HIV/AIDS

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview 

Acquired immunodeficiency syndrome (AIDS) is a chronic and potentially life–threatening condition caused by the human immunodeficiency virus (HIV). This virus impairs the immune system, making it difficult for the body to defend against infections and diseases.

HIV is primarily transmitted through sexual contact, but it can also spread through contact with infected blood or by sharing needles during illicit drug use. Additionally, mother–to–child transmission can occur during pregnancy, childbirth, or breastfeeding. Without treatment, HIV can progressively weaken the immune system over the course of several years until it develops into AIDS.

While there is currently no cure for HIV/AIDS, medical advancements have led to the development of antiviral medications that effectively control the infection and prevent the progression of the disease. These treatments have significantly reduced AIDS–related deaths worldwide.

Symptoms 

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection (Acute HIV): Following HIV infection, some individuals may experience primary (acute) HIV infection, presenting flu–like symptoms within 2 to 4 weeks that can last for a few weeks. These symptoms include fever, headache, muscle and joint pain, rash, sore throat, painful mouth sores, swollen lymph glands (mainly in the neck), diarrhea, weight loss, cough, and night sweats. Although the symptoms may be mild and easily overlooked, the viral load in the bloodstream is significantly high during this period, making the infection highly transmissible compared to later stages.
Clinical latent infection (Chronic HIV): During this stage of infection, HIV remains present in the body and can be found in white blood cells. However, it’s important to note that many individuals may not experience any symptoms or infections at this time. If antiretroviral therapy (ART) is initiated, this stage can persist for many years. Nevertheless, some people may develop more severe disease relatively early on in this stage.
Symptomatic HIV infection: As the virus continues to replicate and damage immune cells responsible for fighting off infections, you may experience mild infections or persistent signs and symptoms, including fever, fatigue, swollen lymph nodes (often an early indication of HIV infection), diarrhea, weight loss, oral yeast infections (thrush), shingles (herpes zoster), and pneumonia.
Progression to AIDS: The availability of improved antiviral treatments has significantly reduced AIDS–related deaths worldwide, even in resource–limited regions. These life–saving therapies have led to a remarkable decline in the development of AIDS among individuals with HIV in the United States today. Without treatment, HIV typically progresses to AIDS within 8 to 10 years.

When AIDS occurs, it severely weakens the immune system, making individuals more susceptible to opportunistic infections or cancers that would not normally cause illness in those with a healthy immune system. Some of the signs and symptoms of these infections may include:

Sweating
Chills
Recurring fever
Chronic diarrhea
Swollen lymph glands
Persistent white spots or unusual lesions on the tongue or in the mouth
Persistent, unexplained fatigue
Weakness
Weight loss
Skin rashes or bumps

If you suspect you might have been exposed to HIV or are at risk of contracting the virus, it is essential to seek medical attention from a healthcare provider promptly.

Causes 

HIV infection occurs when infected blood, semen, or vaginal secretions enter the body, which can happen through various routes:

Sexual intercourse:  Infection can occur through vaginal, anal, or oral sex with an HIV–positive partner, as the virus can enter your body through their blood, semen, or vaginal secretions. Mouth sores or small tears that may develop during sexual activity can also provide entry points for the virus into your body.
Sharing needles: Sharing used needles and syringes for drug injection greatly raises the risk of getting HIV and other infectious diseases like hepatitis.
Blood transfusions: HIV transmission can occur through blood transfusions. In low–income countries without the capability to screen all donated blood, the risk of transmission may be higher.
During pregnancy or delivery or through breastfeeding: Infected mothers can transmit the virus to their babies. However, the risk can be significantly reduced if HIV–positive mothers receive treatment during pregnancy.

HIV cannot be transmitted through ordinary contact, so activities like hugging, kissing, dancing, or shaking hands with someone who has the infection will not result in the transmission of HIV or AIDS. It’s important to know that HIV is not spread through the air, water, or insect bites as well. Transmission of HIV occurs through specific modes, such as unprotected sexual contact, sharing needles with an infected person, or from an infected mother to her baby during childbirth or breastfeeding.  

Risk factors 

HIV/AIDS can infect anyone of any age, color, gender, or sexual orientation. However, several risk factors may contribute to a person’s susceptibility to HIV/AIDS, such as:

Unprotected sex: Having sex without condom and having several sexual partners increases one’s risk of getting HIV. Anal sex is more dangerous than vaginal sex. It is recommended that every sexual intercourse, one should use a fresh latex or polyurethane condom. An internal condom, also known as a female condom, can also be used. It is inserted inside the vagina or anus.

Having an STI: Being diagnosed with STIs can put a person at a higher risk for an HIV infection. Open sores or lesions can serve as entry points for HIV into the body. Many STIs cause open sores on the vaginal area.
Using illicit injection drugs: Sharing contaminated needles and syringes to take drugs can get a person infected with HIV. Users of illegal injectable substances are more exposed to blood droplets from other people which increase the risk for infection.

Diagnosis 

Although there is currently no cure for HIV, significant progress has been made in its treatment with the use of antiretroviral therapy (ART). ART involves taking a combination of oral medications daily, which is the most effective approach in inhibiting HIV replication and preventing damage to the body’s cells. Some combination pills contain multiple medications in one, personalized by healthcare providers for each individual. The primary goal of ART is to lower the viral load in the blood to undetectable levels through regular HIV testing, while also slowing down the virus’s impact on the immune system. Some common options for HIV testing include:

Antigen/antibody tests:  HIV tests typically require a blood sample from a vein to detect antigens, which are substances present on the HIV virus and become detectable within a few weeks after HIV exposure, resulting in a positive test. On the other hand, antibodies, produced by the immune system in response to HIV exposure, may take weeks to months to become detectable. Combination antigen/antibody tests usually yield positive results within 2 to 6 weeks after exposure to HIV.
Antibody tests:  HIV tests detect antibodies in blood or saliva, and most rapid tests, including self–tests done at home, are based on this principle. It can take anywhere from 3 to 12 weeks after exposure for antibody tests to yield positive results.
Nucleic acid tests (NATs):  These tests examine the viral load of the actual HIV virus in your blood and require a blood sample drawn from a vein. If you suspect recent exposure to HIV in the past few weeks, your healthcare provider may suggest NAT (nucleic acid test). NAT is the first test to detect HIV after exposure.

Discuss with your healthcare provider to determine the most suitable HIV test for you. Even if any of the initial tests show negative results, it is important to consider a follow–up test weeks to months later to confirm the accuracy of the results.

If one had a probable exposure within three months of testing, retesting to confirm the negative result is required.

Upon receiving a diagnosis of HIV/AIDS, your healthcare provider may conduct several tests to determine the stage of the disease and the most appropriate treatment. These tests include:

CD4 T cell count: This test assesses the number of CD4 T cells, which are white blood cells targeted and damaged by HIV. The progression to AIDS occurs when the CD4 T cell count falls below 200, even if there are no noticeable symptoms.
Viral load (HIV RNA): Measuring the amount of HIV virus in your blood, this test helps monitor the effectiveness of HIV treatment. The goal is to achieve an undetectable viral load, which significantly reduces the risk of opportunistic infections and other HIV–related complications.
Drug resistance: Some strains of HIV may be resistant to certain medications. This test identifies whether your particular virus has developed resistance, assisting your healthcare provider in making informed decisions about your treatment plan.
Test complication: Your healthcare provider may order lab tests to screen for various infections and potential complications, such as tuberculosis, hepatitis B or C virus infections, sexually transmitted infections (STIs), liver or kidney damage, urinary tract infections, cervical and anal cancer, cytomegalovirus, and toxoplasmosis. These tests are essential in diagnosing and managing any underlying health conditions and ensuring appropriate and timely treatment.

Treatment 

Currently, there’s no cure for HIV/AIDS. Once you have the infection, your body can’t get rid of it. However, there are many medications that can control HIV and prevent complications. These medications are called antiretroviral therapy (ART). Everyone diagnosed with HIV should be started on ART, regardless of their stage of infection or complications.

ART is usually a combination of two or more medications from several different drug classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that combine multiple HIV medications into one pill, taken once daily.

Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from different classes to:

Account for individual drug resistance (viral genotype)
Avoid creating new drug–resistant strains of HIV
Maximize suppression of virus in the blood

Two drugs from one class, plus a third drug from a second class, are typically used.

There are several types of medications used to treat HIV, each targeting specific stages of the virus’s replication process:

Non–nucleoside reverse transcriptase inhibitors (NNRTIs) work by inhibiting a protein essential for HIV to replicate itself. Examples of NNRTIs include efavirenz, rilpivirine, and doravirine.
Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are modified versions of the building blocks that HIV requires for replication. NRTIs include medications such as abacavir, tenofovir disoproxil fumarate, emtricitabine, lamivudine, and zidovudine. Combination drugs are also available, which combine multiple medications into a single pill. Examples of combination drugs include emtricitabine/tenofovir disoproxil fumarate and emtricitabine/tenofovir alafenamide fumarate.
Protease inhibitors (PIs) target and disable another critical protein (protease) required for HIV replication. Commonly used PIs include atazanavir, darunavir, and lopinavir/ritonavir.
Integrase inhibitors function by blocking the activity of a protein called integrase, which HIV employs to insert its genetic material into CD4 T cells. Examples of integrase inhibitors include bictegravir sodium/emtricitabine/tenofovir alafenamide fumarate, raltegravir, dolutegravir, and cabotegravir.
Entry or fusion inhibitors prevent HIV from entering CD4 T cells. Notable examples of these inhibitors are enfuvirtide and maraviroc.

Starting and maintaining treatment

Everyone with HIV infection, regardless of CD4 T cell count or symptoms, should be offered antiviral medication to maintain an undetectable viral load. Taking the prescribed medications consistently is crucial to keep the immune system strong, reduce infection risks, prevent treatment–resistant HIV, and lower the chances of transmitting the virus to others. Despite challenges, such as side effects or mental health issues, maintaining ART with regular follow–up appointments and open communication with healthcare providers is vital to address any difficulties and ensure a healthier outcome.

Treatment side effects

HIV medication can cause various side effects, including problems like feeling sick, heart issues, harm to the kidneys and liver, weaker bones, unusual cholesterol levels, higher blood sugar, and difficulties with thinking, emotions, and sleep.

Treatment for age-related diseases

As you get older with HIV, dealing with some health problems might become harder. Medications used for age–related issues, like heart or bone conditions, may not mix well with HIV drugs. That’s why it’s important to talk to your healthcare provider about all your health conditions and the medicines you take. If another provider gives you medications, make sure they know about your HIV treatment to avoid any harmful interactions between the drugs. Good communication between all your healthcare providers is crucial for your well–being.

Treatment response

Your health care provider will regularly assess your viral load and CD4 T cell counts to evaluate your response to HIV treatment. These tests will be conducted initially after 4 to 6 weeks and subsequently every 3 to 6 months. The goal of the treatment is to reduce the viral load to an undetectable level in the blood, but this doesn’t imply that HIV is completely eradicated from the body. It may still be present in other areas, like lymph nodes and internal organs.

Diseases & Conditions HIV/AIDS