Definition
The Human Immunodeficiency Virus (HIV) is a virus that affects the body's immune system, leading to a weakened immune response and increased vulnerability to infections. If left untreated, HIV can progress to Acquired Immunodeficiency Syndrome (AIDS), a serious stage of HIV infection characterized by severe impairment of the immune system.
Without proper treatment and management, HIV can destroy the immune system, leading to AIDS in less than 10 years. AIDS represents the most severe and final stage of HIV infection. In this condition, the body struggles to fend off infections from bacteria that typically wouldn't be fatal in healthy adults, known as opportunistic infections, leading to potentially fatal outcomes. Additionally, AIDS can increase the risk of developing certain cancers.
The key difference between HIV and AIDS is that HIV is the virus responsible for weakening the immune system. At the same time, AIDS is the condition that arises from an HIV infection when the immune system becomes severely compromised. Although treatment can slow the progression of the virus, not everyone with HIV will develop AIDS.
Causes
HIV is a variant of a virus that originated from African chimpanzees. Researchers believe it shares similarities with the simian immunodeficiency virus (SIV) found in chimpanzees. In the human population, the virus mutated into what is known as HIV.
HIV can be transmitted through various bodily fluids, including blood, semen, vaginal fluid, breast milk, and rectal fluid of an infected individual. The virus cannot enter through intact skin unless open wounds are present. Pregnant mothers with HIV can transmit the virus to their children during pregnancy, childbirth, or breastfeeding. However, HIV cannot be transmitted without direct contact with the virus.
Risk factor
The risk factors for HIV/AIDS include exposure to bodily fluids from infected individuals, which can happen through unprotected sexual intercourse or by sharing needles with someone who has HIV.
Symptoms
Not everyone with HIV will exhibit typical symptoms, particularly in the early stages. Early symptoms can resemble those of the flu and may include fever, chills, fatigue, sore throat, muscle aches, night sweats, skin rash, swollen lymph nodes, and mouth sores.
HIV infection progresses through three stages:
- Acute HIV infection
Some individuals may experience flu-like symptoms for a month or two after contracting HIV. These symptoms typically disappear within 1 week to 1 month.
- Chronic or clinical latency stage
You can have HIV for several years without experiencing symptoms. It's important to note that you can transmit HIV to others even if you feel fine.
- AIDS stage
At this stage, HIV has severely weakened your immune system, and symptoms correspond to opportunistic infections (infections that occur when your immune system is weakened by HIV). You have a higher risk of developing certain cancers when you have AIDS.
Diagnosis
HIV diagnosis is conducted through blood or saliva testing. This test can be performed at home, in a hospital, or in a laboratory offering testing services. Suppose your test results are negative, and you haven't had potential exposure within the past 3 months before the test. In that case, no further testing is necessary unless advised otherwise by a healthcare professional.
If you've had potential exposure within the past 3 months, it's advisable to consider retesting to confirm your negative result. If your test results are positive, further laboratory testing is needed to confirm the diagnosis.
There are three types of HIV tests available:
- Antigen/Antibody Test
This test looks for p24 (antigen) markers and substances in your body that react with this marker (antibodies). It can detect both the virus and your body's response to it. A blood sample is drawn from your arm and sent to a laboratory for testing. The antigen/antibody test can typically detect HIV infection within 18 to 45 days after exposure.
- Antibody Test
This test specifically looks for antibodies your body produces in response to HIV infection. It can be performed using a blood sample from your arm or finger, or a saliva sample collected from your gums. The antibody test can detect HIV infection 23 to 90 days after exposure.
- Nucleic Acid Tests (NATs)
NATs directly detect the genetic material of the HIV virus (RNA or DNA) in the blood. A blood sample is taken from your arm and sent to a laboratory for testing. NATs can detect HIV infection from 10 to 33 days after exposure.
NATs are not typically performed routinely unless there is a high risk of exposure. If your test results are positive, your doctor will likely recommend further testing to assess your health.
Additionally, a comprehensive blood test may include screenings for other infections, such as hepatitis viruses, a chest X-ray, a Pap smear, a CD4 count (a measure of immune function), and tuberculosis testing.
Management
Individuals infected with HIV can take a combination of medications orally every day. This combination is known as antiretroviral therapy or ART. The combination of drugs is one of the most effective ways to prevent HIV from replicating and destroying your immune cells.
Complications
Complications in HIV/AIDS occur in the third stage, where HIV reduces the body's ability to fight infections, leading to various related complications and an increased risk of cancer. Current treatments are quite effective in preventing infections, but in HIV patients not receiving treatment, latent infections can become serious issues.
Several opportunistic infections can lead to complications, including:
- Candidiasis
- Coccidioidomycosis
- Cryptococcosis
- Cryptosporidiosis
- Cytomegalovirus disease (CMV)
- Herpes
- Histoplasmosis
- Tuberculosis
- Mycobacterial infections
- Recurrent pneumonia
- Toxoplasmosis
- Salmonella
Additionally, other health issues such as encephalopathy and a higher risk of cancer can also occur in people infected with HIV. Regular medical monitoring and adherence to treatment can help manage these complications and improve overall health outcomes for HIV patients.
Prevention
The best way to reduce the risk of HIV infection is by being more aware of how the virus spreads and taking steps to protect yourself. Some things you can do include:
- Using protection (condoms) during sexual intercourse
- Avoiding sharing needles when using drugs
- Not using condoms made from animal products
- Using water-based lubricants
- Getting tested and treated for other sexually transmitted infections
For those already infected with HIV, the focus shifts to preventing complications to prolong life, especially in the later stages of HIV. Some things you can do to prevent complications include:
- Taking medication regularly
- Getting vaccinated for potential opportunistic infections
- Identifying and limiting exposure to environments that could cause infections
- Avoiding foods with a high risk of contamination, such as undercooked eggs, and refraining from consuming water directly from rivers or lakes or in certain countries.
When to see a doctor?
If you think you might have been exposed to HIV, it's important to contact your doctor right away. Beginning treatment promptly is key to managing HIV effectively. If you're diagnosed, carefully adhere to your doctor's guidelines. Moreover, it's vital to treat any infections quickly. Reach out to your doctor immediately if you notice symptoms like fever, night sweats, diarrhea, or any other worrying signs.
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- dr. Lukita Tarigan