HIV infection

Symptoms Of HIV Infection 

There are several symptoms of HIV infection which vary from person to person and also as per the stage of the infection. The three stages of HIV infection are: 

Stage 1: Acute HIV infection

It is estimated that 50-70% of individuals with HIV infection experience a flu-like illness within 2 to 4 weeks after a primary infection. This is known as primary or acute HIV infection and lasts for weeks. Some people do not have any symptoms during this phase. The symptoms can include:

• Fever

• Chills 

• Rashes

• Headache 

• Swollen lymph glands, mainly on the neck

• Night sweats

• Mouth ulcers or genital ulcers

• Joint Pain

• Fatigue

Stage 2: Clinical latency

In this stage, the virus is getting multiplied, but at a very low level. There are no detectable signs and symptoms in this stage. This stage is called Chronic HIV infection. Although the length of time from initial infection to the development of clinical disease varies greatly, the median time for untreated patients is ~10 years. The rate of ongoing progression is directly correlated with HIV RNA levels. Patients with high levels of HIV RNA in plasma progress to symptomatic disease faster than do patients with low levels of HIV RNA. The transmission of HIV is highest during this stage if viral load is detected in the blood. There is a risk of transmitting HIV to your sexual partner. 

Stage 3: AIDS

If a person is having HIV and is not on HIV treatment, gradually the virus will weaken the immune system and progress to AIDS. A diagnosis of AIDS is made in any individual age 6 years and older with HIV infection and a CD4+ T cell count <200 per microliter and in anyone with HIV infection who develops one of the HIV associated diseases considered to be indicative of a severe defect in cell mediated immunity.

Symptoms of AIDS include:

• Pneumonia

• Sores of the mouth and anus

• Extreme tiredness

• Rapid weight loss

• Recurring fever

• Memory loss and depression

Each of these symptoms can lead to another illness. Many of the severe symptoms of HIV are opportunistic infections. These infections come into action when the immune system of the body weakens.

Causes Of HIV Infection 

The human immunodeficiency virus belongs to the family of human retroviruses and subfamily of lentiviruses, it causes AIDS. HIV is a sexually transmitted disease (STD). AIDS is caused by HIV. HIV is a virus that attacks the immune system of the body. As HIV progressively damages the immune cells of the body, the immunity of the body gets compromised and it will get prone to many opportunistic infections. The point of very advanced HIV infection is called AIDS. It can take many years for AIDS to develop. 

The main causes of HIV include: 

1. Sexual contact: The most frequent cause of transmission of the virus is through sexual contact through unprotected vaginal or anal sex. 

2. Blood transfusion: In some cases, you can come in contact with the virus through blood transfusion. 

3. Sharing Infected needles: HIV can be transmitted by sharing infected needles and syringes.

4. From mother to child: The virus is passed from the expectant mother to the child, during or before birth or even during breastfeeding.

5. Through body fluids: These fluids have also proven to spread HIV infection like blood, semen, vaginal fluid, breast milk, the amniotic fluid surrounding the fetus, and cerebrospinal fluid surrounding the brain and spinal cord. 

Risk Factors For HIV Infection 

A risk factor increases the chances of getting the disease. Certain lifestyle factors are related to HIV infection, by changing them the risk of getting HIV gradually lowers. The most common risk is:

• Having unprotected sex: Most people get HIV by having unprotected sex. During sex, the rectum, mouth, and genitals allow the virus to enter the body. To avoid this protection should be used. The use of condoms will lower the risk of sexually transmitted diseases. The chances are also higher for men having men as a partner and having multiple partners. 

• Drug use: Sharing needles used by other people increases the risk of getting HIV. Even a small amount of blood is enough to transmit HIV.

• Certain health problems: Having certain sexually transmitted diseases increases the risk of HIV. The common ones are gonorrhea, warts, syphilis, and genital herpes.

• Blood products: Blood banks do not test for HIV. The infection can be passed on to normal individuals during a blood transfusion. 

• Having certain professions: Working in places where you come in contact with bodily fluids and blood samples of patients makes you at a higher risk of having HIV. Like healthcare professionals and people working in laboratories.

The risk factors for mother-to-child transmission of HIV via breastfeeding include:

1. Detectable levels of HIV in breast milk

2. The presence of mastitis(inflammation in breast tissues)

3. Lower maternal CD4+ T cell counts

4. Maternal Vitamin A deficiency

Diagnosis Of HIV Infection 

HIV test is done to test Human Immunodeficiency Virus in serum, saliva, and urine. The only way one could be sure if the person is infected with HIV is to have an HIV test. The symptoms of HIV may not appear for many years. Anyone who thinks they could have HIV should get tested. 

Clinical history 

The doctor will ask about your symptoms and health history. A physical examination is done to confirm certain risks that make your chances of infection higher. If the doctor suspects HIV, you need confirmatory tests to start the treatment as soon as possible.

Laboratory tests (nucleic acid testing and antigen/antibody tests)

The following test can be done to confirm if a person is HIV positive or negative.

• HIV 1 and HIV 2 antibody test: HIV is of two types HIV-1 and HIV-2. HIV-1 is found in people having a higher risk of AIDS. HIV -2 infected patients are found in West Africa. This test primarily checks the amount of virus present and p24 antigen present in the blood, these usually increase during the first week of infection. 

• CD4 count: The CD4 cells are a type of White Blood Cells (WBC) that are specifically destroyed and targeted by HIV. A healthy person has a CD4 count of up to 1000. The CD4 count is associated with immunity levels of the patient, the higher the CD4 count the better the immunity, But when HIV infection progresses to AIDS the CD4 count becomes less than 200. 

• Enzyme-linked immunosorbent assay (ELISA): The ELISA test is a blood antibody test that detects the proteins that are made during HIV infection. It is the most sought-after method for the detection of HIV. The ELISA test is also called enzyme immunoassay, as it is used to detect HIV antibodies.

• Western blot: A positive ELISA test is always followed by a western blot. It is a confirmatory diagnostic test for AIDS. 

Rapid antibody screening

It is usually done by taking blood from a finger prick or with oral fluids. The results are obtained within 30 minutes.

Rapid antigen/antibody test

The rapid test is an immunoassay used for screening and produces results within 30 minutes. It uses blood or oral fluids to look for antibodies for HIV. All immunoassays that give a positive result need further follow-up from a doctor. 

Oral fluid antibody self test

The OraQuick in-home HIV test is a self-administered over-the-counter test (OTC). The test uses oral fluid to check for antibodies to HIV-1 and HIV-2, the virus that causes AIDS. 

Note:

No HIV test can detect HIV soon after the infection. The time between acquiring the infection and when a test can tell for sure whether the virus is present or not is called the Window Period. The window period varies from person to person and depends on the type of test to detect HIV. 

• A nucleic acid test usually tells after 10 to 33 days after HIV exposure.

• An antigen/antibody test performed in the laboratory detects HIV infection after 18 to 45 days after exposure. A rapid finger prick usually takes a longer time than 18 to 90 days. 

• Antibody tests usually take 23 to 90 days to detect the infection.

Prevention Of HIV Infection 

There is no vaccine to prevent HIV infection and no cure for HIV has been discovered till now. To help prevent the spread of HIV following are some measures:

• Spreading awareness among the masses.

• Safe blood transfusion from authorized and accredited blood banks.

• Get tested for HIV: Before having sex get yourself tested and talk to your partner about this.

• Use of condoms: It is a protection against HIV and many Sexually Transmitted Infections. It is very important if condoms are put on before any sexual contact occurs between the vagina, penis, mouth, or anus. 

• Don’t share syringes and needles: While injecting drugs, always use sterile drug injection equipment and water and never share them with others. 

• Limit the number of sexual partners: The partner HIV-positive person has more chances of having STDs increase.

• Get tested and treated for STDs: Having a Sexually Transmitted Disease increases the risk of getting HIV or spreading it to others.

• HIV prevention medicine: If you are HIV negative, you can take pre-exposure prophylaxis (PrEP) medicine to reduce the risk of HIV. PrEP is available for people who are at a higher risk of having HIV infection( whose partner is HIV positive). A tablet is usually taken before you have sex and are exposed to HIV infection. 

• Prevention of mother to child transmission of HIV: Pregnant women with HIV take HIV medicines for their health and prevention of HIV from mother to child.

Specialist to Visit 

In most cases, a general physician is a go-to doctor when it comes to the diagnosis of HIV infection. You can also visit an HIV healthcare provider who helps to track the progress and helps to guide whether HIV treatment is going in the right direction. 

Most people with HIV see their health care provider after every six months. Some people seek their doctors more frequently during the first two years of treatment. It also varies from person to person and symptoms. People taking HIV medications regularly and having an undetectable viral load only need to have their lab tests checked twice a year. 

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Treatment Of HIV Infection  

There is no cure for HIV as of now, there are very effective treatments that enable most people with the virus to live a healthy and long life. 

A. Antiretroviral therapy (ART)

It reduces HIV-related morbidity at all stages of HIV infection and HIV transmission. HIV-positive. It suppresses viral load, maintains the CD4 count, prevents AIDS, and prolongs survival. Healthcare providers play a crucial role in helping patients initiate ART which leads to viral load suppression. Most people take daily HIV treatment to reach an undetectable viral load within six months of starting treatment. These include nasal sprays, inhalers as well as some recreational drugs

There are different classes of ART and some of them are:

1. Entry inhibitors: These work by blocking the entry of the virus into human cells. Some of the common examples include:

• Maraviroc

• Enfuvirtide

• Ibalizumab

• Fostemsavir

2. Integrase inhibitors: They are a class of antiretroviral drugs that prevent HIV by inserting its genetic code into the HIV-positive, DeoxyriboNucleic  Acid (DNA) of an infected individual. It blocks the enzyme integrase of the hosts that HIV requires to make multiple copies of itself. These drugs do not cure HIV infection, they can only decrease the amount of HIV in the body. The most common side effects are nausea, headache, vomiting, fatigue, nasal infection, and throat infection. Examples include:

• Isentress

• Raltegravir

• Dolutegravir

• Carbotegravir 

• Abamune (abacavir)

3. Protease inhibitors: They are a class of HIV antiviral drugs. These inhibitors break down the structural proteins that are necessary for the assembly and morphogenesis of virus particles. The role of protease is to break down viral particles into smaller fragments required for the assembly of new virus particles. Protease inhibitors block this step and hence the virus cannot replicate. Examples include :

• Indinavir

• Ritonavir

• Atazanavir 

4. Fusion inhibitors: It works on host CD4 cells and thus prevents HIV from entering a cell. They bind to the envelope protein of the virus and block the fusion with the host CD4 cells. Enfuvirtide  is the commonly used medicine in this category.            
       

B. Nucleoside reverse transcriptase inhibitors (NRTIs)

They are active inhibitors of reverse transcriptase in retrovirus. The different NRTIs are activated differently but they all have the same mechanism of action. But it has the major side effect of mitochondrial dysfunction which has been confirmed by side effects like cardiomyopathy, bone marrow suppression, and mitochondrial diseases. 

Examples are:

• Lamivudine

• Didanosine 

• Stavudine

• Zidovudine

• Emtricitabine

• Tenofovir

C. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

These are a therapeutic class of compounds. They are used in combination with antiretroviral drugs to treat HIV-1 infection. NNRTIs. It blocks HIV-1 infection by preventing reverse transcriptase from completing the reverse transcription of the single-stranded RNA genome into DNA. Examples are:

• Efavirenz

• Nevirapine

• Etravirine

D. Multi-drug combination

It combines two or more different classes of drugs. It is a combination therapy against multidrug resistance. It has potential benefits such as broad-spectrum, greater potency than drugs used in monotherapy, and reduction in the number of resistant organisms. Common examples are:

• Dolutegravir + tenofovir + emtricitabine

• Raltegravir + tenofovir + emtricitabine

Home-care For HIV Infection 

Living with someone who has HIV is itself a life-changing experience for the person and the family itself. HIV symptoms vary from person to person and hence the care required also varies. However, a few tips can help to take care of someone. 

1. Talk and understand the situation

Be available to have an open and honest conversation about HIV. Do things together like you used to do before the diagnosis. Make them feel like the same person and make them realize that they matter. 

2. Listen

Being diagnosed with HIV is life-changing news. Listen to your loved ones and reassure them that it is a manageable health condition. 

3. Learn

To educate yourself about HIV, from the transmission to treatment. Having an understanding of HIV is a big step in forwarding your support to the family member. 

4. Encourage treatment

Starting HIV treatment early, adhering to the treatment, staying with the caregiver thus helps to control the viral load and prevent HIV infection from progressing to AIDS. 

5. Support medication adherence

HIV patients need to adhere to HIV medication. Help them in making a routine and following them. 

6. Join HIV support groups

Connecting with people facing the same challenges may help the person and boost morale. Few societies in India help people with HIV and encourage them to take advantage to engage with other patients in a safe and supportive environment.

Complications Of HIV Infection 

If left untreated, HIV may severely hamper a patient’s life and can cause various complications like:

1. HIV does not directly invade the neurons but it infects the glial cells that support neurons. HIV triggers inflammation that leads to damage to the brain and spinal cord. Some common symptoms of this are: 

• Inability to concentrate

• Headache

• Behavioral changes

• Anxiety and depression

• Lack of coordination and walking

2. HIV infection can cause the shrinking of the brain that is involved in learning and information processing.

3. Some nervous system complications that occur as a result of HIV infection and drugs are pain, seizures, stroke, vision loss, and coma.

4. In children, HIV infection can cause developmental delays, nerve pain, slow growth, eye problems, and brain lesions.

5. HIV-associated dementia occurs in the most advanced stages of infection that include a decline in cognitive functions, concentration, memory, and slowing of motor functions.

6. Damage to the peripheral nerves causes progressive weakness and loss of sensation in the arms and legs. 

7. Cardiomyopathy or chronic disease of the heart muscle can happen during stage IV infection that can result in heart failure.

8. Hepatobiliary diseases (heterogeneous group of diseases of the liver, bile ducts, and/or gallbladder)commonly occur in HIV patients. These include granulomatous hepatitis and AIDS  cholangiopathy.

9. Diseases of the kidney and urinary tract: HIV-associated nephropathy is seen in the majority of the patients. 

10. AIDS-associated arthropathy: This syndrome is characterized by joint disorders like subacute oligoarticular arthritis developing over a period of 1-6 weeks and lasting up to 6 months.

11. Higher risk of genitourinary infections seen with patients with HIV infection.

12. Immune reconstitution inflammatory syndrome (IRIS): It starts following the initiation of ART, a worsening of pre-existing, untreated, or partially treated opportunistic infections may be noted.

Alternative Therapies For HIV Infection 

Many people use alternative health treatment in addition to medical treatment. Some alternative therapies include:

1. Physical therapies 

Physical, and body therapies include activities such as yoga, massage, and aromatherapy. It promotes healing of the body. 

• Yoga: It is a set of exercises that improve fitness, reduce stress, and increase flexibility. Many people, including those with HIV, use yoga to relax and become more relaxed. 

• Massage: It is an excellent way to reduce stress and reduce muscle and back pain, headache, and soreness. 

• Acupuncture: During acupuncture, tiny needles are inserted into certain areas. It is used to treat symptoms like nausea, fatigue and help with neuropathy. 

• Aromatherapy: It is based on the idea that certain smells can change the way you think. People use aromatherapy to deal with stress or fatigue. 

2. Relaxation therapies

Relaxation therapy such as meditation and visualization can promote overall health and well-being.

• Meditation: It helps people to relax and calm their minds. 

• Visualization: It helps people to feel more relaxed and less anxious. 

3. Herbal medicines

Herbal medicines are substances that come from plants, roots, leaves, and flowers and they work like standard medicines. These medicines can only reduce the symptoms, there is no cure as of now. 

Living With HIV Infection 

Taking care of yourself when living with HIV:

Taking antiretroviral treatment (ART) for HIV

If you’ve been diagnosed with HIV then start treatment as soon as possible. ART is not a cure for HIV, but it keeps HIV under control, protecting your immune system so that you can stay healthy and live a long life.

Adopt positive healthy living with an appropriate balanced diet

HIV infection weakens the immune system, for longevity and productive life positive people need to take special care of their health and well-being. Eating the right amount of food to maintain weight and including a variety of foods from the five food groups: fruits, vegetables, grains, protein foods, and dairy. 

Exercising regularly

Having a healthy diet and exercising regularly are a must to boost your immunity along with the medication. Till date, there is no cure for HIV infection but taking antiretroviral therapy (ART medicines) and exercising regularly are helping people live a healthy and happy life for almost decades.

Avoid excessive alcohol or drug use

Consumption of alcohol can damage the liver. The liver helps in the processing of anti-HIV drugs, so it is recommended to keep your alcohol consumption within the recommended limits. Heavy drinking and taking recreational drugs can also weaken your immune system, making it harder for your body to recover from infections.

Managing stress and getting support

Stress-management techniques, such as yoga, meditation, cognitive restructuring, coping skills training, and interpersonal-skills training may reduce anxiety, depression, and social isolation in HIV-infected persons by lowering physical tension and increasing a sense of control and self-efficacy.

HIV and pregnancy

Women living with HIV who become pregnant or who acquire the virus during pregnancy are at risk of both maternal and perinatal morbidity and mortality mainly if the virus is poorly controlled. There is a risk of  transmission to the fetus during pregnancy labor and postpartum through breastfeeding. 

Breastfeeding is a potential source of infection for the baby. Appropriate management reduces the consequences of HIV in pregnancy, ideally starting with preconception counseling and planning pregnancies when the viral load is minimum. During pregnancy, an appropriate combined antiretroviral (cART) medication is mandatory with very close monitoring of the viral load. Planning delivery and in special cases care must be taken to limit vertical transmission in women whose viral load is unknown or not controlled at the time of delivery.