CONDITIONS
HIV/AIDS
HIV/AIDS
Acquired immunodeficiency syndrome (AIDS), is an ongoing, long-term (chronic) condition caused by a virus known as the human immunodeficiency virus (HIV). HIV damages and weakens the immune system resulting in decreased capability of fighting infections and becoming more prone to diseases.
Untreated HIV may take years before weakening the immune system enough to become AIDS. AIDS is not transmitted from 1 person to another but the HIV virus can. There is currently no cure for HIV, but with an early diagnosis and effective treatments, most people with HIV will not progress to any AIDS-related illnesses and can live a near-normal lifespan.
In India, the current national prevalence is about 0.26% compared with a global average of 0.2% but this percentage is higher in most high-risk groups including female sex workers (may reach upto 7%). The main promoters of HIV in decreasing order are commercial sex work, general heterosexual intercourse, injecting drug use and unprotected anal sex between men who have sex with men.
What are the symptoms of HIV?
Symptoms depend on the phases of infection and type of person and happens in 3 stages. Since some people may not show any symptoms for many months/years, the only way to know for sure if a person has HIV is to get tested.
Symptoms of Primary infection (Acute HIV):
Some people infected by HIV get flu-like illness within 2 to 4 weeks after the virus enters the body. This stage may last upto 2 weeks and then go away.
Early signs of HIV include:
- Headache
- Fatigue
- Aching muscles
- Sore throat
- Swollen lymph nodes
- A red rash that doesn’t itch, usually on your torso
- Fever
- Ulcers (sores) in your mouth, oesophagus, anus, or genitals
These symptoms plus any contact with someone with HIV in the past 2 to 6 weeks should consult a doctor and get an HIV test.
Early testing is important for helping you not to spread the virus and also keep the immune system healthy.
Second Stage: Clinical Latency Symptoms
In this asymptomatic period, the flu-like symptoms will go away, but HIV is still in the body and cells of the immune system. In HIV, if untreated the virus kills the CD4 T cells (Cells that coordinate body’s immune system’s response). This stage can last for many years for people who aren’t getting antiretroviral therapy (ART). Some people get more-severe disease much sooner.
Third Stage: AIDS Symptoms
In this stage, the HIV infection moves to an advanced stage called AIDS. This happens when the CD4 T-cell number drops below 200 since immune system has worsened and damaged. The low immunity makes a person more prone to opportunistic infections (illnesses that happen more often in people who have weakened immune systems such as Kaposi’s sarcoma (a form of skin cancer) and pneumocystis pneumonia (a lung disease)), are also considered “AIDS-defining illnesses.”
Some of the following symptoms may make a person realize about HIV infection:
- Being tired all the time
- Swollen lymph nodes in your neck or groin
- Fever that lasts more than 10 days
- Night sweats
- Weight loss without any reason
- Purplish spots on your skin that not disappearing.
- Shortness of breath
- Severe, long-lasting diarrhoea
- Yeast infections in your mouth, throat, or vagina
- Bruises or bleeding you can’t explain.
- Neurological symptoms such as memory loss, confusion, balance problems, behaviour changes, seizures, and vision changes
Without mediation, people with AIDS may live for about 3 years, or less if they get another infection. However, HIV is still treatable at this stage. Initiating of treatment of HIV within time, taking the HIV drugs regularly while following doctor’s advice, and keeping healthy habits can help you live a long time.
What are the causes of HIV?
HIV is a virus found in the body fluids including semen, vaginal and anal fluids, blood, and breast milk of an infected person. It’s a fragile virus that does not survive outside the body for long.
HIV destroys white blood cells called CD4 T cells, which are the cells of the immune system of the body. Once the immune system is weak, an HIV infected person is more prone of even simplest of infections.
How can HIV spread?
HIV spreads via infected blood, semen or fluids from a vagina enter your body and this may happen via the following:
Sex: Having vaginal or anal sex with an infected partner. Oral sex carries less risk but a risk nevertheless, as the virus may enter the body through mouth sores.
Needle sharing: Sharing needles and syringes for injecting illicit drugs
Pregnancy, birthing or breastfeeding: Pregnant woman with HIV infection could pass the virus to their babies but these chances of mother-to-child transmission may reduce to almost 1% if both the women and the infant are given HIV medicine throughout pregnancy and in the first several weeks of the newborn’s life.
How does HIV not spread?
Casual contact does not transmit HIV infection.
- Actions such as hugging, kissing, dancing or shaking hands with someone who has HIV infection does not result in transmission of infection.
- HIV isn’t spread through air, water or insect bites.
- HIV cannot be contacted by blood donation.
- HIV does not spread through saliva, sweat, tears, swimming pools, telephones, toilet seats
The risk factors for HIV infection:
Working in certain professions which increase chances of contact with infected HIV fluids, such as:
- Health care (doctors, nurses, technicians)
- Prisons
- Labs that handle blood or semen
In rare or negligible cases, there might be a possibility of HIV infection in:
- Food pre-chewed by someone with HIV (in infants)
- A blood transfusion
- Organ or tissue transplant
- Artificial insemination
- Getting tattoos or body piercings.
How can HIV be diagnosed?
HIV can be diagnosed through blood or saliva testing and these tests are:
Antigen-antibody tests: Using blood from a vein in the body, these tests try to detect the presence of antigens (substances on the HIV virus itself). They are seen in the blood within a few weeks after HIV exposure while the antibodies (substances made by the immune system to fight the virus) are made post exposure to HIV and for this to be seen in the blood may take weeks to months.
Antibody tests: Tests for antibodies to HIV in blood or saliva. Most rapid HIV tests are antibody tests but positive results may not be seen until 3 to 12 weeks post exposure to HIV.
Nucleic acid tests (NATs): Check for virus in the blood. Nucleic acid tests are the first test to become positive after exposure to HIV.
How can HIV be treated?
Although there’s no cure for HIV, there are advanced treatment options for people to be able to live a long, almost-normal active lives with HIV.
Antiretroviral therapy (ART):
The treatment option for HIV infection is antiretroviral therapy (ART) medicines, also called ART. These medicines decrease the amount of virus in blood and keeps it at a low level (viral suppression). Eventually the viral load in the body becomes undetectable even in the blood test, and at that stage an HIV infected person may stay healthy and essentially have no risk of passing the virus on to other people.
ART is usually a mix of two or more medicines from several classes as this approach is the best to lower the amount of HIV in the blood. Each class of medicines blocks the virus in a different manner and this mixing of medicines is done for:
- To prevent medicine resistance.
- To prevent creating new medicine-resistant strains of HIV.
- Viral suppression in the blood.
How does the doctor measure treatment response?
- A response to the HIV treatment is recorded by the doctor by checking the viral load and CD4 T cell counts.
- The first check is at 4 to 6 weeks followed by visiting the doctor every 3 to 6 months.
- The goal of the treatment is to lower your viral load to go undetected in the blood.
- However, absence of HIV in the blood test does not indicate a cure of the infection. IT means that although HIV is still in the body, it may not spread.
How can one prevent HIV infection?
There’s no vaccine to prevent HIV infection and no cure for HIV/AIDS, but one can protect themselves and others from its spread:
- Preexposure prophylaxis (PrEP) medicine: The two PrEP medicines, one oral (taken by mouth), and one injectable (medicine in the form of a shot) can reduce the risk of sexually transmitted HIV infection in people at very high risk such as sex workers. The doctor prescribes these medicines to prevent HIV to people who do not have HIV infection yet.
- Using treatment as prevention (TasP): In case a person has HIV infection, taking HIV medicines will prevent a person’s partner from getting infected with the virus.
- Using post-exposure prophylaxis (PEP): In case a person suspects HIV exposure (in case exposure through sex, through needles or in the workplace is suspected), contact the doctor or go to the emergency ward of the hospital. Taking PEP within the first 72 hours greatly reduces the risk of getting HIV with the duration of course being 28 days.
- Using a new condom with every anal or vaginal sexual encounter: Using water-based lubricants are recommended as the oil-based lubricants can weaken condoms and cause them to break.
- Telling the sexual partners about HIV infection: It is vital to inform all current and past sexual partners about the HIV positive infection as they would need to be tested.
- Using clean needles: Do not use illicit drugs, but in case a person still uses them, make sure the needles are sterile and not used before. Seeking help for drug use goes a long way in prevention from many diseases.
- Pregnancy: Treatment during pregnancy may lessen a baby’s risk of infection greatly.
- Consider male circumcision: Removing the foreskin from the penis (circumcision) may help in reducing the risk of getting HIV infection.
References
- Paranjape RS, Challacombe SJ. HIV/AIDS in India: an overview of the Indian epidemic. Oral Dis. 2016 Apr;22 Suppl 1:10-4.
- HIV/AIDS. Mayo Clinic. February 2024. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524
- HIV & AIDS Resource Center. WebMD. February 2024.
- HIV and AIDS. NHS UK. February 2024. https://www.nhs.uk/conditions/hiv-and-aids/
