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AIDS, or acquired immunodeficiency syndrome, is the final stage of HIV, or human immunodeficiency virus infection, in which CD4 white blood cells, or T-cells of the body's immune system, are considerably infected and destroyed. As a result, the body's immunity is low, leading to debilitating complications by opportunistic infections such as tuberculosis, pneumonia, PJP, meningitis, and certain types of cancer. HIV treatment continues to advance, allowing the quick diagnosis of the disease. Highly effective antiretroviral drugs effectively treat and increase the amount of CD4 white blood cells in the body, allowing the infected person to become stronger, live longer, and reduce the death rate significantly.
AIDS (Acquired Immune Deficiency Syndrome) is due to long-term, untreated HIV (Human immunodeficiency virus) infection for approximately ten years. When HIV enters the body, it invades and destroys T-cells of the immune system, weakening the immune system to protect from external pathogens that enter the body, resulting in disease with acute, complex conditions, including severe opportunistic infections that are difficult to eradicate.
HIV is a virus in the retrovirus family with RNA genetic material. Retroviruses have unique properties that allow them to transform their genomic material into DNA and integrate it into the host cell chromosomes. The virus then hijacks the cell machinery to continue to replicate.
There are three stages of HIV infection:
- Stage 1: Primary infection (Acute HIV) is the initial stage of HIV infection, with flu-like symptoms occurring within the first 2-4 weeks of infection and may last a month. At this early stage, the virus multiplies rapidly. At the same time, the immune system responds by activating various immune cells, such as CD8+ T cells, natural killer cells, and B cells, to fight the virus. However, HIV is able to avoid immune detection by integrating into the host's DNA, such as CD4+ T cells. This allows the virus to persist in the body and continue replicating. Some infected people may not show any signs or symptoms of the infection, preventing them from seeing a doctor for an initial diagnosis and getting the antiretroviral drugs promptly. Because of the high blood viral load of acute HIV infection, the infected person is more infectious during this stage.
- Stage 2: Clinical latent infection (chronic HIV), the HIV resides in the body without causing symptoms (asymptomatic HIV infection). At this stage, HIV continues to multiply and gradually destroys CD4 white blood cells, or T-cells, of the body's immune system until the number of CD4 cells in the body drops to between 200 and 1000 cells/mm3, lowering immunity and making infected people more likely to catch infections. Typically, this stage last for 5-10 years. Those infected with fast-replicating HIV may only be in this stage for 2–5 years, whereas those with stronger immunity can control the infection better (elite controllers) and extend the stage duration to 10–15 years.
- Stage 3: Progression to AIDS is the final stage at which HIV infection progresses to full-blown AIDS. At this stage, people infected have CD4 counts of less than 200 cells/mm3, significantly weakening the body's immunity and leading to complications and opportunistic infectious diseases (Ols).
Symptoms of a stage 1 HIV infection: Primary infections: (acute HIV)
Those with primary HIV infections will go through a state in which the body responds to the acute infection (acute retroviral syndrome, or ARS). Typically, the symptoms will appear approximately 1-2 weeks after the initial viral infection which may last a few weeks and then disappear. Stage 1 HIV includes flu-like symptoms such as fever, chills, sore throat, fatigue, body aches, night sweats, rash, swollen lymph nodes, and mouth sores. Some infected people may experience dizziness, nausea, vomiting, loose stools, weight loss, and white oral thrush.
Symptoms of a stage 2 HIV infection: Clinical latent infection (Chronic HIV)
Those with clinical latent infection, or chronic HIV stage, are typically asymptomatic or exhibit no symptoms for approximately 5–10 years after infection, depending on the severity of the viral infection and the individual's immunity. Those infected with HIV at this stage will have low body immunity, and may exhibit the following symptoms:
- Stage 2 HIV with mild symptoms includes HIV-infected individuals with CD4 counts greater than 500 cells/mm3. An infected person may experience fever, fatigue, enlarged lymph nodes, aphthous ulcer in the oral cavity, scalp dermatitis, white oral thrush on the tongue, nail fungus, and psoriasis flare-up (in those with preexisting conditions.)
- Stage 2 HIV with moderate symptoms includes HIV-infected individuals with CD4 counts between 200-500 cells/mm3. An infected person may have recurring fever for several months in a row, enlarged lymph nodes in the neck, armpits, or groin, herpes simplex at the mouth or genital herpes (chronic), muscle aches, oral or cervical thrush, chronic diarrhea, unexplained weight loss, herpes zoster, chronic sinusitis, and pneumonia.
Symptoms of a stage 3 HIV infection: Progression to AIDS
Those infected with HIV for a 10-year duration of untreated disease eventually reach the AIDS stage. Full-blown AIDS symptoms include chronic fever, tuberculosis, pneumonia PJP, cryptococcal meningitis, chronic diarrhea, fatigue, weight loss, difficulty swallowing (dysphagia) or sore throat when swallowing due to esophagitis, an itchy rash, skin discoloration, blurred vision, coughing up blood, bleeding from thrombocytopenia, green-red bruises on the skin, frequent vaginal discharge (in female), severe headache, nausea, and vomiting. Neurological symptoms of a brain infection include forgetfulness, loss of concentration, amnesia, muscle weakness, and loss of consciousness due to encephalitis. Those with advanced AIDS typically live another 2–3 years before their demise.
HIV/AIDS can be transmitted from person to person through direct contact with bodily fluids such as blood, sperm, vaginal-penis lubricants, anal lubricants, and breast milk. AIDS and HIV infections can spread through the following behaviors:
- Unprotected penile-vaginal, penile-anal, or vaginal-vaginal intercourse via direct exposure to bodily fluids. Most notably, unprotected sex is the leading cause of more than 80% of HIV infections in AIDS patients worldwide.
- Sharing a needle or syringe with an HIV-infected person is common among drug users in injecting drugs into their veins.
- HIV infection by direct contact with blood or lymph of an open wound in the skin or oral ulcers, including sharing sharp personal objects with an HIV-infected person, such as skin tattoo needles, eyebrow tattoo needles, nail clippers, razors, and organ piercing needles such as ear-piercing needles or navel-piercing needles.
- HIV transmission from mother to child during pregnancy, childbirth, and breastfeeding.
- Transfusion with HIV-infected, unscreened donor blood. (This is a rare occurrence nowadays due to the standardized, multi-step screening process).
HIV diagnosis is crucial. If an infected person is promptly diagnosed with HIV and receives highly effective antiviral drugs, this will prevent the virus from progressing to AIDS. Currently, there are three effective and quick HIV diagnostic tests available, including:
- Antigen/antibody tests are the quickest and most accurate HIV testing methods. The doctor will draw a blood sample to test for a viral protein called p24 antigen and an antibodies. This method can detect HIV after the first 18-45 days of suspected infection when the body has not yet produced antibodies to fight the virus..
- Anti-HIV antibody tests detect HIV antibodies in blood samples. This HIV detection method is suitable after the first 23–90 days of suspected infection.
- Nucleic acid tests (NATs) test for virus in blood samples to detect the genetic material of HIV. Doctors commonly use this method to measure the virus quantitatively (viral load assays) both before and as a follow-up test after treatment to evaluate treatment results. However, this examination is neither used to diagnose HIV infection nor screen infants born to HIV-positive mothers. It is suitable for use after the first 10-33 days of suspected infection.
As soon as the HIV test is confirmed positive, the doctor will prescribe antiretroviral drugs (ARV), a combination of several classes of drugs that can fight and inhibit the virus's multiplication. The simultaneous administration of drugs improves treatment efficacy over monotherapy. ARV drugs act synergistically to reduce the number of HIV viruses to undetectable levels, slowing the body's immune system deterioration. And encourage the infected person to maintain a healthy and normal physical condition as best possible.
Individuals suspected of being infected with HIV should see a doctor as soon as possible, within 72 hours of exposure, for post-exposure prophylaxis (PEP) to help prevent the virus from developing to a detectable level.
Individuals who are not infected with HIV but are at risk of becoming infected can also see their doctor for pre-exposure prophylaxis (PrEP) by taking ARV medication to prevent infection. To achieve the best preventative result, those at risk of exposure must take medicine daily and see a doctor for a check-up after exposure to the risk. According to studies, patients exposed to HIV and who took ARV within 72 hours could have negative HIV tests.
In addition, specialized treatments such as bone marrow transplantation can cure some HIV-infected patients. As such, the goal of HIV treatment today is to focus on improving a patient's quality of life, preventing AIDS complications, and preventing the spread of HIV to others. However, an infected person must have discipline in taking antiretroviral drugs daily to prevent the emergence of drugs resistant HIV.
HIV/AIDS infection is preventable by reducing and avoiding risky behaviors that can lead to viral infection. Those already infected with HIV should take precautionary measures to avoid infecting others. The prevention strategies for HIV/AIDS infection are as follows:
- Always use a condom for sex.
- If there is a bleeding open wound, it should be cleaned and tightly bandaged.
- Never share needles or syringes with anyone.
- Avoiding risky sexual behaviors and limiting sexual partners
- Pre-marital screening examination
- Seek prompt medical attention for anti-HIV medications before or after suspected HIV exposure.
- Annual blood tests or health checkups to assess the body's immunity levels.
AIDS complications are due to a weakened immune system, allowing opportunistic infections such as tuberculosis, pneumonia, PJP, or cryptococcal meningitis to materialize. Several cancers are more common in HIV patients, including cerebral lymphoma, cervical cancer, cancers of the vascular wall, and anal cancer.
Can a pregnant woman with HIV transmit the virus to her unborn child?
Pregnant women with HIV can transmit the virus to their unborn children in the womb. However, medical professionals have found ways to reduce the chance of mother-to-child HIV transmission by taking antiretroviral medications while pregnant. Although antiretroviral drugs cannot fully shield the fetus from infection, studies show that they can lower the rate of HIV infection in the fetus by 8%. Women with HIV who desire to get pregnant should have a premarital health checkup and discuss with a medical professional the chance of having a healthy pregnancy, including the possibility of a safe pregnancy with other interventions.
Early HIV detection and treatment can help prevent AIDS
The primary goal of HIV treatment is to keep the virus from progressing to the AIDS stage. Early detection after a risky behavior, as well as adherence to taking the prescribed daily antiretroviral therapy, will provide those infected with HIV with stable immunity, maintain good physical health, as well as reduce the spread of infection to others, and allow them to live a healthy life.
AIDS is currently rarely curable. As a result, seeing a healthcare professional for pre- and post-exposure ARV prophylaxis and getting a blood test after unprotected sex or exposure to other risky behaviors is crucial to lowering the risk of HIV infection, the proximate cause of AIDS. Those suffering from AIDS complications or opportunistic diseases require a holistic and systematic treatment approach from a multidisciplinary team of experienced specialists to treat the acute, complex conditions, alleviate symptoms, and help the infected person live a long life.
Dr Rapeephan R.Maude
A doctor specializing in infectious disease