AIDS: Causes, Risk Factors, Symptoms, Treatment

AIDS/HIV (Acquired Immune Deficiency Syndrome)

HIV (Human immunodeficiency virus) is a virus that attacks the body’s immune system and thereby decreases the ability of the human body to fight against infections as they majorly affect the CD4 T lymphocyte cells or helper T cells. The HIV virus spreads from one person to another person when the infected human body fluids like blood, semen, vaginal fluid, rectal fluid, breast milk comes into contact with another human body mucous membranes (present in the mouth, penis, vagina or rectum) or when any of these fluids enter into the body through the cuts or scratches on the skin or by using HIV contaminated needles and syringes. The virus does not spread through human saliva, sweat, urine or through mosquito bites or pets. When a person is infected with the HIV virus, it causes symptoms which are similar to the flu or viral infection. The symptoms include fever with or without chills, sore throat, muscle pains, headache, diarrhoea, rash, mouth ulcers, night sweats etc. The stage-2 is the longer period i.e about 10-20 years where HIV infected individuals do not experience any symptoms. If HIV is not treated in the initial stages, it leads to AIDS(Acquired immune deficiency syndrome) wherein the CD4cell count decreases to less than 200cells/mm3 and makes the individual susceptible to various bacterial, viral, fungal, and protozoan infections. HIV is can be controlled with treatment. Antiretroviral therapy(ART) combination medications are used in the treatment of HIV. When an infected individual is started on ART therapy, it takes about six months for the virus to be present in undetectable low amounts in the blood. However, no medications can completely eliminate the HIV virus from the human body. Thus, prevention is better than cure.

If you have engaged in risky behaviors or exhibit symptoms like unexplained weight loss, persistent fever, or recurrent infections, consult with an Infectious Disease specialist or a General Practitioner in the Internal Medicine department for HIV/AIDS testing and management.

Causes

HIV (Human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is not treated then it later after a few years it progresses to Acquired immuno-deficiency syndrome(AIDS). The HIV virus weakens the immune system, which makes it possible for the infections to attack easily. And makes the body to prone to infections easily. The Human immunodeficiency virus (HIV) virus spreads from person to person through body fluids like: l Blood l Semen l Rectal fluids l Vaginal fluids l Breast milk HIV (Human immunodeficiency virus) spreads when the above mentioned body fluids come into contact with human body: l Mucous membranes which are present inside of the mouth, penis, vagina and or rectum l When the fluid comes into contact with the skin, when there are cuts or scratches l Into the blood stream by injectables or any sharps

Risk Factors

Risk factors Ø Factors that could increase the risk of HIV infection include - Ø Presence of any sexually transmitted diseases (STD’s) like syphilis, gonorrhea, herpes, chlamydia, bacterial vaginosis Ø Individuals who are positive for HIV and are not on Antiretroviral therapy (ART), transmit HIV through vaginal or anal sex Ø Sharing contaminated syringes and needles, injecting equipments and drug solutions when injecting drugs Ø Involving in harmful use of drugs and alcohol (substance abuse) in the context of sexual behaviour. Ø Unprotected sex (not using condom) Ø When a female individual is positive for HIV and not on Antiretroviral therapy (ART), she can transmit to the baby during pregnancy Ø Health care workers are at high risk of acquiring HIV due to the needle-stick injuries or sharp objects that are contaminated by HIV

Symptoms

Human immunodeficiency virus(HIV) not only attacks but also destroys the infection-fighting cells called CD4 T lymphocyte cells and thereby effecting the body’s immune system. CD4 T lymphocyte cells are also known as T4 cells or helper T cells. Usually, CD4 T lymphocyte cells normal range is from 500 to 1500cells/mm3. When the CD4 T lymphocyte cells are destroyed, the human body cannot fight against infections and certain cancers. CD4 cell count decreases to below 350cells/mm3 HIV infected individuals develop symptoms. Many individuals do not experience any symptoms i.e. they remain asymptomatic. However, a few individuals might experience the symptoms after initial exposure to the virus.The initial symptoms of HIV mimic the symptoms of flu or viral illness, which includes: u Fever u Sweating during night time u Muscle pains u Headache u Sore throat u Skin rash u Diarrhoea u Mouth ulcers u Yeast infections in the mouth u Swollen lymph nodes u Fatigue or Weakness The HIV virus takes a few weeks to a few months to progress from stage -1 acute HIV infection to Stage-2 chronic and asymptomatic stage. Stage-2 is completely asymptomatic and, as the individual does not experience any symptoms, nobody would suspect HIV infection. This stage lasts for 10 years or longer. A few individuals remain healthy for longer periods, like 10-20 years. However, a few individuals progress from stage-2 to stage-3 within a few years of acquiring HIV infection. If an individual is left untreated, stage -2 progresses to stage-3 which is known as acquired immuno-deficiency syndrome(AIDS). CD4 cell count decreases to below 200cells/mm3, which leads to serious complications. In individuals with AIDS (acquired immuno-deficiency syndrome) as the individuals immune system is weakened and completely destroyed by the HIV virus the infected individual is at risk for severe bacterial, fungal, viral and protozoan infections. Individuals with HIV could develop lung infections in which they experience cough fever, shortness of breath. Intestinal infections cause symptoms like pain in the abdomen, nausea, vomiting, diarrhoea, difficulty in swallowing. Children with HIV viral load less than 200cells/mm3 are considered to have advanced HIV disease.

Diagnosis

Diagnosing HIV is crucial for timely and effective treatment and it also helps in preventing the spread of infection. Health care professionals might advise a few screening tests, which include rapid diagnostic tests that detect the antigen/antibody combination tests(antibodies are produced by the body’s immune system) which provide the results on the same day, that helps in accurate and early diagnosis of HIV. Generally, individuals develop antibodies to HIV within 28 days of infection. During the initial stages(within 28 days of infection), as the viral count is low, the diagnostic testing could be negative and but the individuals might transmit the HIV infection to others. Hence, your health care professional would advise you to be retested again after a few weeks. Once the screening tests are positive and an individual is diagnosed with HIV, then Healthcare professional would suggest a few blood tests to detect the Ø HIV viral load Ø CD4 cell counts Ø Regular blood tests like complete blood picture, liver function tests and renal function tests Ø A few blood and urine tests which could help to rule out the presence of any sexually transmitted diseases Ø Blood or sputum tests or a chest X-ray for tuberculosis (TB). For individuals with recent high-risk exposure(intercourse with an individual whose HIV or viral status is unknown), health care professionals could advise for a few other diagnostic blood and urine tests to rule out the presence of any Sexually Transmitted Diseases (STDs) like syphilis, gonorrhea, herpes, chlamydia, bacterial vaginosis, Hepatitis, Trichomoniasis, mycoplasma genitalia (Mgen) Pap smear test for human papilloma virus(HPV)

Treatments

HIV can be prevented and treated with Antiretroviral therapy (ART). Antiretroviral therapy (ART) medications used to treat HIV are generally well tolerated with less side effects. The health care provider will decide which combination and dose of antiretroviral medications can be used based on the HIV viral load, age and co-morbidities. Antiretroviral therapy (ART) medications helps in reducing the level of viral load in the blood. When an infected individual is started on antiretroviral therapy (ART) medications then it usually takes about six months for the virus to get under control or the virus to be present in very minute quantity. Health care professional might also advise a few anti-bacterial medications in order to prevent a few bacterial infections, which depend upon the CD4 cell count and other co-morbid conditions.These antiretroviral therapy (ART) medications should be taken everyday for the rest of an individuals life. Consistent use of antiretroviral therapy (ART) medications eliminates the risk of transmitting HIV from pregnant mother to the fetus and also from breast feeding mother to baby through the breast milk. In case of recent high risk exposure(intercourse with an individual whose HIV or viral status is not known) with an individual, after advising a few blood and urine tests and even though the screening tests are negative, the health care professional might start you on prophylactic therapy for HIV within 24-48hrs of exposure.

Preventive Measures

Human immuno deficiency virus(HIV) is a preventable disease. There is no vaccine available to prevent Human immuno deficiency virus(HIV). Ø HIV can be prevented by not sharing and reusing single-use disposable needles and syringes and by not being involved in illegal drug usage. Ø Avoid contact with body fluids (blood, semen, rectal fluids, vaginal fluids, breast milk) through unprotected sex. Ø Being tested for Human immuno deficiency virus (HIV) and Sexually Transmitted Diseases (STDs) helps in preventing the spread of infection to others. Ø Antiretroviral therapy (ART) medications are used to prevent mothers from passing on the HIV virus to the fetus.

Do's & Don’t's

Do's Don't 
Do Practice Safe Sex: Use condoms consistently and correctly to reduce the risk of HIV transmission during sexual activity.  Don't Ignore Symptoms: If you experience flu-like symptoms after a potential exposure to HIV, seek medical attention promptly. Early detection and intervention can be crucial. 
Do Communicate Openly: Discuss your HIV status and sexual health with your partner(s). Open communication helps in making informed decisions and reducing the risk of transmission. Don't Assume: Do not assume someone's HIV status based on appearances. It's important to communicate openly and get tested for a clear understanding.
Do Get Vaccinated: Protect yourself from other infections by getting vaccinated against diseases such as Hepatitis B, which can be more severe for individuals with HIV.  Don't Share Personal Items: Avoid sharing personal items like razors or toothbrushes, as they may carry traces of blood that can potentially transmit HIV.
Do Adhere to Medication: If prescribed antiretroviral therapy (ART), take medications consistently as directed. Adherence is crucial for controlling the virus and maintaining overall health.  Don't Stigmatize: Avoid stigmatizing or discriminating against individuals with HIV. Treat everyone with respect and understanding.


If you have engaged in risky behaviors or exhibit symptoms like unexplained weight loss, persistent fever, or recurrent infections, consult with an Infectious Disease specialist or a General Practitioner in the Internal Medicine department for HIV/AIDS testing and management.

Frequently Asked Questions
HIV does not spread through sweat, saliva or urine.It also does not spread by mosquitoes and pets.
An intimate contact with a person who is on antiretroviral therapy does not spread the infection from one to another as the viral load will be undetectably low due to the use of antiretroviral therapy.
Consistent treatment with antiretroviral therapy(ART) medications makes the virus to be present in undectectably low load in the human body. However, it does not completely eliminate the HIV virus from the human body. Thus, prevention is better than cure.
If a pregnant woman is diagnosed with the HIV virus, then health care professional will start her on a combination drugs of antiretroviral therapy (ART), which helps in preventing the HIV transmission from pregnant women to the fetus and from breast feeding mother to the baby. However, if a pregnant woman is not started on antiretroviral therapy (ART) then the risk of transmitting HIV to the fetus is high.
When an individual is diagnosed to have HIV then that person should take Antiretroviral therapy (ART) medications through their life. Generally, the health care professional will advise a combination of ART medications which will be available in a single pill and should be taken at the same time everday without fail.
If a HIV infected individual is started on Antiretroviral therapy (ART) medications and the HIV viral load is undetectably low, then the HIV infected individual does not transmit HIV to their partner through sex.
All the individuals who are diagnosed to have HIV should be started on Antiretroviral therapy (ART) medications irrespective of the presence or absence of any symptoms and even if the HIV infected person is healthy. Delaying treatment for HIV will only reduce the immunity of the infected individual and will put the HIV infected individual at higher risk for transmitting HIV to their partners.
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