all clinical statuses of HIV
People with HIV who are detected early enough might expect to live a near-normal life.

Human immunodeficiency virus (HIV) infection can present with a range of symptoms often confused in the initial stages as cold or flu. As a result, the only reliable way to determine whether a person has HIV is to receive an HIV test.

Symptoms that a patient with HIV may have depends on how long they've had the infection and whether they're on treatment.

Three stages of HIV infection include:

  1. Acute infection 
  2. Chronic infection
  3. Acquired immunodeficiency syndrome (AIDS)

Acute infection

This stage usually begins between a few days to weeks of being exposed to HIV.

Nine common signs and symptoms of acute HIV infection include:

  1. Flu-like symptoms
  2. Fatigue (feeling tired or sapped of energy)
  3. Fever
  4. Mouth sores
  5. Muscle aches
  6. Night sweats
  7. Skin rashes
  8. Sore throat
  9. Swollen lymph nodes

If a person experiences any clinical manifestations of acute HIV infection, they normally resolve on their own within a few days or weeks, roughly the same time it takes to recover from a cold or flu. It's crucial to realize that many people go through this acute stage of HIV infection with no symptoms at all.

Chronic infection

  • Chronic infection can persist for a decade or more if HIV therapy is not started and indefinitely if HIV drugs are used.
  • During the chronic HIV infection phase, a person may have no symptoms. 
  • This is because HIV multiplies at a very slow pace during this stage.
  • If the virus is not treated, it will continue to take over and destroy immune cells, transforming them into HIV factories.
  • When a person begins HIV therapy, the drugs prevent HIV from replicating itself. This permits the immune system to recover.

A person on therapy for HIV can stay in the chronic stage indefinitely. Indeed, owing to HIV medications, many people living with HIV today have a lifetime compared with those who do not have HIV.

AIDS

When patients living with HIV continue without HIV therapy for an extended period, typically 10 years or more, they frequently enter the advanced infection phase, which can be fatal. This is the stage in which an individual is diagnosed with AIDS.

Symptoms of advanced HIV illness vary greatly because HIV is not generally the source of symptoms. Instead, such symptoms are the result of another illness or disease that has taken root in the body due to the immune system's inability to guard it.

Four common clinical findings of advanced HIV disease include:

  1. Kaposi's sarcoma: Cancer caused by a virus that can affect the skin, stomach, and lungs
  2. Meningitis: Swelling around the brain caused by viruses, bacteria, or fungi
  3. Thrush (a.k.a. candidiasis): Fungal infection of the mouth and throat that makes it painful to swallow
  4. Wasting syndrome: People lose more than 10 percent of their body weight

The term AIDS refers to a highly specific medical condition. One of the following two clinical findings must be met to be diagnosed with AIDS:

  1. CD4 count:
    • The CD4 cell count is less than 200 cells/mm3.
    • CD4 cells are components of the immune system. They are a type of immune cell known as a T cell, and they are in charge of battling infections in the body.
  2. Opportunistic infections:
    • The patient becomes ill with an “AIDS-defining disease,” often known as an opportunistic illness.
    • This is one of over two dozen distinct disorders (including numerous malignancies and bacterial, fungal, or viral infections) that can be lethal in patients with impaired immune systems.

SLIDESHOW

A Timeline of the HIV/AIDS Pandemic See Slideshow

Testing for HIV

Testing for HIV is the only approach to confirm an HIV infection diagnosis. There are many sorts of testing available, depending on how long the person has been exposed to the HIV:

  • Antibody tests:
    • They are the most commonly used HIV tests, which include home testing.
    • Antibody tests look for HIV-1 antibodies, which the immune system produces after being exposed to the HIV.
    • It takes at least three weeks, and often up to 12 weeks, for a person to produce enough antibodies to be detected in this sort of test.
  • Combination or fourth-generation tests:
    • These detect HIV-1 antibodies and p24 antigens. The p24 antigen is found in HIV and may be discovered as early as two weeks after infection in some people, but it can take up to six weeks in others.
    • Antibodies steadily lower the quantity of p24 antigen in the blood, rendering it inappropriate for use in HIV diagnosis after the very early stages.
  • Nucleic acid tests:
    • These detect HIV in the bloodstream. They are costly and are typically done only when there has been high-risk exposure, or the person displays signs of acute HIV infection.
    • Nucleic acid tests can identify HIV in some people as soon as one week after infection, but it might take up to four weeks for others.

HIV test window period

The window period is the interval between when a person becomes infected and when a test may reliably detect HIV infection.

  • Antibody tests: 21 to 84 days after infection
  • Fourth-generation tests: 13 to 42 days after infection
  • Nucleic acid tests: 7 to 28 days after infection

Because everyone reacts differently to infection, HIV may not be identified until much later in certain circumstances (indicated by the second number). If an early HIV test yields a negative result, it is recommended that another test be performed after the window period is over.

How does HIV spread?

Human immunodeficiency virus (HIV) is transmitted when virus-containing bodily fluids, such as blood, semen, vaginal fluid, anal secretions, or breast milk, enter the circulation of a person who does not have HIV, which can occur through:

  • Unprotected anal or vaginal sex.
  • Sharing injecting tools, particularly needles and syringes.
  • Unsterile body piercing and tattoos.
  • Unsterile surgical or dental treatments.
  • The natural transmission of fluids from an HIV-positive mom to her kid during pregnancy, delivery, or lactation (especially in countries that do not have regulations for HIV testing and prevention).
  • Any wounds or sores in or around the mouth or genital area.

HIV cannot be transmitted through normal social interactions such as shaking hands, sharing a glass, sharing food or drink, or hugging and kissing. HIV is not transmitted through saliva, tears, sweat, feces, or urine. The patient cannot obtain HIV through a bug or animal bite or by sharing a bathroom with someone who has HIV.

In most workplaces and schools, people are not in danger of contracting HIV. However, there may be some danger if a job, education, or sport involves contact with blood and bodily fluids. Always practice basic hygiene, such as handwashing and safe management of bodily fluids such as blood spills.

QUESTION

What is HIV? See Answer

What are the treatment options for HIV?

There is still no cure for human immunodeficiency virus (HIV) that is effective. Treatment methods stop the virus from replicating in the body and producing illness. Treatment will be continuous and will include a range of antiviral drug combinations (antiretroviral therapy [ART]). Beginning antiretroviral medication slows HIV progression and can keep a patient healthy for many years. 

Drug therapy

  • Treatment is frequently based on triple treatment, or highly active antiretroviral therapy, which includes of two or three reverse-transcriptase inhibitors (RTIs) or two RTIs paired with a protease inhibitor.
  • Antiretroviral medicine is quite successful, but it must be taken for the remainder of the patient's life. Thus, patients must follow their doctor's treatment plan exactly.
  • Antiretroviral medications are typically well-tolerated and generate few adverse effects. If the patient has poor tolerance for the treatment, it should be changed until another one is identified that allows the patient to have the same quality of life as a non-HIV-infected person.

Four types of antiretroviral medications include:

  1. RTIs:
    • RTIs function by blocking the HIV enzyme (reverse transcriptase) that converts viral RNA into viral DNA, which is subsequently integrated into human CD4 cell DNA. 
  2. Protease inhibitors:
    • Protease inhibitors are particularly efficient against HIV because they act late in the replication cycle.
    • They inhibit the protease enzyme, which HIV uses to cut new protein chains that develop inside the infected human cell into pieces so that new viral particles may be assembled. 
  3. Entry inhibitors:
    • These medications keep HIV from infiltrating CD4 cells.
  4. Integrase inhibitors:
    • This class of medications prevents HIV from integrating into the genetic material of an infected human cell. 

Psychological treatment

  • Psychological support is critical for helping patients with HIV deal with the different scenarios that may occur, especially when it comes to complicated therapy.
  • A thorough infection-treatment plan enhances the patient's quality of life.
  • Nongovernmental organizations can provide free psychological and social assistance.
  • One of the fundamental characteristics of community programs and services is that they assist society's most vulnerable members.
  • This is done in a welcoming and safe environment, where a positive relationship is built to provide psychological support and comprehensive services such as help with adjusting to a new situation, health promotion, and awareness about the patient's rights.

Vaccination

  • The most important issue that requires attention is the development of effective anti-acquired immunodeficiency syndrome vaccines.
  • Vaccination is our most effective method of eliminating HIV infection. However, it is a difficult scientific endeavor due to HIV's adaptability and escape mechanisms for resisting the body's immune response, as well as the challenges involved in developing, deploying, and testing prototype vaccines.
  • Currently, there are no vaccines available to prevent HIV infection.
  • Vaccines may, however, be given to patients with HIV to prevent other infections such as flu, tetanus, and pneumonia.

Post-exposure prophylaxis (PEP)

  • PEP is an antiretroviral medication cocktail intended to help prevent HIV infection when taken appropriately although it is not 100 percent effective. 
  • PEP must begin as soon as feasible following suspected HIV infection and within 72 hours.

Pre-exposure prophylaxis (PrEP)

  • Another method of lowering the risk of acute HIV infection is PrEP.
  • PrEP is a combination of two drugs that, when taken regularly, can reduce a person's risk of contracting HIV. 
  • PrEP is usually indicated for patients who are at a high risk of HIV.

Most HIV treatments aim to prevent the virus from replicating and, as a result, the virus from attacking white blood cells (immune cells). The virus must go through many biochemical steps to enter white blood cells, proliferate, and then escape to infect new ones. HIV medication either prevents or inhibits these activities.

To prevent HIV from replicating, HIV therapy involves a range of assault strategies. Some therapies block the virus from entering immune cells, whereas others kill or prevent the virus from multiplying within immune cells or from escaping in a condition that may infect new cells.

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Side effects of HIV treatment

Side effects of HIV medicine may vary from one drug to the next and from one person to another. Many of today's HIV drugs make it possible to find a therapy that has few side effects for the individual.

HIV drug side effects may be judged troublesome or detected only through blood sample monitoring, which includes:

Some side effects may cause damage in the:

  • Bone marrow
  • Kidneys
  • Liver and pancreas

Side effects can occasionally increase the risk of cardiovascular disease and diabetes. Furthermore, HIV infection may increase the likelihood of developing such diseases. Routine checkups are thus required, both to monitor the action of the drug and identify any side effects.

Prognosis of HIV

People with HIV who are detected early enough might expect to live a near-normal life. A 20-year-old with a decent CD4 count a year after starting ART might expect to survive up to the age of 78 years.

People who are identified late have a lower CD4 level or do not react well to the first year of ART have a worse prognosis (prognosis). Even if someone has been diagnosed with a low CD4 count, therapy can effectively restore them to good health.

Various variables that influence life expectancy include smoking, alcohol use, and the use of other medications. In short, the prognosis for people who have access to modern treatments has substantially improved in recent years.

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Medically Reviewed on 5/26/2022
References
Image Source: iStock Image

HIV/AIDS: https://www.who.int/news-room/fact-sheets/detail/hiv-aids

Clinical Manifestations of HIV Infection: https://www.ncbi.nlm.nih.gov/books/NBK219125/

About HIV: https://www.cdc.gov/hiv/basics/whatishiv.html

HIV: Clinical manifestations: https://www.jacionline.org/article/S0091-6749(02)00032-5/fulltext

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS): https://www.health.vic.gov.au/infectious-diseases/human-immunodeficiency-virus-hiv-and-acquired-immunodeficiency-syndrome-aids