Its biology uses human cells to reproduce and permanently embeds genetic material into its DNA. Therefore, a person with HIV will have it for the rest of their life.
HIV targets cells in the immune system with a specific molecule (CD4) found on their cell membrane. Specialized cells involved in the immune response to infections and anti-cancer response possess this molecule. This molecule helps attach and communicate with other cells, which is especially important when all immune cells attack foreign pathogens.
HIV targets the CD4 molecule and attaches to it through a protein called gp120 located on its envelope and through the co-receptor – CCR5. These subunits are necessary because some drugs used to treat HIV work through these molecules.
What Is AIDS?
AIDS is a multi-symptomatic, severe disease caused by the development of untreated HIV infection. The name of the disease is an abbreviation of the English words acquired immunodeficiency syndrome, which means acquired immune deficiency syndrome. The virus causing the disease can multiply in the cells of the immune system and gradually destroy them.
If an appropriate treatment that inhibits virus multiplication is not undertaken in time, the immune system ceases to fulfill its function – protecting the body against diseases. Therefore, AIDS is a combination of various types of infections and many types of cancer that the inactive immune system cannot fight.
HIV infection may not cause any symptoms for up to several years. Patients often see a doctor only with the first symptoms of AIDS when it is too late for effective treatment.
The names HIV and AIDS are often used interchangeably, which is not correct – they are not synonyms. HIV is the name of the virus, and AIDS refers only to the full-blown disease. You cannot get AIDS unless you have previously been infected with HIV. Moreover, simply carrying the virus does not mean that you will suffer from AIDS.
Symptoms
The initial stage of HIV infection may be asymptomatic or cause non-specific symptoms. It is the so-called primary HIV infection.
The most common symptoms of primary HIV infection are:
- Fever not exceeding 38.9 degrees Celsius
- Feeling tired
- A rash (reddish, non-itchy, morbilliform or maculopapular)
- Headaches
- Enlarged lymph nodes
- Pharyngitis
- Muscle and joint pain
- Digestive system symptoms, e.g., nausea, vomiting, or diarrhea
- Night sweats
After the acute phase, the disease turns into a chronic, asymptomatic form, in which chronic generalized lymphadenopathy may sometimes occur. It is the enlargement of nodes in at least two non-adjacent places, except the inguinal area. As the disease progresses, symptomatic infection may occur, characterized by several clinical symptoms associated with the infection. In this phase of the disease, diseases that are not indicative of AIDS may occur:
- General symptoms that cannot be attributed to any other disease, lasting for at least a month
- Hairy leukoplakia of the oral cavity
- Peripheral neuropathy
- Idiopathic thrombocytopenia
- Dysplasia of the cervical mucosa
- Pelvic inflammatory diseases (may be accompanied by ovarian or fallopian tube abscesses)
- Angiomatosis bacillaris
- Oral or vaginal candidiasis
- Idiopathic thrombocytopenia
- Listeriosis
- Peripheral neuropathies
The last stage of the disease is AIDS, an advanced stage of infection diagnosed based on emerging indicator diseases, ending in death on average two years after diagnosis.
Symptoms of HIV infection can be very vague and so non-specific that they are often underestimated, and the long duration of the disease (8-10 years) means that the patient is completely unaware of the infection.
Causes
The human immunodeficiency virus enters the human body through the portals of infection resulting from disruption of the skin and mucous membranes, as well as through the placenta and with the milk of the sick mother. After entering the body, HIV combines with blood cells.
HIV infection may be caused through:
- Sexual intercourse with an infected person. The highest risk comes from anal intercourse, and in the case of heterosexual intercourse, the risk of infection by the woman is always higher, which results directly from the anatomical structure of the female genital organs
- Involvement in prostitution
- Rape and other forms of sexual violence
- In vitro fertilization with the semen of an infected man
- Sexual contact without consistent and correct use of a condom
The risk of HIV transmission increases in the case of sexually transmitted diseases, especially those involving ulcerations and erosions on the genitals.
You can get blood-borne route through:
- Using intravenous drugs with equipment used by an HIV-infected person
- Medical or cosmetic procedures performed with non-sterile equipment
- Contact with the blood of infected people
- Tissue or organ transplants from HIV-infected people
- Tattooing, piercing, acupuncture, or cosmetic treatments performed with non-sterile equipment
The HIV can be transmitted from an infected mother to her baby at various stages:
- Fetal life through the placenta
- During childbirth
- Through breastfeeding, along with mother’s milk
The risk of transmitting the infection during pregnancy, childbirth, or while breastfeeding a newborn is highest if the woman does not know about her infection. Suppose a woman is aware of the infection and remains under the care of a gynecologist and an infectious disease specialist during pregnancy.
In many countries, women planning to have a child or who are pregnant are offered an anti-HIV antibody test as one of the routine diagnostic tests performed for the safety of both the mother and her child.
Diagnosis
Anyone who believes that they may have been infected with HIV should contact the appropriate health center, where they will be able to perform HIV laboratory tests free of charge and anonymously.
However, serological tests give reliable results only about three months after infection. Diagnosis of HIV infection is possible using techniques that detect antibodies in the blood that specifically recognize viral proteins (so-called anti-HIV antibodies) and methods that enable the determination of the virus’s genetic material and the main viral protein called p24 in body fluids, cells, and tissues.
Recommended diagnostic tests to detect HIV infection include:
- A diagnostic problem in the early phase of HIV infection is the so-called serological window. It is the period immediately after HIV infection. If a person may be exposed to HIV infection and tests too early, the outcome will be negative despite the existing condition. The officially recognized serological window period for HIV diagnosis is 12 weeks. A medical consultation and a recommendation to repeat the test after a certain period are intended to eliminate such situations. These tests have certain limitations – they can be performed only 3 months after exposure to infection.
- During the serological window period, tests based on the detection of an HIV protein called p24 can be performed. After seroconversion, the p24 antigen is not present in the serum in a free state, but in immune complexes, and a reliable assay cannot be performed. Fourth-generation tests are also available, detecting both the p24 antigen and anti-HIV antibodies, allowing the diagnosis of infection in the shortest possible period after exposure.
- Nucleic acid amplification tests allow you to determine the level of HIV RNA. If HIV infection is suspected, despite negative antibody test results, an HIV RNA test may be performed. Molecular tests are sensitive and specific but, unfortunately, also expensive.
- In people diagnosed with HIV infection, blood morphological tests to determine the number of CD4+ T lymphocytes are significant. They should be performed by HIV-infected people regularly every 3-6 months.
Treatment
The goal of antiretroviral therapy is:
- Maintaining health as long as possible and slowing down the progression of the disease
- Strengthening the immune system
- Preventing opportunistic infections
- Prevention of vertical infections during pregnancy
The introduction of a new group of drugs into therapy – HIV protease inhibitors – resulted in a breakthrough in the treatment of people infected with HIV. The simultaneous use of three antiretroviral drugs, most often two nucleoside reverse transcriptase inhibitors and one protease inhibitor, allowed people already diagnosed with AIDS to recover, and patients whose treatment was started at an asymptomatic stage were much less likely to suffer from diseases related to HIV infection.
Specialists may use highly active antiretroviral therapy (HAART). It allows to stop the multiplication (replication) of the virus and the progression of the disease. Since the treatment does not remove the virus from the body but only slows down its replication, the person should continue it for the rest of their life.
Specialists use drugs from the following groups:
- Nucleoside reverse transcriptase inhibitors – work by inhibiting the activity of an enzyme involved in the HIV replication cycle
- Non-nucleoside reverse transcriptase inhibitors – also inhibit enzymes necessary for the replication of HIV
- Protease inhibitors – inhibiting the process of creating the HIV ready to be secreted from the cell
- Fusion inhibitors – inhibiting the fusion and entry of the virus into sensitive cells
Unfortunately, due to the high instability of HIV, as in the case of many other viruses, but also bacteria and fungi, new genetic variants that are resistant to treatment are constantly emerging.
Antiretroviral drugs may cause side effects shortly after starting their use (most often affecting the gastrointestinal tract), but also late ones, appearing after a long time (disorders of fat tissue distribution – lipodystrophy, carbohydrate and fat metabolism). It is easier to prevent these disorders (e.g., by living a healthy lifestyle with a balanced diet and increased physical activity) than to treat them, and each patient treated with ARV drugs should monitor the concentration of glucose, cholesterol, and triglycerides.
Antiretroviral therapy is the only way to slow the progression of HIV infection to AIDS and death, the only option – if started late – is to restore the function of the immune system.
Prevention
The most important rule to protect against HIV infection is to avoid risky behavior. Measures to prevent sexual infection include:
- Limiting the number of sexual partners
- Monogamous relationship with a healthy partner
- Consistent and correct use of a good quality condom, also during oral-genital intercourse
- Limiting risky sexual behaviors (casual sexual partners, prostitution, and unprotected intercourse) and situations conducive to them (alcohol and drugs)
- Preventing sexually transmitted infections and avoiding sexual contact in the case of venereal diseases, as they increase the risk of infection
- Testing for HIV and other sexually transmitted diseases before sexual intercourse
To prevent blood-borne HIV infection you should:
- Avoid performing cosmetic treatments, tattoos, piercings, and acupuncture in suspicious places
- Use needles, syringes, and supplemental tools exchange programs substitution treatment in the case of opioid addiction or referral to addiction treatment centers
- Avoid contamination of wounds with body secretions of another person, e.g., blood and semen
To prevent vertical infection of the child:
- Every woman planning a pregnancy and who is pregnant should be tested for antibodies to the HIV
- If the mother is diagnosed with an infection, she should undergo preventive treatment
There is currently no vaccine against HIV. The difficulties in creating it are related to the high frequency of mutations in the virus’s surface proteins, which causes a diversity of antigenic types. Nevertheless, intensive research is still ongoing to create such a vaccine.
Remember that in some countries, exposing another person to HIV infection by a person aware of their HIV status is subject to criminal liability.
Living with HIV
The currently used combination antiretroviral therapy makes HIV infection a chronic disease. A person infected with HIV can lead a normal life – work, start a family and have children. They must follow safety rules that will protect people in contact with them against infection.
First of all, remember that HIV is transmitted through blood, semen, and genital secretions and not through tears, sweat, urine, or feces (unless it contains blood). If you know about your disease, you should not donate blood at blood donation stations or consent to have your organs or tissues harvested for transplants.
A person with HIV, even if their partner is also infected, should always use a condom during sexual intercourse. If both partners are carriers, intercourse without a condom may result in superinfection with a different type of virus (e.g., more difficult to treat).
People infected with HIV can also have children because the sperm themselves do not transmit the virus and, after being selected from the seminal fluid, can be used for fertilization.
People with HIV must remember to take medications and undergo tests regularly (usually every 3-6 months) and should be in constant contact with their doctor.
Remember also about your mental health. HIV-related stigma perpetuates and reproduces existing social inequalities, especially those related to gender and sexuality, ethnicity, and socioeconomic status. Erroneous and harmful beliefs result, among other things, in underestimating the risk of infection among people who do not identify with any of the social groups stereotypically associated with HIV and, as a result, postponing or avoiding HIV testing despite engaging in risky behaviors that may result in infection.
Other cognitive components of HIV-related stigmatization considered in research include moral judgments and condemnation of infected people, holding them responsible for the infection, and attributing to them particular characteristics such as irresponsibility or sexual permissiveness. In the group of HIV-infected people, social stigmatization processes result from experiences of rejection and unfair treatment due to their HIV status, as well as awareness of the social devaluation of these people.
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