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HIV and AIDS explained – Human Immunodeficiency Virus

HIV is a bloodborne virus transmitted through sexual intercourse. The virus can cause a complicated condition called AIDS.

Mistaking HIV for AIDS or AIDS for HIV is a common mistake in the general population. HIV attains for human immunodeficiency virus, a blood borne virus transmitted through body fluids. Like many other viral infections, HIV infection produces a disease.

The disease, in this case, is AIDS. Up to this day, AIDS remains an incurable disease. Thankfully what used to be a death sentence has evolved into a manageable condition. 

According to the world health organization (WHO), HIV infections remain a significant public health issue worldwide. At the end of 2019, about thirty-eight million people were living with HIV infection around the world. Of those people, 690.000 persons died from AIDS complications (mainly due to lack of treatment).

Each year, approximately 1.7 million people are newly infected. Most developed countries have managed to reduce their infection rate and the rate of mortality due to HIV. However, the disease remains rampant in many underdeveloped countries, particularly in sub-Saharan Africa, where 5.2 percent of the population has HIV. 

What are HIV and AIDS?

HIV is the initials for the Human Immunodeficiency Virus. It forms part of a particular family of viruses called a retrovirus. These viruses have the ability to insert themselves inside cellular DNA and remain there indefinitely; this is why HIV infection is incurable (so far).

HIV attacks a particular type of cell, the CD4 cell. CD4 cells are a type of T lymphocyte, vital in many immune responses against infectious disease. After some time (several years after the infection), the CD4 count drops low enough to increase the risk of infection and certain cancers. 

AIDS stands for acquired immunodeficiency syndrome. It is the final stage of HIV infection. In this stage, the person’s immune system is severely damaged because of HIV. With early treatment and diagnosis, HIV patients can avoid reaching this stage.

In developed countries, the great majority of patients don’t reach this stage. An AIDS patient’s life expectancy is approximately three years; however, antiviral treatment can be lifesaving for them.

Doctors can diagnose AIDS when one of these two things happen:

  1. The number of CD4 cells drops below 200 cells per cubic millimeter of blood. In healthy individuals, that number varies between 500 to 1600 CD4 cells per cubic millimeter.
  2. They have an opportunistic infection. Opportunistic infections are infections that do not affect individuals with a competent immune system, only those that, for whatever reason, have a problem in their immune response. Some examples include.
  • Cryptococcal Meningitis
  • Cerebral Toxoplasmosis
  • Pneumocystis pneumonia 
  • Oral and esophageal candidiasis 
  • Cytomegalovirus infection 
  • Histoplasmosis 
  • Tuberculosis (TB)

How is HIV transmitted?

HIV is spread through body fluids such as blood, vaginal fluids, rectal fluids, breast milk, and semen. HIV is mostly a sexually transmitted infection, although there are other ways besides sexual intercourse in which the disease can transmit, including:

  • By sharing needles and syringes (particularly in recreational drug users).
  • By sharing tattoo equipment without the proper sterilization techniques (very common in the prison setting).
  • From mother to child, in the labor process in which the child has direct contact with vaginal fluids 
  • From breastfeeding 

Less common ways of transition (possible but very unlikely include):

  • Through blood transfusion (since the discovery of HIV transfusion, blood is always tested, nowadays transmission through blood transfusions is almost impossible)
  • Organ tissue transplant (again, almost impossible)
  • Oral sex: the only way is for the person to have bleeding gums or sores in the mouth
  • Being bitten by an HIV patient: Only if the saliva in question is bloody

It is important to know that HIV CAN NOT BE TRANSFERRED THROUGH:

  • Direct skin contact: such as handshaking and hugging
  • Through saliva and sweat 
  • Through kissing 
  • Sharing common spaces such as Toilets, bedding, and housing 
  • Mosquito bites

Keep in mind that treated patients can have a viral load close to cero and are unlikely to transmit the infection in any way. 

Who is at risk for HIV?

Everyone can get HIV by having unprotected sex, doing intravenous drugs, etc. However, some key populations have an increased risk of engaging in this behavior compared to others.

These key populations are often criminalized and marginalized; through little or no fault of their own, they face constant human rights abuses that increase their chances of suffering from HIV.

Key populations include:

  • Men that have sex with other men (26 times more likely to have HIV)
  • Sex workers (30 times more likely to have HIV)
  • Intravenous drug users (29 times more likely to have HIV)
  • Transgender individuals (13 times more likely to have HIV)
  • Imprisoned individuals 

What are the stages of HIV? 

AIDS is the final, most severe stage of HIV infection, but it is not the only one. HIV has three main stages:

  • First Stage: Acute HIV infection 
  • Second Stage: Chronic HIV infection 
  • Third Stage: AIDS

What is acute HIV infection?

The acute infection period occurs 2 to 4 weeks after a new HIV infection. During this period, around two-thirds of patients experience flu-like symptoms like:

  • Fever
  • Swollen lymph nodes
  • Night sweats
  • Sore throat
  • Weakness
  • Rash
  • Mouth ulcers

These symptoms can last up to two weeks, but they resolve within a few days in most patients. During this stage, people have a very high viral load in their blood and are extremely contagious. Many patients do not develop symptoms during this stage. These are unspecific symptoms that can happen with any viral disease and are not specific to HIV. However, if you engaged in high-risk behavior within two weeks of the beginning of symptoms, you should consider getting tested. 

What happens during stage 2? 

The chronic HIV infection period, clinical latency period, or asymptomatic HIV infection follow the acute infection phase. It can last up to ten years, although it may end a little earlier than that in some patients.

During this phase, the virus reproduces at a very slow rate; there are still enough CD4 cells to protect the organism against infection in this stage. Therefore, patients remain asymptomatic or without symptoms during this phase. 

Although the viral replication and the viral load are relatively low during this phase, an infected person remains contagious and can transmit it. When patients take their antiretroviral medicines each day, they can decrease their viral load to 0 and have effectively no risk of transmitting the disease to sexual partners.

With adequate treatment, patients remain in this phase for life. On the other hand, untreated patients move on to phase thee or AIDS within 10 to 15 years.

What are the symptoms of HIV aids?

In the end-stage, your body will be unable to defend itself against infection and cancer.

Some symptoms and complications of AIDs include:

  • Rapid weight loss with no apparent explanation 
  • Frequent and severe cases of pneumonia 
  • Neurologic disorders, including memory loss, changes in personality, depression, and decreased consciousness.
  • Constant fatigue 
  • Chronic diarrhea (more than four weeks of diarrhea)
  • Swollen lymph nodes 
  • Night sweats 
  • Recurrent fevers
  • Bumps, lesions, and other skin disorders
  • Anal Abscess 
  • Sores in the mouth, genitals, or anus 

Some of these symptoms are a direct consequence of HIV. In contrast, others are the result of opportunistic and non-opportunistic infections. 

How do you know if you have HIV?

Because HIV patients can remain asymptomatic for years after infection, the only way to diagnose it before it reaches stage 3 (AIDS) is by testing. Serologic tests are the most common and effective way of diagnosing VIH.

These tests detect VIH antigens and antibodies in the blood. An antigen is a specific protein pattern in the virus’s surface that the immune system recognizes to begin an immune response. The antibody is a protein made by B cells to combat infection. 

Moreover, the 4th generation ELISA tests detect the HIV-1 P24 viral antigen in the first 15 to 45 days of the infection. This 4th generation antigen is the first test for a person that engaged in risky behavior in the previous weeks and wants to rule out VIH for disease control. On the other hand, antibody tests take between 23 to 90 days to turn positive after infection. Antibody tests are done with mouth swabs or blood samples.

Who should undergo an ELISA test?

Experts recommend doing HIV testing after being exposed to VIH or engaging in risky behavior. Some examples include: 

  1. Intravenous drug use
  2. Possessing different sexually transmitted disease, such as syphilis or gonorrhea 
  3. People who had unprotected sex with a person of unknown HIV status or confirmed HIV positive status.

According to the college of obstetricians and gynecologist, all pregnant women should get tested for HIV during the prenatal period. This way, they can begin HIV medicine early to lower their viral load and reduce the risk of passing the disease to the baby. 

What happens after a positive ELISA test?

False positives after a single ELISA test are not unheard of. Having certain diseases such as syphilis, lupus, and Lyme disease can cause a false positive in an HIV test. To confirm the results, doctors perform other more sophisticated and expensive tests in which the ELISA test is positive.

Some of these tests include: 

  • The nucleic acid test: This HIV test is quite expensive, and therefore it is only for patients in which the ELISA test is positive. This test looks for the genetic sequence of the virus in the blood. Nucleic acid testing can detect the virus after the 5th day after infection. 
  • Western blot test: It separates the blood from the proteins it contains to isolate HIV antibodies. Combined with an ELISA test, it is 99.99 percent accurate.

What is the window period?

The window period is the period between infection and the moment the virus becomes detectable in blood. During the window period, there is no way to diagnose HIV. Thanks to modern 4th generation ELISA tests, this period is now only 18 days; during the first generation ELISAs era, the window period was approximately two months.

Therefore, someone exposed to HIV or that has a high suspicion of being contagious but is in the window period can benefit from post-exposure prophylaxis. It consists of taking antiretroviral medicines within 72 hours after exposure to prevent getting HIV. During the window period, individuals are still contagious, so they shouldn’t engage in unprotected sexual intercourse.

How are HIV and AIDS treated? 

Regardless of viral load, treatment should begin as soon as possible. The sooner an infected person begins treatment, the better the prognosis or possible outcomes. If started early enough, antiretroviral medicines can prevent an exposed person from getting the disease. 

Antiretroviral therapy consists of taking a combination of medicines each day that stop viral reproduction, preventing the viral load from going up. Thus, sparing CD4 cells and preventing an immunodeficiency syndrome, the treatment also prevents transmission once viral load drops low enough.

Although retroviral therapy can manage the disease for an indefinite amount of time, it is not a cure. Suppose HIV positive patient with an undetectable viral load stops taking his HIV medication. In that case, his or her viral load will begin to rise, and in a few years, he or she might enter stage 3 or AIDS. 

Patients have to take at least two separate antiretroviral drugs to prevent HIV resistance to medication. Medications have to be taken every day, exactly as indicated, or viral resistance may arise. 

Furthermore, some side effects of antiviral medications include nausea, headaches, and dizziness. More serious side effects include kidney and liver damage. If the side effects are bad, your doctor might switch treatment to another that agrees more with you.

HIV prevention

For many years now, researchers have been working on an HIV vaccine with no success so far. However, HIV is still preventable with some of these measures

  • Avoid having unprotected sex
  • Get regularly tested if you have more than one stable sexual partner a year 
  • Avoid sharing needles or similar objects

Do you have symptoms of this disease?

This tool is a VIH Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this disease. Therefore, the tool will tell anybody who uses it the likelihood of their symptoms because of HIV. Also, the results could be positive for someone with several risk factors for the disease. Using this tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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