June 24, 2024
HIV

Overview

What is HIV?

Acquired immunodeficiency syndrome (AIDS) is a persistent, or chronic, illness caused by the human immunodeficiency virus (HIV). HIV impairs the immune system, making the body less effective in combating infections and diseases. Without treatment, it may take several years for HIV to sufficiently weaken the immune system to progress to AIDS. Fortunately, due to treatment, the majority of individuals in the United States do not develop AIDS.

HIV can be transmitted through genital contact, such as unprotected sexual intercourse, leading to a sexually transmitted infection (STI). Additionally, HIV can be spread through blood contact, for example, when sharing needles or syringes. Furthermore, untreated HIV can be passed from a mother to her child during pregnancy, childbirth, or breastfeeding.

There is currently no known cure for HIV/AIDS. However, medications can effectively manage the infection and prevent the disease from progressing. The use of antiviral treatments has significantly decreased the number of AIDS-related deaths globally. Efforts are continuously being made to enhance accessibility to prevention and treatment methods for HIV/AIDS in countries with limited resources.

Symptoms of HIV

The symptoms of HIV and AIDS differ based on the person and the stage of infection.

Primary infection, also called acute HIV

Certain individuals who contract HIV may experience flu-like symptoms within 2 to 4 weeks of the virus entering their system. This phase can persist for a few days to several weeks. Some people have no symptoms during this stage.

Possible symptoms include:

1. Headache.
2. Fever.
3. Rash.
4. Diarrhea.
5. Weight loss.
6. Cough.
7. Night sweats.
8. Muscle aches and joint pain.
9. Sore throat and uncomfortable mouth ulcers.
10. Enlarged lymph nodes, primarily located on the neck.

The symptoms may be mild enough to go unnoticed, but the viral load in your bloodstream is significantly elevated. Consequently, the infection is more likely to spread to others during the initial stage than in the subsequent phase.

Clinical latent infection, also called chronic HIV

During this phase of infection, HIV remains present in the body and within the immune system’s white blood cells. However, it is important to note that during this period, a significant number of individuals do not exhibit any symptoms or experience the infections that can be caused by HIV.

The duration of this phase can extend over several years for individuals who are not receiving antiretroviral therapy, commonly known as ART. Certain individuals may experience a more rapid progression to severe illness.

Symptomatic HIV infection

As the virus replicates and devastates immune cells, you might experience mild infections or persistent symptoms, including:

1. Fever.
2. Fatigue.
3. Diarrhea.
4. Weight loss.
5. Pneumonia.
6. Enlarged lymph nodes, frequently among the initial symptoms of HIV infection..
7. Thrush, also known as oral yeast infection,..
8. Shingles, alternatively known as herpes zoster..

Progression to AIDS

Improved antiviral therapies have significantly reduced the number of deaths caused by AIDS on a global scale. As a result of these effective treatments, the majority of individuals living with HIV in the United States are able to avoid developing AIDS. If left untreated, HIV typically progresses to AIDS within a span of 8 to 10 years.

People who have AIDS experience severe damage to their immune system, which makes them more susceptible to diseases that they would not normally contract if their immune system was healthy. These diseases are referred to as opportunistic infections or opportunistic cancers. During the acute stage of the disease, some individuals may develop opportunistic infections.

Some of the symptoms of certain infections might encompass:

1. Sweats.
2. Chills.
3. Ongoing diarrhea.
4. Swollen lymph glands.
5. Constant fatigue.
6. Weakness.
7. Rapid weight loss.
8. Skin rashes or bumps.
9. Recurring fever.
10. Persistent white spots or lesions on the tongue or within the mouth.

When to see a doctor

If you suspect that you might have contracted HIV or are in danger of acquiring the virus, it is imperative to promptly seek the assistance of a healthcare professional.

Causes of HIV

HIV is the result of a viral infection. It can be transmitted through sexual intercourse, the injection of illegal substances using shared needles, or contact with contaminated blood. Additionally, it can be passed from mother to child during pregnancy, delivery, or breastfeeding.

HIV targets and eliminates CD4 T cells, which are essential in supporting the immune system’s ability to combat illnesses. A decrease in the number of CD4 T cells results in a compromised immune system.

How does HIV become AIDS?

An individual may carry an HIV infection for several years without showing any or only a few symptoms before it progresses to AIDS. AIDS is typically identified when the CD4 T cell count drops below 200 or when complications arise that are specific to AIDS, such as severe infections or certain types of cancer.

How HIV spreads

HIV infection can occur if contaminated blood, semen, or vaginal fluids enter your body. This transmission can take place under the following circumstances:

1. Have sex: Infection may occur through vaginal or anal intercourse with an infected partner, while the risk is lower with oral sex. The virus can enter the body through mouth sores or minor tears that may occur in the rectum or vagina during sexual activity.
2. Share needles to inject illicit drugs: Using contaminated needles and syringes greatly increases your vulnerability to contracting HIV and other contagious illnesses like hepatitis.
3. Have a blood transfusion: Occasionally, the virus can be spread through donated blood. Medical facilities and blood donation centers carefully test the blood for HIV, reducing the risk significantly in these locations. However, the risk may be elevated in developing countries that lack the resources to screen all donated blood.
4. Have a pregnancy, give birth or breastfeed: Expectant individuals with HIV have the potential to transmit the virus to their infants. However, those who are HIV positive and receive treatment for the condition while pregnant can significantly reduce the chances of transmission to their babies.

How HIV doesn’t spread

It is important to note that HIV cannot be transmitted through casual contact. This implies that hugging, kissing, dancing, or shaking hands with someone who is infected with HIV will not result in the transmission of the virus or the development of AIDS.

HIV cannot be transmitted through the air, water, or insect bites. Donating blood does not pose a risk of contracting HIV.

Risk factors

Individuals of any age, ethnicity, gender, or sexual orientation can be affected by HIV/AIDS. Nevertheless, the highest vulnerability to HIV/AIDS lies with those who:

1. Have unprotected sex: It is essential to utilize a new latex or polyurethane condom on each occasion of sexual intercourse. Engaging in anal sex poses a higher risk compared to vaginal sex. The likelihood of contracting HIV escalates when one has multiple sexual partners.
2. Have an STI: Numerous sexually transmitted infections result in genital ulcers. These ulcers create an entry point for HIV to infect the body.
3. Inject illicit drugs: Sharing needles and syringes may result in exposure to contaminated blood.

Complications

HIV infection compromises the functionality of your immune system, rendering it weaker. Consequently, your susceptibility to various infections and specific forms of cancer significantly increases.

Infections common to HIV/AIDS

1. Pneumocystis pneumonia, also called PCP: This fungal infection has the potential to induce serious illness. Its occurrence is less frequent in the United States due to the availability of treatments for HIV/AIDS. Nevertheless, PCP remains the primary cause of pneumonia in individuals infected with HIV.
2. Candidiasis, also called thrush: Candidiasis is a prevalent infection associated with HIV. It results in the formation of a dense, white layer on the mouth, tongue, esophagus, or vagina.
3. Tuberculosis, also called TB: TB, which is commonly associated with HIV, is an opportunistic infection that poses a significant threat to individuals living with AIDS worldwide. Among people with AIDS, TB stands as a prominent cause of mortality. However, due to the extensive utilization of HIV medications, its occurrence is comparatively less prevalent in the United States.
4. Cytomegalovirus: The herpes virus is typically transmitted through bodily fluids like saliva, blood, urine, semen, and breast milk. While a strong immune system can keep the virus dormant, it remains present in the body. When the immune system is compromised, the virus can reactivate and lead to complications in various organs such as the eyes, digestive system, and lungs.
5. Cryptococcal meningitis: Meningitis refers to the inflammation of the meninges, which are the membranes and fluid surrounding the brain and spinal cord. Cryptococcal meningitis, a prevalent infection of the central nervous system, is associated with HIV and is caused by a fungus present in soil.
6. Toxoplasmosis: Toxoplasma gondii, a parasite primarily transmitted by cats, is responsible for causing this infection. The parasites are excreted in the feces of infected cats, which can then lead to the transmission of the parasites to other animals and humans.

Toxoplasmosis has the potential to lead to heart disease, with seizures occurring upon spreading to the brain, ultimately resulting in fatality.

Cancers common to HIV/AIDS

1. Lymphoma: The origin of this cancer is in the white blood cells. A frequent initial symptom is the painless enlargement of the lymph nodes, typically found in the neck, armpit, or groin.
2. Kaposi sarcoma: Kaposi sarcoma is a type of tumor that develops in the walls of blood vessels. It typically manifests as lesions on the skin and in the mouth, appearing as pink, red, or purple sores in individuals with white skin. However, in individuals with Black or brown skin, the lesions may have a dark brown or black appearance. Additionally, Kaposi sarcoma can also impact internal organs such as the lungs and organs within the digestive system.
3. Human papillomavirus (HPV)-related cancers: HPV infection leads to the development of various types of cancer, namely anal, oral, and cervical cancers.

Other complications

1. Wasting syndrome: Untreated HIV/AIDS may lead to significant weight loss, accompanied by symptoms such as diarrhea, weakness, and fever.
2. Brain and nervous system, called neurological, complications: HIV has the potential to induce neurological manifestations, including confusion, memory loss, depression, anxiety, and impaired mobility. Neurological disorders associated with HIV can vary from mild behavioral changes and cognitive decline to debilitating dementia, resulting in weakness and functional impairment.
3. Kidney disease: HIV-associated nephropathy (HIVAN) refers to the inflammation and swelling of the small filters within the kidneys, which are responsible for eliminating surplus fluid and waste from the bloodstream and transferring them to the urine. It is worth noting that kidney disease predominantly impacts individuals of Black and Hispanic descent.
4. Liver disease: Liver disease is a significant complication, particularly in individuals co-infected with hepatitis B or hepatitis C.

Prevention

There is currently no vaccine available to prevent HIV infection, and there is no known cure for HIV/AIDS. However, it is possible to take measures to protect oneself and others from becoming infected.

To help prevent the spread of HIV:

1. Consider preexposure prophylaxis, also called PrEP: Two medications for PrEP are administered orally, known as oral, while one medication is given through injection. The oral medications include Truvada (emtricitabine-tenofovir disoproxil fumarate) and Descovy (emtricitabine-tenofovir alafenamide fumarate). The injectable medication is called Apretude (cabotegravir). PrEP has the potential to lower the chances of contracting HIV through sexual transmission for individuals at a heightened risk.

According to the Centers for Disease Control and Prevention, PrEP can significantly decrease the likelihood of contracting HIV through sexual intercourse by approximately 99% and through intravenous drug use by a minimum of 74%. It is important to note that Descovy has not been thoroughly examined in individuals who engage in receptive vaginal sex, which involves the insertion of a penis into the vagina.

Cabotegravir (Apretude) is the initial PrEP approved by the U.S. Food and Drug Administration that can be administered as an injection to lower the chances of contracting sexually transmitted HIV infection in individuals with a significantly high risk. The injection is administered by a healthcare professional. Following two monthly injections, Apretude is then given every two months. This injection serves as an alternative to the daily intake of a PrEP pill.

The medications prescribed by your healthcare provider are specifically intended for individuals without an existing HIV infection, aiming to prevent its occurrence. Prior to commencing any PrEP medication, it is essential to undergo an HIV test. Additionally, it is necessary to undergo the test every three months if you are taking pills or before each shot, as long as you continue with PrEP.

It is essential to adhere to a daily pill regimen or strictly follow the shot schedule. Additionally, it is crucial to continue practicing safe sex to safeguard against other sexually transmitted infections. If you have hepatitis B, it is advisable to consult with an infectious disease or liver specialist prior to commencing PrEP therapy.

2. Use treatment as prevention, also called TasP: If an individual is diagnosed with HIV, the administration of HIV medications can effectively prevent the transmission of the virus to their partner. When blood tests indicate an absence of the virus, it signifies that the viral load is undetectable. Consequently, the individual will not transmit the virus to any sexual partners.

To ensure the effectiveness of TasP, it is crucial to adhere to the prescribed medication regimen and schedule regular checkups.

3. Use post-exposure prophylaxis, also called PEP, if you’ve been exposed to HIV: If you suspect exposure to HIV through sexual activity, needle use, or in a work setting, it is important to seek medical assistance from a healthcare professional or visit an emergency room. Taking PEP (Post-Exposure Prophylaxis) within the initial 72 hours significantly decreases the chances of contracting HIV. It is crucial to adhere to a 28-day medication regimen.

4. Use a new condom every time you have anal or vaginal sex: Male and female condoms are both available. Ensure that the lubricant you use is water-based, as oil-based lubricants can compromise the integrity of condoms and lead to breakage.

When engaging in oral sex, it is advisable to utilize a cut-open condom or a dental dam made of medical-grade latex, without the addition of any lubricant.

5. Tell your sexual partners you have HIV: It is crucial to inform all of your present and previous sexual partners about your HIV positive status, as they should undergo testing.

6. Use clean needles: It is important to ensure that needles used for injecting illicit drugs are sterile and not shared with others. Utilizing needle-exchange programs available in your community is highly recommended. Seeking assistance for drug use is crucial.

7. If you’re pregnant, get medical care right away: It is possible to transmit HIV to your child. However, by receiving treatment while pregnant, you can significantly reduce the risk of transmission to your baby.

8. Consider male circumcision: Research indicates that circumcision, the removal of the foreskin from the penis, has been found to lower the chances of contracting HIV.

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