HIV/AIDS – Causes, Symptoms, Treatments

What is HIV/AIDS?

HIV/AIDS, which stands for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, is one of the most significant public health challenges of our time. HIV is a virus that attacks the immune system, specifically targeting CD4 cells, which play a crucial role in the body’s ability to fight off infections. Over time, HIV can weaken the immune system, making the body vulnerable to opportunistic infections and certain cancers. When HIV infection progresses to a point where the immune system is severely compromised and opportunistic infections become frequent, it is then classified as AIDS.

First identified in the early 1980s, HIV/AIDS has since become a global pandemic, affecting millions of people worldwide. Despite significant progress in understanding the virus, developing effective treatments, and improving prevention strategies, HIV/AIDS continues to exact a heavy toll on individuals, families, and communities, particularly in regions with limited access to healthcare and resources.

According to the latest estimates from UNAIDS [UN Joint Programme on HIV/AIDS] around 85.6 million [64.8 million–113.0 million] people have become infected with HIV since the start of the epidemic. An estimated 40.4 million [32.9 million–51.3 million] people have died from AIDS-related illnesses since the beginning of the HIV/AIDS epidemic.

Current Status

HIV/AIDS remains a significant global public health challenge, although significant progress has been made. There has been a dramatic increase in access to antiretroviral therapy (ART) which can significantly control the virus and allow people with HIV to live long and healthy lives. In 2022, 29.8 million people were accessing ART.

Increased access to prevention methods like condoms and pre-exposure prophylaxis (PrEP) has helped reduce new HIV infections. AIDS-related deaths have declined significantly, with a 69% reduction since the peak in 2004.

Scientists believe HIV originated from a similar virus in chimpanzees called Simian Immunodeficiency Virus (SIV). Here’s the breakdown of the connection and how the jump from chimps to humans might have happened:

• Close relatives: HIV and SIV are both lentiviruses, which target the immune system. They share a very similar genetic structure, suggesting a common ancestor.
• Chimpanzee connection: SIV infects chimpanzees and gorillas without causing serious illness.  There are two main strains of HIV (HIV-1 and HIV-2), and each is most closely related to a specific type of SIV found in chimpanzees.
• Transfer from chimps to humans: The exact way SIV jumped to humans is uncertain, but the leading theory involves hunting and butchering infected chimpanzees. Blood contact during this process could have allowed the virus to enter the human body.
• Dating the jump: Estimates suggest this cross-species transmission likely occurred sometime between the late 1800s and the 1920s in Central Africa.

Further details:

• While SIV is common in chimps and gorillas, they don’t develop AIDS-like illnesses. This suggests humans lacked the natural defenses to keep HIV in check.
• There are actually two types of HIV (HIV-1 and HIV-2) which differ slightly in their origin and virulence.

How is HIV/AIDS transmitted?

HIV can only be transmitted through specific activities that involve the exchange of certain bodily fluids from a person with HIV to an uninfected person. Here are the main ways HIV can spread:

• Unprotected sex: This includes vaginal, anal, and oral sex without using a condom or another barrier method consistently and correctly. Anal sex is considered the highest risk for HIV transmission during sex.
• Sharing needles and syringes: This is a major risk for people who inject drugs. Sharing needles, syringes, or other injection equipment (like cookers) that contain infected blood can transmit HIV.
• Mother-to-child transmission: A pregnant woman with HIV can transmit the virus to her baby during pregnancy, childbirth, or breastfeeding. However, with proper medical care during pregnancy and delivery, and by not breastfeeding, the risk of transmission can be significantly reduced.

It’s important to note that HIV cannot be transmitted through casual contact. You cannot get HIV from:

• Hugging, kissing, or shaking hands
• Sharing utensils, plates, or cups
• Coughing, sneezing, or spitting
• Using toilets, showers, or swimming pools
• Sharing towels or bedding

What is Antiretroviral Therapy?

The development of antiretroviral therapy (ART) has been a game-changer in the fight against HIV/AIDS. Here’s how it’s revolutionized HIV management:

From Death Sentence to Manageable Condition:

• Before ART: HIV infection progressed to AIDS, a condition where the immune system is severely compromised, leading to opportunistic infections and death. Life expectancy after diagnosis was very short.
• With ART: ART doesn’t cure HIV, but it can suppress the virus to undetectable levels in the blood. This significantly reduces the risk of developing AIDS and allows people with HIV to live long and healthy lives.

Improved Quality of Life:

• Stronger Immune System: By suppressing the virus, ART helps the immune system recover and fight off illnesses. People with HIV on effective treatment can experience a dramatic improvement in their health and well-being.
• Reduced Risk of Transmission: When the HIV viral load is undetectable in the blood, the risk of transmitting the virus to others becomes extremely low. This concept is known as U=U (Undetectable equals Untransmittable).

What ART Involves:

ART is a combination therapy, meaning it typically involves taking several medications daily from different drug classes. These medications work in various ways to target the HIV virus and prevent it from replicating:

• Entry Inhibitors: Block the virus from entering healthy cells.
• Reverse Transcriptase Inhibitors: Stop the virus from converting its genetic material into a form usable by human cells.
• Integrase Inhibitors: Prevent the viral DNA from integrating into the DNA of the host cell.
• Protease Inhibitors: Block an enzyme essential for the virus to mature.

The specific drug combination and regimen will vary depending on individual factors.

Challenges with ART:

• Strict Adherence: For ART to be effective, it’s crucial to take the medications exactly as prescribed, every day. Missing doses can allow the virus to develop resistance to the drugs.
• Side Effects: Some people experience side effects from ART medications, although these have become milder and more manageable with newer drugs.
• Cost: ART can be expensive, although access programs have helped make treatment more affordable in many countries.

What is Pre-exposure Prophylaxis?

Pre-exposure prophylaxis, or PrEP, is a powerful tool for HIV prevention. Here’s a breakdown of what it is and its effectiveness:

PrEP Explained:

• Function: PrEP is a medication regimen involving one pill taken daily to prevent HIV infection in people who are HIV-negative but at substantial risk of getting HIV.
• Target: PrEP doesn’t target the body’s immune system directly. Instead, the medication works by interfering with the ability of HIV to replicate in the body, significantly reducing the risk of establishing an infection.

PrEP Effectiveness:

• Highly Effective: Studies show that when taken consistently as prescribed, PrEP is highly effective in preventing HIV transmission. Here’s a breakdown of its effectiveness:
  • Sex: PrEP reduces the risk of getting HIV from sex by about 99%.
  • Injection Drug Use: PrEP reduces the risk of getting HIV from injection drug use by at least 74%.
• Crucial Note: It’s important to understand that consistent use is key. If PrEP is not taken as prescribed, its effectiveness is significantly reduced.

What are the Stages of HIV/AIDS Infection?

HIV infection progresses through various stages, and symptoms can differ depending on the specific phase. Here’s a deep dive into what you might experience at each stage:

Early Stage (Acute HIV Infection):

This initial stage occurs within 2-4 weeks after contracting HIV. However, an important thing to remember is that a significant portion of people (up to 80%) don’t experience any noticeable symptoms at all during this time.

For those who do develop symptoms, they often resemble the flu and typically last for a week or two. These symptoms can include:

• Fever: An unexplained rise in body temperature is a common early indicator.
• Headache: This can range from mild to severe and can be accompanied by a general feeling of achiness.
• Fatigue: An overwhelming sense of tiredness and lack of energy is a frequent complaint during this stage.
• Muscle aches and pains: Discomfort and soreness in muscles throughout the body is a potential symptom.
• Sore throat: A scratchy or painful throat can be present, similar to what you might experience with a cold.
• Swollen lymph nodes: Lymph nodes, which are part of the immune system, may become enlarged and tender, particularly in the neck, armpits, or groin.
• Rash: A red, non-itchy rash can sometimes appear on the torso or elsewhere on the body.

It’s crucial to understand that these symptoms are fairly common and can be caused by various other illnesses. If you’re experiencing any of these, it doesn’t necessarily indicate HIV infection. However, if you suspect you might be at risk due to potential exposure, it’s vital to get tested to determine your HIV status.

Chronic HIV Infection (Later Stage):

As HIV persists in the body and gradually weakens the immune system, some individuals may develop various symptoms over time. It’s important to remember that the absence of symptoms doesn’t guarantee someone is HIV-negative. People can carry the virus for years without experiencing any noticeable signs.

If symptoms do arise in the chronic stage, they are often general and non-specific, but can include:

• Fatigue: Persistent tiredness and lack of energy are frequent complaints.
• Weight loss: Unintentional weight loss can occur due to the effects of the virus on the body.
• Swollen lymph nodes: Lymph node enlargement can persist or come and go throughout this stage.
• Fever or night sweats: Unexplained low-grade fevers or night sweats can be present.
• Frequent yeast infections (thrush): Fungal infections, particularly in the mouth (thrush) or vagina, can become more frequent.
• Shortness of breath: This can develop due to various opportunistic infections that may affect the lungs.
• Diarrhea: Chronic diarrhea can occur due to damage to the digestive system caused by the virus.
• Skin conditions: Rashes, sores, or other skin problems can develop due to a weakened immune system.

Advanced Stage (AIDS):

This represents the most severe stage of HIV infection. By this point, the immune system is significantly compromised, leaving the body highly vulnerable to opportunistic infections (infections that typically wouldn’t cause problems in a healthy person) and certain cancers.

Symptoms at this stage can be severe and depend on the specific opportunistic infections or illnesses a person contracts. Some potential complications include:

• Pneumonia: This serious lung infection can be caused by various bacteria or fungi that exploit the weakened immune system.
• Tuberculosis (TB): TB is a bacterial infection that can become life-threatening in people with AIDS.
• Meningitis: Inflammation of the membranes surrounding the brain and spinal cord can be caused by viruses, bacteria, or fungi.
• Cytomegalovirus (CMV): This viral infection can affect various organs, including the eyes, lungs, intestines, and brain.
• Kaposi’s sarcoma: This is a type of cancer that causes reddish or purplish skin lesions.
• Wasting syndrome: Severe weight loss, muscle atrophy, and weakness can occur in this condition.

Strategies to Reduce HIV Transmission

ART and PrEP are powerful tools, but HIV prevention is a multi-pronged approach.

1. Safer Sex Practices:

Using condoms (male or female) consistently and correctly is a highly effective way to prevent HIV transmission during vaginal, anal, and oral sex. Condoms create a barrier that prevents the exchange of bodily fluids that can transmit HIV.

Using water-based lubricants with condoms can reduce friction and increase comfort, making condom use more enjoyable and therefore more likely to be used consistently. Oil-based lubricants (like petroleum jelly) can damage latex condoms and should be avoided.

Having fewer sexual partners reduces your overall risk of exposure to HIV. Talking openly and honestly with your partner(s) about your sexual history, HIV status, and risk factors is essential. This allows for informed decision-making about safer sex practices.

2. Harm Reduction for People Who Inject Drugs:

Providing clean needles and syringes to people who inject drugs helps prevent them from sharing needles and syringes, a major risk factor for HIV transmission.

Medication-Assisted Treatment (MAT) programs combine behavioral therapy with medications like methadone or buprenorphine to help people overcome opioid addiction. By addressing addiction, MAT can indirectly reduce risky injection practices that can lead to HIV transmission.

3. Prevention of Mother-to-Child Transmission (PMTCT):

Pregnant women living with HIV can take ART medications to significantly reduce the risk of transmitting the virus to their babies during pregnancy, childbirth, and breastfeeding.

In situations where the mother is not on effective ART or chooses not to breastfeed, counseling on safe infant feeding practices (like using formula) is crucial to prevent HIV transmission through breast milk.

4. Education and Awareness:

Providing young people with accurate and comprehensive sex education empowers them to make informed choices about their sexual health and reduce their risk of HIV infection. This education should include information about HIV transmission, prevention methods, and where to access testing and services.

Raising public awareness about HIV transmission, testing, and treatment options is essential for reducing stigma and encouraging people to get tested and access prevention resources.

5. Stigma Reduction:

Stigma and discrimination surrounding HIV can prevent people from getting tested, treated, or accessing prevention services. Efforts to promote empathy, understanding, and acceptance are crucial for a successful HIV prevention strategy.

How is HIV/AIDS Diagnosed?

Diagnosing HIV/AIDS involves a two-step process.

1. Initial Screening:

This stage typically involves blood tests that detect the presence of HIV antibodies or antigens in the body. Here’s a breakdown of the different types of tests used:

• Antibody Tests: These are the most common tests used for initial HIV screening. They look for antibodies, which are proteins produced by the immune system in response to a foreign invader like HIV. However, it’s important to remember that it takes time for the body to produce antibodies after HIV infection. This is known as the window period. Antibody tests may not be accurate until several weeks or even months after exposure.
• Types of Antibody Tests:
  • ELISA (Enzyme-Linked Immunosorbent Assay): This is the most widely used initial screening test. It’s fast and inexpensive but requires confirmation with a more specific test if positive.
  • Rapid Tests: These tests provide results within minutes and can be done in various settings, including clinics, doctor’s offices, and even at home with self-testing kits. However, they may not be as accurate as ELISA tests, so a confirmatory test is still needed if positive.
• Antigen/Antibody Tests: These tests look for both HIV antibodies and antigens (parts of the virus itself). While they can detect HIV infection sooner than antibody tests alone, they are not as commonly used for initial screening.

2. Confirmatory Testing:

If an initial screening test comes back positive, a confirmatory test is required to establish a definitive diagnosis. This typically involves a more specific blood test like a Western Blot that can differentiate HIV antibodies from antibodies to other viruses.

Additional Tests:

• Viral Load Test: This test measures the amount of HIV virus present in the blood. While not routinely used for diagnosis, it can be helpful for monitoring the effectiveness of treatment in people living with HIV.
• CD4 Cell Count: CD4 cells are a type of white blood cell crucial for the immune system. An HIV diagnosis is often accompanied by a decline in CD4 cell count. Monitoring CD4 cell count helps assess the severity of HIV infection and guide treatment decisions.

How is HIV/AIDS Treated?

There is currently no cure for HIV/AIDS, but there is highly effective treatment available called antiretroviral therapy (ART). ART doesn’t eliminate the virus entirely, but it can suppress it to very low levels in the blood, essentially rendering it undetectable and significantly reducing the risk of transmission to others. Here’s a deeper look at HIV/AIDS treatment:

ART:

ART is a combination therapy, meaning it involves taking a specific regimen of multiple medications from different drug classes, typically one pill once or twice daily. These medications work together to target the HIV virus at various stages of its life cycle, effectively preventing it from replicating and causing further damage to the immune system.

When taken consistently and correctly, ART offers numerous benefits. It can suppress HIV viral load to undetectable levels in the blood. This means the amount of virus is too low to be measured by standard tests and significantly reduces the risk of transmitting HIV to others. This concept is known as Undetectable equals Untransmittable (U=U).

By suppressing the virus, ART allows the immune system to recover and fight off infections and illnesses. This can lead to a dramatic improvement in health and quality of life for people living with HIV. A weakened immune system in later stages of HIV infection makes people vulnerable to opportunistic infections. ART helps prevent these infections by keeping the immune system strong. With effective treatment, people with HIV can live long and healthy lives.

Medication Classes in ART:

Several drug classes are used in ART regimens, and the specific combination prescribed will depend on individual factors. Here are some of the most common ones:

• Nucleoside Reverse Transcriptase Inhibitors (NRTIs): Block an enzyme called reverse transcriptase, which HIV needs to convert its genetic material into a form usable by human cells.
• Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs): Similar to NRTIs, target the reverse transcriptase enzyme but at a different location.
• Integrase Strand Transfer Inhibitors (INSTIs): Prevent the virus from integrating its genetic material into the DNA of human cells, a critical step for replication.
• Protease Inhibitors (PIs): Block an enzyme called protease, which HIV needs to mature into infectious particles. (Less commonly used initially due to potential side effects).

Treatment Regimen and Monitoring:

A healthcare provider will determine the most suitable ART regimen based on factors like medical history, prior use of ART, and potential side effects. People on ART require regular checkups and blood tests to monitor viral load, CD4 cell count (a type of white blood cell crucial for immunity), and potential side effects.

What Medications are Most Often Prescribed for HIV/AIDS Treatment?

HIV/AIDS isn’t treated with a single medication, but rather a combination therapy approach known as antiretroviral therapy (ART). ART involves taking a specific regimen of multiple medications from different drug classes to target the HIV virus at various stages of its life cycle. The specific combination of medications prescribed will depend on individual factors but here’s a breakdown of the most common drug classes used in ART:

• Nucleoside Reverse Transcriptase Inhibitors (NRTIs): These medications block an enzyme called reverse transcriptase, which HIV needs to convert its genetic material into a form usable by human cells. Examples of NRTIs include abacavir (Ziagen), lamivudine (Epivir), tenofovir disoproxil fumarate (Viread), and emtricitabine (Emtriva).
• Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs): Similar to NRTIs, NNRTIs also target the reverse transcriptase enzyme but bind to it at a different location. Examples of NNRTIs include doravirine (Pifeltro), efavirenz (Sustiva), and rilpivirine (Edurant).
• Integrase Strand Transfer Inhibitors (INSTIs): These medications prevent the HIV virus from integrating its genetic material into the DNA of human cells, a critical step for viral replication. Examples of INSTIs include dolutegravir (Tivicay), bictegravir (Biktarvy), raltegravir (Isentress), and elvitegravir (Vitekta).
• Protease Inhibitors (PIs):  PIs block an enzyme called protease, which HIV needs to mature into infectious particles. PIs are less commonly used in first-line treatment regimens due to potential side effects, but they can still be a valuable option in some cases. Examples of PIs include atazanavir (Reyataz), darunavir (Prezista), and lopinavir/ritonavir (Kaletra).
• Fusion Inhibitors: These medications prevent the HIV virus from fusing with the membrane of a human cell, a critical step for entering the cell.  Enfuvirtide (Fuzeon) is typically used in combination with other ART medications due to its dosing requirements and injection route.
• Entry Inhibitors: This is a newer class of medications that target different steps in the HIV entry process. Currently, maraviroc (Selzentry) is the only approved entry inhibitor. It’s used in specific situations, often for people who have developed resistance to other ART medications.