HIV

Symptoms: Headache, chills accompanied by fever, muscle ache, sore throat, swollen lymph nodes, red blotches and rashes on skin, noticeable swelling in different body parts, night sweats
Causes: Sexual contact, use of drugs, contact with infected blood and needles from mother to child during pregnancy
Risk Factors: Individuals who inject drugs and share needles, individuals with current or former partners with HIV, individuals who have multiple sexual partners, individuals who have unprotected sex, babies born from parents with HIV

Prevalence: Globally, 39.0 million [33.1-45.7 million] people were living with HIV at the end of 2022. HIV affects approximately 0.7% [0.6-0.8%] of adults aged 15-49 years worldwide. In India, this indicator was expected to be 0.22% (0.17-0.29%) in 2019. In the same year, HIV prevalence among adult males (15-49 years) was estimated at 0.24% (0.18-0.32%), and among adult females at 0.20% (0.15-0.26%).
Severity: Mild to severe
Which doctor to consult: General Physician, Infectious Disease Specialist
 

Overview:

Acquired immunodeficiency syndrome (AIDS) is a chronic condition. It's caused by the human immunodeficiency virus or HIV. HIV impairs the immune system, reducing the body's ability to fight infection and disease. If HIV is not treated, it can take years to weaken the immune system to the point where AIDS develops. Because of treatment, most people in the United States do not contract AIDS.

HIV is transmitted through genital contact, such as during unprotected sex. This type of infection is known as a sexually transmitted infection (STI). HIV can also be spread through blood contact, such as sharing needles or syringes. A person with untreated HIV may also transmit the virus to a child during pregnancy, childbirth, or breastfeeding. 

There is no cure for HIV/AIDS. However, medications can control the infection and prevent the disease from worsening. Antiviral HIV treatments have significantly reduced AIDS deaths worldwide. There is an ongoing effort to make HIV/AIDS prevention and treatment more accessible in resource-poor countries. 

Stages of HIV:

There are four stages of HIV. It can progress to the final stage if left untreated for too long. The following are the four stages of HIV:
Stage 1: Seroconversion Illness
This is the primary stage of HIV when the disease is an acute infection. It usually begins 2 to 4 weeks after the virus spreads in the body.
Seroconversion is the process by which the immune system of the body reacts by producing antibodies.
Most individuals in this stage show flu-like symptoms, including fever, chills, fatigue, and body aches. Because of this, the infection is not diagnosed at this stage. Most individuals ignore it as flu. However, this is the stage when the disease is most infectious.
Stage 2: Asymptomatic Stage
This stage comes as soon as the process of seroconversion is over. As the name suggests, individuals show no symptoms and feel better after the flu-like symptoms.
This stage may last for five to ten years at a stretch without showing any visible symptoms. But the virus continues to infect new cells, spread in the body and make copies of itself. An HIV screening test in this stage can reveal the infection in the body.
Stage 3: Symptomatic HIV
The immune system becomes weakened after fighting the virus for many years. The infection becomes stronger as the tissues and lymph nodes are destroyed completely.
At this stage, the symptoms are opportunistic because they take advantage of the body's weakened immune system. The most common symptoms include weight loss, fever, night sweats, diarrhoea, and swollen lymph nodes at this stage.
Stage 4: Late-Stage HIV
This is the final and most severe stage. If the infection has damaged the body's immune system and no treatment was followed in the previous stages, the body starts showing the symptoms of AIDS. AIDS stands for Acquired Immunodeficiency Syndrome, and without treatment, individuals can survive only up to three to five years.
 

Signs and symptoms:

The symptoms of HIV differ according to the stage of infection.

The disease spreads more easily in the first few months after infection, but many people are unaware of their condition until the late stages. People may not experience symptoms for several weeks after becoming infected. Others may have a flu-like illness, including:

• fever

• headache

• rash

• sore throat.

The infection gradually weakened the immune system. This can result in additional signs and symptoms:

• swollen lymph nodes

• weight loss

• fever

• diarrhoea

• cough.

Without treatment, people infected with HIV can develop serious illnesses:

• tuberculosis (TB)

• cryptococcal meningitis

• severe bacterial infections

• cancers such as lymphomas and Kaposi's sarcoma.

HIV causes other infections to get worse, such as hepatitis C, hepatitis B and pox.

Transmission/Causes:

HIV can be transmitted through the exchange of bodily fluids from HIV-positive individuals, including blood, breast milk, sperm, and vaginal secretions. HIV can also pass from mother to child during pregnancy and delivery. People cannot become infected through simple everyday contact such as kissing, hugging, shaking hands, or sharing personal items, food, or water. 

It is important to note that HIV patients who are on ART and have an undetectable viral load do not transmit HIV to their sexual partners. Early access to ART and support to stay on treatment are therefore critical not only to improve the health of people living with HIV, but also to prevent transmission.

Prevension:

HIV is a preventable disease. 
To reduce the risk of HIV infection,
To prevent sexually transmitted infections, consider using a condom, getting tested for HIV, undergoing voluntary medical male circumcision, and seeking harm reduction services for drug users. 
Doctors may recommend drugs and medical devices to help prevent HIV, including: 
ARVs include oral PrEP, dapivirine vaginal rings, and injectable long-acting cabotegravir. 
ARVs can also be used to keep mothers from transmitting HIV to their children. 
People on antiretroviral therapy (ART) who have no evidence of a virus in their blood will not transmit HIV to their sexual partners. Access to testing and antiretroviral therapy is critical for HIV prevention. 

Risk factors:

Behaviours and conditions that put people at greater risk of contracting HIV include:

Having condomless anal or vaginal sex;
Having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis;
Engaging in harmful use of alcohol and drugs in the context of sexual behaviour;
Sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
Receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and
Experiencing accidental needle stick injuries, including among health workers.

 

When to Consult a Doctor?

Since the disease is often asymptomatic, an individual should consult a doctor if he/she thinks he/she has been exposed to the virus. Visiting a doctor should be considered if:
He/she had unprotected sex with somebody other than their partner in recent times;
He/she has multiple sexual partners;
He/she had sex with somebody who has been diagnosed with HIV;
He/she lives in an area with high HIV rates;
He/she has shared injections in recent times;
He/she has a history of sexually transmitted infections;
 

Diagnosis: 

HIV can only be diagnosed after getting a test to confirm the presence of the virus in the body. Symptoms alone are not enough for a diagnosis as they may not always appear, even if an individual carries the virus.
 

Lab Tests 

Different types of tests can detect HIV. Usually, a blood sample or saliva is tested for an HIV test.
Antigen/Antibody Tests: If an individual has been exposed to the virus, a positive test will reveal the antigens in the blood, confirming the infection. The antibody test can also help detect HIV, as a person’s immune system produces antibodies weeks after exposure to the virus. Doctors may prescribe additional tests if the blood test report comes back positive. These additional tests help to confirm the HIV stage the individual is at.
CD4 T-Cells Count: HIV usually destroys the white blood cells, which results in weakened immunity. CD4 T-cells are the white blood cells measured in this test.
Viral Load (HIV RNA): This test measures the amount of virus present in the body.
Drug Resistance Test: Using a blood sample, it is measured if any drug will be effective against the virus strain that affected the body.
 

Treatment:

HIV has no cure. Once the virus infects the body, one cannot get rid of it. However, the treatment plan prescribed by the doctor helps to manage the symptoms and prevent the infection from spreading further. The body reacts best to the treatment if it is started in the acute or first stage, where there are no symptoms.
 

Home Care

One of the primary needs during the treatment is nutritional fulfilment and fulfilling essential emotional and social support by loved ones.
Here are a few tips for HIV patients to follow at home:
Following the treatment regime without fail, as only a proper treatment plan can help in managing the symptoms of HIV
Going for light exercises that do not strain too much but keep the individual active
Doing activities that one enjoys to find ways of relaxation
Alcohol consumption and smoking can be harmful and interfere with the treatment, so avoiding cigarettes and alcohol at any cost should be necessary.
Getting support from your family and friends whenever required
 

Medication 

The treatment for HIV is known as antiretroviral therapy (ART). ART entails taking a combination of HIV medications (known as an HIV treatment regimen) every day. Everyone with HIV is advised to use antiretroviral therapy. People with HIV should begin taking their medications as soon as possible.

Combination HIV medicines combine two or more HIV medications from one or more drug classes.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs): Efavirenz, Lamivudine, and Tenofovir disoproxil fumarate

Surgical Treatment 

There are no surgical treatments for patients with HIV. 
 

Alternative Management:

Alternative management practice is followed with primary treatment, and research has proven that it can yield good results. It cannot cure the disease, but it manages the symptoms effectively.
Yoga, meditation and massage therapy can help to cope with symptoms like body pain, fatigue, and depression. It also helps improve blood circulation and the individual's psychological well-being. These relaxation techniques can certainly help individuals with HIV by improving their immunity.
Acupuncture also helps patients with HIV. It reduces inflammation and improves the quality of life for patients.
Risks & Complications if Left Untreated
If HIV is not treated, it can progress to AIDS. The symptoms of AIDS can be severe, and it is a life-threatening condition. Individuals with AIDS can only live up to three years.
Other than AIDS, the infection can take advantage of the weakened immune system. This leads to cancer, neurological disorders, and other infections. Individuals may experience diarrhoea, loss of appetite, pain in the abdomen, weakness and fever.
Neurological problems like confusion, forgetfulness, depression, anxiety and difficulty walking become common.