HIV is a virus that targets and alters the immune system, increasing the risk and impact of other infections and diseases. Without treatment, the infection might progress to an advanced disease stage called AIDS.
However, modern advances in treatment mean that people living with HIV in countries with good access to healthcare very rarely develop AIDS once they are receiving treatment.
The life expectancy of a person who carries the HIV virus is now approaching that of a person that tests negative for the virus, as long as they adhere to a combination of medications called antiretroviral therapy (ART) on an ongoing basis.
A Kaiser Permanente study in 2016 suggested that between 1996 and 2016, the gap in life expectancy between people who are HIV positive and HIV negative closed from 44 years to 12 years.
The World Health Organization (WHO) also advises that a person living with HIV can resume a high quality of life with treatment, and that 20.9 million people worldwide were receiving ART as of mid-2017.
In this article, we explain HIV and AIDS, their symptoms, causes, and treatments.
What is HIV?
Share on PinterestWhile HIV is a life-changing illness, a person can live a long and full live with it.
Human immunodeficiency virus (HIV) is a virus that attacks immune cells called CD4 cells, which are a type of T cell.
These are white blood cells that move around the body, detecting faults and anomalies in cells as well as infections. When HIV targets and infiltrates these cells, it reduces the body’s ability to combat other diseases.
This increases the risk and impact of opportunistic infections and cancers. However, a person can carry HIV without experiencing symptoms for a long time.
HIV is a lifelong infection. However, receiving treatment and managing the disease effectively can prevent HIV from reaching a severe level and reduce the risk of a person passing on the virus.
What is AIDS?
AIDS is the most advanced stage of HIV infection. Once HIV infection develops into AIDS, infections and cancer pose a greater risk.
Without treatment, HIV infection is likely to develop into AIDS as the immune system gradually wears down. However, advances in ART mean than an ever-decreasing number of people progress to this stage.
By the close of 2015, around 1,122,900 people were HIV-positive. To compare, figures from 2016 show that medical professionals diagnosed AIDS in an estimated 18,160 people.
Causes
People transmit HIV in bodily fluids, including:
blood
semen
vaginal secretions
anal fluids
breast milk
In the United States, the main causes of this transfer of fluids are:
anal or vaginal intercourse with a person who has HIV while not using a condom or PrEP, a preventive HIV medication for people at high risk of infection
sharing equipment for injectable illicit drugs, hormones, and steroids with a person who has HIV
A woman living with HIV who is pregnant or has recently given birth might transfer the disease to her child during pregnancy, childbirth, or breastfeeding.
The risk of HIV transmitting through blood transfusions is extremely low in countries that have effective screening procedures in place for blood donations.
Undetectable = untransmittable
To transmit HIV, these fluids must contain enough of the virus. If a person has ‘undetectable’ HIV, they will not transmit HIV to another person, even if after a transfer of fluids.
Undetectable HIV is when the amount of HIV in the body is so low that a blood test cannot detect it. People may be able to achieve undetectable levels of HIV by closely following the prescribed course of treatment.
Confirming and regularly monitoring undetectable status using a blood test is important, as this does not mean that the person no longer has HIV. Undetectable HIV relies on the person adhering to their treatment, as well as the effectiveness of the treatment itself.
Progression to AIDS
The risk of HIV progressing to AIDS varies widely between individuals and depends on many factors, including:
the age of the individual
the body’s ability to defend against HIV
access to high-quality, sanitary healthcare
the presence of other infections
the individual’s genetic inheritance resistance to certain strains of HIV
drug-resistant strains of HIV
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Symptoms
For the most part, infections by other bacteria, viruses, fungi, or parasites cause the more severe symptoms of HIV.
These conditions tend to progress further in people who live with HIV than in individuals with healthy immune systems. A correctly functioning immune system would protect the body against the more advanced effects of infections, and HIV disrupts this process.
Early symptoms of HIV infection
Share on PinterestSweats are an early sign of HIV, but many people do not know they have the disease for years.
Some people with HIV do not show symptoms until months or even years after contracting the virus.
However, around 80 percent of people may develop a set of flu-like symptoms known as acute retroviral syndrome around 2–6 weeks after the virus enters the body.
The early symptoms of HIV infection may include:
chills
joint pain
muscle aches
sweats. particularly at night
enlarged glands
a red rash
weakness
unintentional weight loss
thrush
These symptoms might also result from the immune system fighting off many types of viruses.
However, people who experience several of these symptoms and know of any reason they might have been at risk of contracting HIV over the last 6 weeks should take a test.
Asymptomatic HIV
In many cases, after the symptoms of acute retroviral syndrome, symptoms might not occur for many years.
During this time, the virus continues to develop and cause immune system and organ damage. Without medication that prevents the replication of the virus, this slow process can continue for an average of around 10 years.
A person living with HIV often experiences no symptoms, feels well, and appears healthy.
Complying rigidly to a course of ART can disrupt this phase and suppress the virus completely. Taking effective antiretroviral medications for life can halt on-going damage to the immune system.
Late-stage HIV infection
Without medication, HIV weakens the ability to fight infection. The person becomes vulnerable to serious illnesses. This stage is known as AIDS or stage 3 HIV.
Symptoms of late-stage HIV infection may include:
blurred vision
diarrhea, which is usually persistent or chronic
dry cough
a fever of over 100 °F (37 °C) lasting for weeks
night sweats
permanent tiredness
shortness of breath, or dyspnea
swollen glands lasting for weeks
unintentional weight loss
white spots on the tongue or mouth
During late-stage HIV infection, the risk of developing a life-threatening illness increases greatly. A person with late-stage HIV can control, prevent and treat serious conditions by taking other medications alongside HIV treatment.
Opportunistic infections
Share on PinterestToxoplasmosis, found in cat and animal feces, is a dangerous opportunistic infection for people who have AIDS.
HIV treatment is nowadays often effective enough to keep many infections at bay.
In reducing the activity of the immune system, late-stage HIV reduces the ability of the body to combat a range of infections, diseases, and cancers. Infections that caused minimal or no health problems before the development of AIDS might pose a serious health risk once the condition has weakened the immune system.
Medical professionals refer to these as opportunistic infections (OIs). Once any of these infections occur, a doctor will diagnose AIDS.
These include:
Candidiasis of the bronchi, trachea, esophagus, and lungs: As a fungal infection that normally occurs in the skin and nails, this frequently causes serious problems in the esophagus and lower respiratory tract for people with AIDS.
Invasive cervical cancer: This type of cancer begins in the cervix and spreads to other areas in the body. Regular checks with a cancer care team can help prevent the cancer or limit the spread.
Coccidioidomycosis: People sometimes refer to the self-limited version of this disease in healthy individuals as valley fever. Inhalation of the fungus Coccidioides immitis causes this infection.
Cryptococcosis: Cryptococcus neoformans is a fungus that can infect any part of the body, but most often enters the lungs to trigger pneumonia or the brain to cause swelling.
Cryptosporidiosis: The protozoan parasite Cryptosporidium causes this infection that leads to severe abdominal cramps and watery diarrhea.
Cytomegalovirus disease (CMV): CMV can cause a range of diseases in the body, including pneumonia, gastroenteritis, and encephalitis, a brain infection. However, CMV retinitis is of particular concern in people with late-stage HIV, and it can infect the retina at the back of the eye, permanently removing sight. CMV retinitis is a medical emergency.
HIV-related encephalopathy: An acute or chronic HIV infection can trigger this brain disorder. While doctors do not fully understand the cause, they consider it to be linked to post-infection inflammation in the brain.
Herpes simplex (HSV): This virus, usually sexually transmitted or passed on in childbirth, is extremely common and rarely causes health issues or causes self-limiting recurrences in people with healthy immune systems. However, it can reactivate in people with HIV, causing painful cold sores around the mouth and ulcers on the genitals and anus that do not resolve. The sores, rather than a herpesdiagnosis, are an indicator of AIDS. HSV can also infect the breathing tube, lungs, or esophagus of people with AIDS.
Histoplasmosis: The fungus Histoplasma capsulatum causes extremely severe, pneumonia-like symptoms in people with advanced HIV. This condition can become progressive disseminated histoplasmosis and can impact on organs outside of the respiratory system.
Chronic intestinal isosporiasis: The parasite Isospora belli can infect the body through contaminated food and water, causing diarrhea, fever, vomiting, weight loss, headaches, and abdominal pain.
Kaposi’s sarcoma (KS): Kaposi’s sarcoma herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8), causes a cancer that leads to the growth of abnormal blood vessels anywhere in the body. If KS reaches organs, such as the intestines or lymph nodes, it can be extremely dangerous. KS appears as solid purple or pink spots on the surface of the skin. They might be flat or raised.
Lymphoma: People refer to cancer of the lymph nodes and lymphoid tissues as lymphoma, and many different types might occur. However, Hodgkin and non-Hodgkin lymphoma have strong links to HIV infection.
Tuberculosis (TB): The bacteria Mycobacterium tuberculosis causes this disease and can transfer in droplets if a person with an active form of the bacteria sneezes, coughs, or speaks. TB causes a severe lung infection as well as weight loss, fever, and tiredness, and can also infect the brain, lymph nodes, bones, or kidneys.
Mycobacteria, including Mycobacterium avium and Mycobacterium kansasii:These bacteria occur naturally in the environment and pose few problems for people with fully-functioning immune systems. However, they can spread throughout the body and cause life-threatening health issues for people with HIV, especially in its later stages.
Pneumocystis jirovecii pneumonia (PJP):A fungus called Pneumocystis jiroveciicauses breathlessness, dry cough, and high fever in people with suppressed immune systems, including those with HIV.
Recurrent pneumonia: Many different infections can cause pneumonia, but a bacteria called Streptococcus pneumoniae is one of its most dangerous causes in people with HIV. Vaccines are available for this bacteria, and every person who has HIV should receive vaccination for Streptococcus pneumoniae.
Progressive multifocal encephalopathy (PML): The John Cunningham (JC) virus occurs in a vast number of people, usually lying dormant in the kidneys. However, in people with compromised immune systems, either due to HIV or medications, such as those for multiple sclerosis (MS), the JC virus attacks the brain, leading to a dangerous conditon called progressive multifocal leukoencephalopathy (PML). PML can be life-threatening, causing paralysis and cognitive difficulties.
Recurrent Salmonella septicemia: This type of bacteria often enters the body in contaminated food and water, circulates the entire body, and overpowers the immune system, causing nausea, diarrhea, and vomiting.
Toxoplasmosis (toxo): Toxoplasma gondiiis a parasite that inhabits warm-blooded animals, including cats and rodents, and leaves the body in their feces. Humans contract the diseases by inhaling contaminated dust or eating contaminated food, but it can also occur in commercial meats. T. gondii causes severe infection in the lungs, retina, heart, liver, pancreas, brain, testes, and colon. Take care to wear protective gloves while changing cat litter and thoroughly wash the hands afterward.
Wasting syndrome: This occurs when a person involuntarily loses 10 percent of their muscle mass through diarrhea, weakness, or fever. Part of the weight loss may also consist of fat loss.
Prevention
Preventing OIs is key to extending life expectancy with late-stage HIV. Aside from managing HIV viral load with medications, a person who lives with the disease must take precautions, including the following steps:
Wear condoms to prevent other STIs.
Receive vaccinations for potential OIs. Discuss these with your primary care physician.
Understand the germs in your surrounding environment that could lead to an OI. A pet cat, for example, could be a source of toxoplasmosis. Limit exposure and take precautions, such as wearing protective gloves while changing litter
Avoid foods that are at risk of contamination, such as undercooked eggs, unpasteurized dairy and fruit juice, or raw seed sprouts.
Do not drink water straight from a lake or river or tap water in certain foreign countries. Drink bottled water or use water filters.
Ask your doctor about work, home, and vacation activities to limit exposure to potential OIs.
Antibiotic, antifungal, or antiparasitic drugs can help treat an OI.
HIV and AIDS myths and facts
Many misconceptions circulate about HIV that are harmful and stigmatizing for people with the virus.
The following cannot transmit the virus:
shaking hands
hugging
kissing
sneezing
touching unbroken skin
using the same toilet
sharing towels
sharing cutlery
mouth-to-mouth resuscitation or other forms of “casual contact”
the saliva, tears, feces, and urine of a person with HIV
Diagnosis
The Centers for Disease Control and Prevention (CDC) estimates that about 1 in every 7 HIV-positive Americans is unaware of their HIV status.
Becoming aware of HIV status is vital for commencing treatment and preventing the development of more severe immune difficulties and subsequent infections.
HIV blood tests and results
A doctor can test for HIV using a specific blood test. A positive result means that they have detected HIV antibody in the bloodstream. The blood is re-tested before a positive result is given.
After potential exposure to the virus, early testing and diagnosis is crucial and greatly improves the chances of successful treatment. Home testing kits are also available.
HIV might take 3 – 6 months to show up in testing, and re-testing may be necessary for a definitive diagnosis. People at risk of infection within the last 6 months can have an immediate test. The test provider will normally recommend another test within a few weeks.
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