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Overview of HIV/AIDS: Symptoms, causes, treatment and prevention

Dr. Ajay KohliDec 11, 2024

With an average of 6,50,000 deaths and 1.5 million new cases in 2021, HIV/AIDS, a chronic and life-threatening condition, is a global menace. An HIV diagnosis can be life-altering. Despite this, access to proper medical care has made HIV/AIDS more manageable to the point that a person living with HIV can still lead a normal and healthy life. Read ahead to know more about this illness.

Contents

What is HIV/AIDS?

HIV, or Human Immunodeficiency Virus, is a retrovirus that weakens the immune system by targeting and destroying T helper cells, also known as CD4 cells. A retrovirus operates differently from regular viruses. It uses an enzyme called reverse transcriptase to convert its RNA into DNA after infecting a host cell. This new DNA integrates into the host’s genome, allowing the virus to replicate every time the host cell divides. This ability to hide within the host's immune system makes HIV difficult to eradicate.

As HIV depletes CD4 cells, the immune system weakens, making the body vulnerable to various infections and diseases. When left untreated, HIV can progress to AIDS (Acquired Immune Deficiency Syndrome). AIDS is diagnosed when a person's CD4 cell count falls below 200 cells per cubic millimetre of blood (200 cells/mm³) or when they develop one or more opportunistic infections. It's important to note that having HIV does not mean someone has AIDS, as it often takes a decade or more for untreated HIV to reach this advanced stage.

How Do HIV and AIDS Differ?

HIV (Human Immunodeficiency Virus) is a virus that compromises the immune system by attacking CD4+ T cells, reducing the body's ability to combat infections. This virus remains in the body for life, even with treatment. AIDS (Acquired Immunodeficiency Syndrome) is the advanced stage of HIV, characterised by a severely weakened immune system, leading to opportunistic infections and certain cancers. A person can have HIV without developing AIDS, but all AIDS cases are preceded by HIV. With timely treatment, progression from HIV to AIDS can be delayed or even prevented.

How Prevalent Is HIV?

As of 2024, HIV affects approximately 39.9 million people worldwide, with a significant concentration in sub-Saharan Africa. Despite substantial progress in prevention and treatment, new infections persist, with 1.3 million people newly infected annually. While significant strides have been made in recent years, challenges remain, particularly in reaching marginalised populations and ensuring equitable access to healthcare. Continued efforts are needed to accelerate progress towards the goal of ending the AIDS epidemic by 2030.

What Are the Different Stages of HIV?

HIV progresses through three main stages, each marked by unique changes in the body. Understanding these stages is important for managing the infection and preventing complications. These are the stages that define the progression of HIV:

1. Acute HIV Infection

Within 2-4 weeks of exposure, individuals may experience flu-like symptoms. The virus multiplies rapidly, spreading throughout the body. During this stage, HIV levels are high, increasing transmission risk.

2. Chronic HIV Infection (Clinical Latency)

This stage can last for years. The virus continues to reproduce at low levels, often without symptoms. With proper treatment, the virus remains controlled. Without treatment, it progresses to the next stage.

3. AIDS

The immune system is severely damaged, making the body vulnerable to opportunistic infections and certain cancers. A CD4 count below 200 cells per microlitre or the presence of specific infections indicates AIDS.

Signs and Symptoms of HIV/AIDS

HIV infection occurs in stages where symptoms vary in severity, and not everyone gets the same symptoms. Most HIV-positive individuals appear perfectly normal for many years or experience a mild flu-like illness, called primary or acute infection, within a month or two after exposure. At this stage, symptoms may resemble other diseases and typically include the following.

Fever
Headaches
Sore throat
Swollen lymph glands (in the neck)
Skin rashes
Upset stomach
Joint aches and muscular pains

These symptoms last for a few days to several weeks.

In most cases, once the initial symptoms subside, you will not encounter any more symptoms for the next ten years or longer, depending on your age, background, and general health. But remember that even during this asymptomatic period, HIV is actively infecting and killing the cells of your immune system. On the contrary, for people on HIV treatment, this asymptomatic phase is often longer than typical.

As the immune system deteriorates, AIDS-related complications begin to surface. In this state, you are at a heightened risk of other serious diseases associated with severe immunodeficiency, known as opportunistic infections, indicated by the following symptoms.

Extreme weight loss
Persistent and unexplained lack of energy
Swollen lymph nodes in the throat, armpits, and groin for more than three months
Recurring fever
Chills and night sweats
Dry and deep cough spells
Chronic pelvic inflammatory diseases that do not respond to treatment
Short-term memory loss
Vision loss
Severe and persistent diarrhoea
Bleeding from mouth, nose, and anus (called shingles)
One or more types of opportunistic cancers (like Kaposi sarcoma, invasive cervical cancer, Burkitt's lymphoma, etc.)
Recurrent yeast infections (in the mouth and vagina)
Seizures and lack of coordination

If you think your odds of contracting HIV are higher, talk to your doctor and get tested as soon as possible to prevent these complications.

What Are Illnesses That Define AIDS?

AIDS is characterised by the presence of certain infections and cancers that take advantage of a weakened immune system. These illnesses are considered indicators of the final stage of HIV infection. They include:

Pneumocystis Pneumonia (PCP)

A severe lung infection caused by Pneumocystis jirovecii, is common in those with compromised immune systems. Symptoms include coughing, fever, and breathing difficulty.

Kaposi's Sarcoma

A cancer that develops from the cells lining lymph or blood vessels, often presenting as purple or brown lesions on the skin. It's more frequent in AIDS patients.

Cytomegalovirus (CMV)

A herpes virus can cause retinitis, leading to blindness, particularly in people with weakened immune systems. CMV can also affect other organs.

Tuberculosis (TB)

HIV significantly increases the risk of developing TB, particularly in countries with high TB prevalence. It remains a leading cause of death among people with HIV.

Candidiasis (Thrush)

A fungal infection affecting the mouth, throat, or genitals. In AIDS patients, it can become systemic and severe, leading to oesophagal or respiratory complications.

In What Ways Does HIV Spread?

HIV spreads through specific modes of transmission, each of which involves direct contact with infected bodily fluids. These are the primary ways HIV is transmitted:

Sexual Contact

Unprotected vaginal, anal, or oral sex with an HIV-positive individual is the most common way HIV spreads. The virus is present in semen, vaginal fluids, and rectal fluids, which act as carriers. Without protection, such as condoms, the risk of transmission increases. Factors like multiple sexual partners, not knowing a partner’s HIV status, and engaging in high-risk sexual practices further elevate the chance of infection. It’s important to note that HIV does not spread through casual contact such as kissing, as the virus does not survive well in saliva. Transmission through kissing would require significant open sores or bleeding gums in both partners, which is extremely rare.

Blood Exposure

HIV can also spread through direct exposure to infected blood. This commonly occurs through sharing needles or syringes in drug use. While the risk from blood transfusions has been significantly reduced due to modern screening processes, sharing needles or other drug paraphernalia continues to be a significant mode of transmission. HIV can also be transmitted through contaminated medical equipment, though this is rare due to improved sterilisation practices.

Mother-to-Child Transmission

HIV can be transmitted from an HIV-positive mother to her child during pregnancy, childbirth, or breastfeeding. Without intervention, the risk of transmission can be high, but this risk can be significantly reduced with antiretroviral therapy (ART). By adhering to ART during pregnancy and delivery, and taking precautions such as avoiding breastfeeding, the likelihood of mother-to-child transmission can be minimised.

Types of HIV

HIV is classified into two distinct types based on genetic variations: HIV-1 and HIV-2. These two types differ in their origin, spread, and impact, though both cause similar symptoms and complications related to AIDS.

HIV-1

This is the most widespread form of HIV globally, responsible for the majority of HIV infections. It accounts for nearly 95% of all HIV cases worldwide and is the dominant strain in regions such as North America, Europe, Asia, and sub-Saharan Africa.

HIV-1 is more aggressive than HIV-2, and it progresses faster through the stages of the infection if left untreated. Its rapid spread is partly due to its higher viral load and transmission efficiency. HIV-1 can be further divided into multiple subtypes and circulating recombinant forms, which can vary in their genetic makeup but generally behave similarly in terms of disease progression and treatment response.

HIV-2

This strain is less common and is primarily found in West Africa, though cases have been reported in other parts of the world, especially in countries with high migration from West Africa. HIV-2 is generally less transmissible than HIV-1 and has a slower rate of progression to AIDS.

People infected with HIV-2 tend to have lower viral loads, which means the virus is present in the body at lower concentrations. Due to this slower progression, individuals with HIV-2 can live for many years without developing AIDS, and some may remain asymptomatic for decades. However, HIV-2 can still lead to significant immune system damage over time, and without treatment, it can progress to AIDS.

Treatment for HIV/AIDS

At present, there is no cure available for HIV. But scientists are trying to find one. Meanwhile, the best way for an HIV patient to live a long life if diagnosed early is to start antiretroviral treatment (ART). The main goals of the treatment are as follows.

Suppress viral replication
Reduce the viral load in the body
Restore the immune system
Stop the onset and progression of the disease
Reduce the risk of other opportunistic illnesses (like coccidioidomycosis, tuberculosis, sarcoidosis, etc.)

But remember that ART is not a cure for HIV. Failure to take them correctly and missing doses can increase an HIV person's risk of infecting others. So, stick to your prescribed treatment schedule to avoid resistance to HIV drugs while keeping your viral load low and having a normal life expectancy.

Diagnosis of HIV/AIDS

Since HIV symptoms do not present for years, establishing the stage of infection and providing the best treatment often gets delayed, which not only compromises the health of the HIV patient but also increases the danger to others. Testing for HIV is, thus, the only sure way to receive prompt treatment, so you can feel better and live longer.

You will be asked to submit your blood and saliva for laboratory testing, where different tests will look for antibodies developed in your body against the virus. It can take anywhere from a few months to even a year for your body to develop enough antibodies to show up on an HIV test.

These tests include the following.

Antibody Test: This test will look for antibodies against HIV 3 to 12 weeks after your initial exposure to find if you are positive.
Antigen/Antibody Test: This kind of test detects both HIV antibodies and antigens in the sample and can take 2 to 6 weeks after exposure to become positive.
Nucleic Acid Test (NAT): This test looks for the whole virus in the blood. Through this test, your doctor can easily tell you whether you have HIV and, if you have HIV, how much virus is present in your blood.
Rapid test or self-help test: You can easily and quickly do this test at home and get the results in 20 to 30 minutes.

How Can I Prevent HIV/AIDS?

Preventing HIV involves understanding both protective measures and risk factors. Since there is no vaccine, taking these steps can help lower your chances of infection:

Educate yourself about HIV transmission methods.
Use condoms consistently and correctly during sexual activity, as unprotected sex increases the risk of transmission.
Limit the number of sexual partners to reduce exposure risk.
Never share needles, syringes, or other drug-injecting equipment, as sharing contaminated needles is a significant risk factor.
Get tested and treated for sexually transmitted infections (STIs) like syphilis, gonorrhoea, chlamydia, and herpes, which can increase susceptibility to HIV.
Avoid unsafe blood transfusions by ensuring blood is properly screened.
Healthcare workers should exercise caution to avoid accidental needlestick injuries.
Consult your doctor about Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP) if you're at risk of exposure to HIV.

By combining these preventive measures with an awareness of risk factors, you can significantly reduce your risk of contracting HIV/AIDS.

Are There Medications to Prevent HIV?

HIV prevention has come a long way in recent years, with key advancements in medications designed to reduce the risk of transmission. Two primary methods used for preventing HIV are Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). These medications have proven highly effective in reducing the chances of HIV infection, particularly for individuals at higher risk of exposure

What is Pre-Exposure Prophylaxis (PrEP)?

PrEP involves a daily antiretroviral pill that significantly reduces the risk of HIV infection for those at high risk. Consistent use reduces the chance of infection by more than 90% in sexual transmission and 70% in injection drug use.

What is Post-Exposure Prophylaxis (PEP)?

PEP is an emergency preventive treatment taken within 72 hours after potential HIV exposure. The treatment involves a 28-day course of antiretroviral drugs and is essential for healthcare workers and individuals exposed through unprotected sex or needle-sharing incidents.

Wrapping Up

HIV/AIDS is a life-changing condition, but with the right care and treatment, individuals can live long, healthy lives. By understanding the virus, its symptoms, and available treatments, you can take proactive steps to manage your health or reduce your risk. Regular testing, safe practices, and seeking timely medical advice are crucial in the fight against HIV. Stay informed, take control, and support others in their journey toward managing HIV with dignity and hope.

Frequently Asked Questions (FAQs)

Here’s a list of common questions and answers about HIV/AIDS.

How do you know if you have AIDS?

AIDS usually refers to the advanced stage of HIV infection. Most people infected with HIV, when left untreated, develop signs of AIDS in 8 to 10 years, where they experience severe bacterial, viral, and fungal infections. A few may also develop rare types of cancers. All these are called opportunistic infections that occur when AIDS sets in.

What is the post-exposure preventive treatment?

Post-exposure prophylaxis (PEP) treatment is a 4-week course of medication taken within a few hours of a probable HIV exposure. Studies indicate that the medicine effectively prevents HIV infection if administered within two hours and no later than 72 hours after HIV exposure.

Why should you take your HIV medicine as prescribed?

When you take HIV medication (Antiretroviral therapy) as prescribed under your HIV treatment plan, the number of virus particles in your blood (also called your viral load) decreases to an extremely low level. It is known as viral suppression. So, if your viral load is too low that a standard lab test cannot identify HIV, your viral load is deemed undetectable. This indirectly points out that you will live a long, healthy life and will not transmit HIV to other people.

How often should a person be tested for HIV?

According to the CDC, anyone between 13 and 64 must get tested for HIV at least once.

Can HIV be cured?

Currently, there is no cure for HIV, but it can be effectively managed with antiretroviral therapy (ART). ART helps reduce the viral load to undetectable levels, allowing individuals to lead healthy lives. Ongoing research continues to explore potential cures, but for now, early diagnosis and consistent treatment remain key to managing the disease.

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