General Information
HIV is an acronym for Human Immunodeficiency Virus while AIDS refers to Acquired Immune Deficiency Syndrome. HIV infects cells of the immune system leading to their destruction. After severely weakening the immune system, HIV usually leads to AIDS.
AIDS is usually the most terminal stage of HIV infection. Additional disease conditions signify progress from HIV to AIDS. HIV progresses to AIDS/ Stage III HIV only when there is lack of proper prior treatment.
HIV virus affects the white blood cells of the body.
Myths
Myths are misconceptions . They are simply untrue details about a phenomenon or disease.
There are various myths about HIV. Here, we will state them.
It is a myth that a healthy person can contract HIV due to;
- Mosquito bites
- Sharing combs, towels, electronics and utensils with infected persons
- Sharing public facilities such as bathrooms with infected people
- Holding hands and hugging infected people
- Mouth-to-mouth resuscitation
- Shaking hands with infected people
- Touching saliva, tears or urine of infected individuals
Epidemiology
- The World Health Organization(WHO) estimated that almost 39 million individuals were infected and living with HIV virus by the end of December 2022.
- In the United States of America, over 1 million individuals were infected with HIV by the beginning of 2022.
- Almost 75% of the population living with HIV receive anti-retroviral therapy.
- AIDS-related deaths have reduced significantly by 50% since 2010.
- 13% of people infected with HIV in the United States do not know that they are living with the virus.
Risk Factors
- Reckless sexual behaviour
- Drunkenness which impairs judgement can make one to decide on having unprotected sexual intercourse
Cause
It is caused by the human immunodeficiency virus, which is a retrovirus. This means that it works in a reverse manner to insert instructions into human Deoxyribonucleic acid(DNA).
HIV virus attacks T-helper cells, thereby weakening the immune system.
Methods of Spreading
- Having unprotected sexual intercourse with HIV-infected persons
- Mother to baby through breastfeeding
- Transfusion with unscreened HIV-infected blood
- Sharing body piercing instruments such as syringes and needles with infected individuals.
Stages
- Stage I: Acute HIV
- Stage II: Chronic stage
- Stage III:AIDS
Signs & Symptoms
Early symptoms;
During stage 1, symptoms are absent for several months, even up to years post-infection.
Fever, Nausea, Weakness, Fatigue, Chills, Night sweating, Sore throat, Muscle aches, Enlarged glands or swollen lymph nodes are some of the early signs.
A person can have HIV and still appear healthy and fit. Only HIV testing can be used to ascertain the reality.
Signs and symptoms also depend on ;
- The stage of infection
- The presence of opportunistic infections such as tuberculosis
Asymptomatic HIV stage;
Symptoms of HIV are absent, sometimes for more than 5-10 years
Late stage HIV symptoms;
- Shortness of breath (dyspnoea)
- Fatigue
- Unintentional loss of weight
- Tongue has white spots
- Chronic diarrhoea
- Dry cough
AIDS-defining Illnesses
AIDS-defining Illnesses are also referred to as Opportunistic infections.
They occur mostly in stage III of HIV, where the body has a weakened immune system and therefore is unable to properly fight off diseases.
These opportunistic infections include;
- Recurrent pneumonia
- Toxoplasmosis
- Pneumocystis jirovecii pneumonia
- HIV-related encephalopathy
- Progressive multifocal leukoencephalopathy(PML)
- Related cancers such as non-Hodgkin’s lymphoma and Kaposi sarcoma herpes virus
- Tuberculosis
- Herpes
- Histoplasmosis
- Cytomegalovirus
- Cryptococcosis
- Candidiasis
- Coccidioidomycosis
- Cryptosporidiosis
Tests for Diagnosis
Note that during the window period, the virus is not detectable in human samples.
For diagnosing, laboratory practitioners can conduct one or several of the following tests;
- Nucleic Acid Test(NAT)- This test can be used to check the quantity of virus in an individual’s blood. Viral detection is between 10-33 days post-exposure
- Rapid and Self-tests- These tests check presence of antibodies in an individual’s fluids- whether oral or blood fluids. HIV antibody detection can be done 23-90 days post-exposure.
- Antigen/antibody tests- To check for antigens and antibodies in blood. Blood is usually drawn from a blood vessel or by pricking a finger. HIV is detected 18-90 days post-exposure.
Apart from these, home testing kits are available. This has the advantage such that it is done in a person’s privacy.
When a test turns out to be positive, it is recommended that the patient’s health be assessed through tests such as;
- Complete blood count
- Chest X-ray
- CD4 count
- Tuberculosis
- Pap Smear in women
- Hepatitis screening
Treatment & Management
There is no established cure for treating HIV. Fortunately, there are drugs that help to;
- Lower risk of transmission
- Increase life expectancy of people
- Improve life and life quality
- Stop HIV progression
Anti-retroviral drug therapy includes;
- Fusion inhibitors
- Protease inhibitors. For HIV to replicate , it requires enzyme protease. Protease inhibitors bind to protease enzyme and therefore inhibit the replicative action. This helps to prevent the virus from making copies.Examples include atazanavir and cobicistat, lopinavir and ritonavir, darunavir and cobicistat
- Nucleoside/ nucleotide reverse transcriptase inhibitors-Abacavir, emtricitabine, tenofovir disoproxil fumarate. These drugs are also referred to as nukes. They interfere with the virus during replication process.
- Non-nucleotide reverse transcriptase inhibitors- Doravirine, etraviirine and nevirapine are examples of NNRTIs
- CCR5 antagonists such as Maraviroc. CCR5 stands for C-C Chemokine Receptor Type 5.Integrase inhibitors.
- These inhibitors block the enzyme integrase, which is required by HIV cells in order to infect T cells. They are recommended as first line treatment by most of the medical practitioners since they have fewer side effects and they are also very much effective. Examples are- dolutegravir and raltegravir
Prevention
- Prophylaxis; Post-exposure and pre-exposure prophylaxis drugs
Post-exposure prophylaxis(PEP) should be taken within 72 hours after exposure, to prevent infection from being established.
The United States agency, Food and Drug Administration(FDA) has approved a second combination regimen as PrEP(pre-exposure prophylaxis drugs). This is tenofovir alafenamide/ emtricitabine. - Practise protected sex using condoms
- Avoid exposure to relevant bodily fluids such as blood samples(these can be infected with a virus), semen and vaginal secretions
- Take medicines as prescribed to lowe the viral load and lower chances of infecting others. Even though, continue practising safe sex.
- Educating the public through posters and advertisements