustments to the lifestyle to manage their decreased immunity.
Adherence: It is absolutely essential to take the HIV drug as prescribed for effective treatment. Missing just a few doses could put the treatment in jeopardy.
Program a regular, methodical regimen around any current lifestyle and schedule to suit the treatment plan. Treatment plans can differ between persons. People often refer to “compliance”
HIV medicines that cause particularly severe side effects which often discourage adherence by people.
When side effects get too serious, speak to your medical team instead of just stopping the drug. We should switch the diet to a more acceptable drug.
Public health: It is important to take steps to avoid illness and other infections. People living with HIV should strive to improve overall health by regular exercise, a healthy, nutritious diet, and any medications, including tobacco, should cease.
Additional precautions: People living with AIDS should take extra precautions, particularly around animals, to avoid any exposure to infection. Evite interaction with animal feces and litter for dogs.
Doctors also prescribe thorough and constant hand washing. Antiretrovirals necessary certain precautions that are required.
Constant contact with doctors: HIV is a lifelong condition, so it is vital to have regular contact with a health care provider to monitor treatment in accordance with advancing age and conditions. The healthcare team must monitor treatment periodically and change it accordingly.
Psychological effects: Current myths about AIDS and HIV are fading with growing awareness of the disease.
Yet in other parts of the world, stigma about the disease remains. HIV-patients can feel excluded, abused and lonely.
A diagnosis of HIV can be very distressing and anxiety or depression is current. If you feel anxious, or have depression symptoms, seek immediate medical help.
Conclusion
HIV is an ill-understood and potentially dangerous disease which reduces the immune system’s effectiveness in fighting other infections.
Modern medicine developments in people living with HIV can have an almost normal life expectancy and an active lifestyle. For the most effective results, a person receiving antiretroviral therapy must adhere strictly to his / her regime.
HIV transmits during sex, or blood, in corporal fluids such as semen or vaginal secretions. In the U.S., HIV most often transmits without a condom or PrEP by sexual intercourse, and exchanges needles while injecting drugs.
And, if a person has a viral load that can not be identified by HIV testing, they can’t pass the virus on to another person.
As HIV progresses, for example in cases where a person is unaware of their HIV status or is not receiving treatment, it may progress to a late stage known as AIDS.
AIDS can open the door to a variety of infections known as opportunistic infections which pose a serious health risk. These are serious or prolonged presentations of infections that in a person with good immune function will normally resolve quickly.
Others may occur because of the microbes that occur naturally in the atmosphere and would not usually cause any infection.
By adhering to medication, a person living with AIDS will revert the disease to HIV.
If you believe you have recently been exposed to the virus, click here to find your nearest test facility.
