Patient's Complete Guide to HIV
Overview of HIV
HIV also known as Human Immunodeficiency Virus or ایچ آئی وی, is a virus that interferes with the immune system. The immune system helps the body fight off diseases and infections. HIV targets the immune T cells known as CD4 cells. As the CD4 cells decrease in number the immune system becomes weak and can’t fight infections and other diseases.
HIV caused AIDS-a serious condition which can’t be cured. However, with proper medical care, people can survive for the rest of their lives. Without proper treatment, patients can develop a more serious condition called AIDS. AIDS, also known as Acquired Immunodeficiency Syndrome, is a serious condition in which the body's immune system becomes too weak that it can't protect the body from other serious infections.
Occurrence of HIV
According to UNAIDS in 2019, globally about 38 million people were HIV positive. Among these, 36.2 million were above age 15.
As per studies, in Pakistan in 2018 160,000 people were tested HIV positive.
HIV can be transmitted through bodily fluids such as:
- Vaginal and rectal fluids
- Breast milk
The virus cannot spread in air or water, or through casual contact.
HIV can spread from person to person in various ways such as:
- By sharing needles, syringes, and other items for injection drug use
- Through vaginal or anal sex
- By sharing tattoo equipment without sterilizing
- During pregnancy, labour, or delivery from a mother to her baby
- During breastfeeding
- Through exposure to the blood of HIV positive
- Through “pre-mastication”
- Transmission through blood transfusions
HIV can’t spread through:
- Skin-to-skin contact
- Air or water
- Mosquitoes or other insects
- Sharing a toilet, towels, or bedding
- Sharing food or drinks, including drinking fountains
- Hugging, shaking hands, or kissing
- Saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
Signs and Symptoms of HIV
Symptoms of HIV can be different for each phase of the infection.
Primary Infection (Acute HIV)
If the symptoms of HIV appear within the first 2-4 weeks after the infection, this condition is known as primary (acute) HIV infection. This condition may last for a few weeks. Some common signs and symptoms of acute HIV are:
- Swollen lymph glands, mainly on the neck
- Muscle aches and joint pain
- Sore throat and painful mouth sores
- Weight loss
- Night sweats
These symptoms are often so mild that they remain unnoticed. However, the viral load in your bloodstream may be maximum at this time. Therefore, viral spread is easier during the primary infection.
Clinical Latent Infection (Chronic HIV)
In this stage of infection, people may become asymptomatic despite HIV presence in white blood cells. This stage can be prolonged if a person does not receive antiretroviral therapy (ART).
Symptomatic HIV Infection
If the virus continuously multiplies and destroy the immune cells, you may experience chronic signs and symptoms such as:
- Swollen lymph nodes — often one of the first signs of HIV infection
- Weight loss
- Shingles (herpes zoster)
- Oral yeast infection (thrush)
Progression to AIDS
Usually, HIV turns into AIDS if proper antiviral treatment is not provided. An AIDS patient’s immune system is completely damaged. It makes the patient more susceptible to opportunistic infections, cancers and other diseases.
Some common signs and symptoms of AIDS are:
- Recurring fever
- Chronic diarrhoea
- Swollen lymph glands
- Persistent, unexplained fatigue
- Persistent white spots or unusual lesions on your tongue
- Weight loss
- Skin rashes or bumps
Causes of HIV
HIV is a mutant form of a virus that was reported for the first time in African chimpanzees. According to scientists, the simian immunodeficiency virus (SIV) is transferred from chimps to people by consuming infected chimps’ meat. After entering the human population, the virus undergoes mutation and the new variant is now known as HIV. This mutation most likely occurred in the 1920s.
HIV spread throughout Africa from one person to another. Eventually, the virus spread to other regions of the world. In human blood, it was isolated in 1959 for the first time.
Risk Factors of HIV
HIV can infect any age group or sex. However, the following factors increase the risk of HIV infection such as:
- Sexually Transmitted Infection STI: Due STIs open sores are developed on the genitals. HIV can enter the body through these sores.
- Unprotected sex can also increase the chances of HIV infection.
- IV Drugs: People often exchange needles and syringes for IV drugs. This increases the chances of developing HIV infection.
Health Complications of HIV
HIV infection makes you susceptible to many opportunistic infections by weakening your immune system.
Infections common due to HIV/AIDS are:
- Pneumocystis pneumonia (PCP) (a fungal infection that causes severe inflammation in the lungs)
- Candidiasis (thrush) (yeast infection of mouth, tongue, oesophagus or vagina)
- Tuberculosis (TB) (common opportunistic infection associated with HIV)
- Cytomegalovirus (damage to eyes, digestive tract, lungs or other organs)
- Cryptococcal meningitis (common central nervous system infection associated with HIV)
- Toxoplasmosis (caused by Toxoplasma gondii, Toxoplasmosis can cause heart disease, and seizures occur when it spreads to the brain)
Cancers Due to the HIV/AIDS are:
- Lymphoma: These cancers develop in the white blood cells (WBCs). The common early sign is painless swollen lymph nodes in the neck, armpit or groin region.
- Kaposi's Sarcoma: Cancer that develops in the walls of blood vessels. Kaposi's sarcoma appears as pink, red or purple lesions. In darker skin people, these lesions appear as dark brown or black. This cancer can also develop in the digestive tract or lungs.
Some other complications include:
- Significant weight loss along with diarrhoea, chronic weakness and fever
- HIV-associated nephropathy (HIVAN), an inflammation of the nephrons
- Neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking
- Liver disease
HIV infection can’t be prevented by vaccination. However, it is possible to protect yourself from infection.
HIV spread can be prevented by the following tips:
- Take HIV medications regularly as per doctor’s prescription.
- Take post-exposure prophylaxis (PEP) PEP as soon as possible if you suspect HIV exposure within the first 72 hours.
- Tell your partner if you have an HIV infection.
- Use a clean and sterile needle to inject drugs.
- A pregnant woman should seek treatment because the infection can be transmitted from mother to child.
For HIV diagnosis blood or saliva testing is performed. These tests include:
- Antibody Tests: Antibodies are produced by the immune system after exposure to the virus. Antigens are substances on the surface of viruses that are recognized by the immune system.
In this test, a blood sample is drawn and is tested for antibodies against HIV. The test became positive after 2-6 weeks of exposure to the virus.
- Nucleic Acid Tests (NATs): NAT is performed to check the viral load in your blood. In this test, blood is collected from the vein. This test is highly sensitive and gives positive results after a few weeks of exposure.
Tests to Stage Disease and Treatment
If your tests for HIV are positive you should consult a specialist who will recommend additional tests if necessary. These tests may include:
- CD4 T Cell Count: HIV specifically targets and destroys CD4 T cells. HIV infection can progress to AIDS without showing any symptoms. In this condition, the CD4 T cell count is dropped below 200.
- Viral Load (HIV RNA): Through this test, the amount of virus is measured in the blood. HIV treatment aims to reduce the viral load. In this way, you can avoid opportunistic infection and other HIV-related complications.
Tests for Complications
Your doctor may also suggest other diagnostic tests to check for the complications such as:
- Hepatitis B or hepatitis C virus infection
- Urinary tract infection
- Liver or kidney damage
- Cervical and anal cancer
Treatment of HIV | When to Consult a Doctor
HIV treatment is done depending upon the severity of the condition. Following are some of the major treatment options.
Emergency HIV Treatment Post-exposure Prophylaxis (PEP)
PEP treatment is recommended after exposure to the virus. This treatment may prevent the infection. This treatment is provided immediately after exposure. PEP is a course of antiviral drugs that lasts for about 28 days. It is strongly recommended to start this process immediately because after 72 hours it is unlikely to work.
PEP is only provided if prescribed by the healthcare. It can get from:
- A sexual health or genitourinary medicine (GUM) clinic
- An HIV clinic
- An A&E department of a hospital
In Pakistan, Punjab AIDS Control Programme has been launched that provides PEP treatment in all the hospitals of Punjab.
Until now, AIDS can’t be cured by any medication, however, its control and prevention are possible. For this purpose, antiretroviral therapy (ART) is the most common approach. After diagnosis, ART is recommended to everyone regardless of the stage of infection or complications. It is a combination of three or more medicines or drugs.
Through this approach, the amount of HIV in the blood can be reduced. Every drug in this combination blocks the virus in a different way.
The classes of anti-HIV drugs include:
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)-Inhibit the protein involved in the multiplication of HIV such as efavirenz (Sustiva).
- Protease inhibitors (PIs)-Inactivate HIV protease that is involved in the multiplication of HIV such as atazanavir (Reyataz).
- Integrase inhibitors-Inactivate a protein called integrase that is involved in the insertion of HIV into the CD4 T cells such as tenofovir alafenamide fumar (Biktarvy).
- Entry or fusion inhibitors-Block entry of viral genome into CD4 T-cells such as enfuvirtide (Fuzeon).
Treatment Side Effects
There are some side effects of HIV treatment such as:
- Nausea, vomiting or diarrhoea
- Kidney and liver damage
- Heart disease
- Abnormal cholesterol levels
- Weakened bones or bone loss
- Cognitive and emotional problems, as well as sleep problems
- Higher blood sugar
If you suspect that you have an HIV infection, consult a doctor as soon as possible.