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HIV: Human Immunodeficiency Virus

Medikoe Health Expert

Medikoe Health Expert

  Koramangala, bengaluru, karnataka, india, Bengaluru     Feb 9, 2017

   7 min     

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Overview

Human immunodeficiency virus infection is a spectrum of conditions caused by the human immunodeficiency virus (HIV). 

A person may not experience any symptoms following initial infection or may experience a short period of influenza-like-illness. This is generally followed by a prolonged period of no signs.  As the disease worsens, HIV starts to interfere with more than the immune system. The person becomes susceptible to other common infections such as tuberculosis and tumours that seldom affect immunocompetent people. 

The often delayed symptoms are referred to as acquired immunodeficiency syndrome (AIDS). 

Signs and Symptoms of HIV

There are three main stages of progression of HIV infection: acute infection, clinical latency, and AIDS.

Acute Infection: 

Also known as primary HIV or acute retroviral syndrome. During this stage, many individuals develop an influenza-like-illness after 2-4 weeks of exposure, while others have no symptoms at all. 

Symptoms are observed in 40-90% of cases and generally include fever, large tender lymph nodes, throat inflammation, rash, headache, fatigue, sores of the mouth and genitals. In 20-50% of cases, the rash is usually present on the trunk and is maculopapular (  flat or raised red bump on the skin). 

Most of the people also develop other opportunistic infections at this stage. Gastrointestinal symptoms, such as vomiting or diarrhoea, may occur.  Neurological symptoms such as peripheral neuropathy or Guillain- Barre syndrome also occurs. 

Clinical Latency:

The symptoms of acute infection are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV. If not treated these symptoms/ stage of HIV infection can last from three years to about 20 years. Although people experience no symptoms at first at the end of the stage, symptoms such as fever, weight loss, gastrointestinal concerns and muscle pains are quite prominent.

Almost 50-70% of people also develop non-painful enlargement of more than one group of lymph nodes for over three to six months.

Most of the HIV-1 infected individuals have detectable virus load and if not diagnosed and treated might progress into AIDS,  a small proportion retains high levels of CD4+ T cells (T helper cells) without antiretroviral therapy for more than five years. These individuals are classified as HIV controllers or long-term nonprogressors. About 1 in 300 infected persons have a low or undetectable viral load without treatment,  known as "elite controllers" or "elite suppressors. 

AIDS 

Chronic HIV or clinical latency usually develop into AIDS, which is considered to be the most debilitating syndrome. This is the last stage of HIV infection. 

Symptoms of AIDS include:

  • Pneumonia

  • Sores of mouth, genitals and anus

  • Rapid loss of weight 

  • Recurring fever or night sweats

  • Extreme and unexplained fatigue

  • Diarrhoea for more than a week 

  • Prolonged swelling of lymph nodes of armpits, groin, or neck. 

  • Red, brown and pink patches on mouth, nose and eyelids. 

  • Loss of memory and depression. 

These symptoms are also observed in other illness. The only way to confirm AIDS is to get tested.

Other infections caused by AIDS include

  • Central:

    • Encephalitis 

    • Meningitis

  • Eyes:

    • Retinitis 

  • Lungs

    • Pneumocystis pneumonia 

    • Tuberculosis ( multiple organs) 

    • Tumour 

  • Gastrointestinal

    • Esophagitis 

    • Chronic diarrhoea

    • Tumour

Transmission of HIV

HIV cannot survive long outside the human body (example on surfaces), it also cannot reproduce outside the host i.e. human body. It cannot spread through 

  • Mosquitoes, ticks or insects

  • Hugging, shaking hands, sharing dishes, sharing toilet, a peck on the mouth with someone who is HIV- positive.

  • Saliva, tears or sweat which not mixed with the blood of HIV- positive person. 

  • Or any other sexual activities that do not involve the exchange of body fluids. 

HIV infection is only transmitted through specific activities. The most common cause of transmission includes sexual exposure and needle or syringe use. 

Only certain body fluids from an infected person can transmit HIV- blood, semen, pre-seminal fluid, vaginal fluids, and breast milk. These fluids must come in contact with a mucous membrane or damaged tissue or should be directly administered into the bloodstream for an infection to occur. 

Mucous membranes are present inside of the rectum, vagina, penis, and mouth.

HIV infection is Mainly Spread by 

  • Having unprotected sexual intercourse with someone who is HIV-positive or taking medicines to treat HIV.

    • The HIV-negative partner is at higher risk if he performs anal sexual intercourse with an infected partner. 

    • Though the partner can also get HIV through vaginal sex, it is less risky than anal sex. 

  • Sharing needles or syringes with someone who has HIV. HIV tends to live in a used needle for 42 days depending upon the environmental factors. 

HIV infection is less commonly spread through

  • From a mother to her child during pregnancy, birth, or breastfeeding. Although the risk is high if the mother is not treated and is living with HIV. 

  • Being stuck with a contaminated needle or other sharp objects. Health care workers are at higher risk.  

HIV infection is seldom spread through 

  • Oral sex- placing the mouth on the penis (Fellatio), vagina (cunnilingus), or anus. There is little no risk in getting infected by performing oral sex. But the transmission can occur if an HIV-positive man ejaculates in his partner’s mouth during oral sex. 

  • Receiving blood products, blood transfusion, organ transplant from a person who is Contaminated with HIV. This was one of the leading causes of transmission but now is obsolete due to the rigorous test that has been performed before transfusion or transplantation.

  • Eating food pre-chewed by a contaminated person. This is only seen in infants-  when infected blood from a caregiver’s mouth mixes with food while chewing.

  • Getting bitten by a HIV-positive person but it is only possible if the skin is broken or the pressure was enough to leave severe trauma with extensive tissue damage.

Diagnosis of HIV

Diagnosis of HIV is usually done by testing blood or saliva for the presence of antibodies against the virus. The body takes time to produce antibodies against the virus- usually 12 weeks. 

A quicker test can be performed which checks for the HIV antigen, a protein produced by the virus after infection. It confirms the infection in no time and allows the person to take preventive steps against the virus. 

Diagnosis of HIV at Home 

Diagnosis of HIV at home is possible for identification of infection before the confirmation at a hospital. You either need a drop of dried blood or a sample of saliva. If the outcomes are positive you may see a doctor and if negative, the test should be performed after a few months to confirm the result. 

Test to determine different stages of HIV

There are several tests that can help your physician determine the stage of your infection and provide you with the best treatment. These tests include:

  • CD4 T cell count: CD4 T cells are WBCs that are predominantly targeted and destroyed by HIV. Even if no symptoms are observed, confirmation of HIV or AIDS can be done. The infection progresses to AIDS when the cell count of CD4 T cells goes below 200.

  • Viral load: This test measures the amount of virus in your blood

  • Drug resistance: Some strains are resistant to medications. This helps determine if the virus is resistant and thereby change the treatment option. 

Treatment of HIV

There‘s no cure for HIV/AIDS, but there are different drugs that are available to control the virus. The drugs targeted against the virus are called antiretroviral therapy or ART. each class of drugs are designed to block the virus is disparate ways. ART is now recommended for everyone, regardless of CD4 T cell counts. It's recommended to combine at least three drugs from two classes to avoid drug-resistant strains of HIV. 

The classes of antiretroviral drugs include:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs)

  • Protease inhibitors (PIs)

  • Entry or fusion inhibitors

  • Integrase inhibitors

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Tags:  Sexual Health - Male,Sexual Health - Female,sexually transmitted disease ,HIV

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