HIV/AIDS (Acquired Immunodeficiency Syndrome)

HIV can be found as two strains or types – HIV-1 and HIV-2. There are many subtypes within these two categories.

HIV-1 

This is the more common type of HIV. This strain has four sub-types:

• Group M 
  The major or most popular of this type, this kind of HIV is found in nearly 90 per cent of the infections. This group has nine sub-groups. They range from A to K, the most common form found all over the world is the form C.
• Group N 
  This is a very rare strain, which has not been found outside Africa. Very little information and research are available on this type.
• Group O 
  Also called the outlier group, this type has many variants within it, but is also extremely rare and less known.
• Group P 
  The newest of the HIV strains found, this group differs from all the other kinds. Very little information has been discovered about this group.

HIV-2 

This type is rarely found outside Africa. It is not transmitted as easily from one person to another and does not progress to AIDS as quickly as HIV-1.

HIV tends to change and mutate within the body. An infection which began as one strain may change into another over time, making the treatment a challenge. In rare cases, more than one strain may be present, causing a condition known as a superinfection.

HIV infection is progressive and goes through three typical stages:

Acute HIV infection

This stage usually develops between two to four weeks after the virus infects a person. In this earliest stage, the virus is usually most active and spreads very rapidly through the whole body, and levels of HIV in the blood are highest. This is, therefore, the period when the risk of spreading the HIV virus is greatest. In this stage, the CD4 cells, which play a major role in the body’s defence mechanism, are attacked. Flu-like symptoms, such as a mild fever, body ache, or a rash might develop.

Chronic HIV infection

This is the second stage and is also called asymptomatic HIV infection. The virus now continues to replicate in the body, but not as aggressively. While people in this stage may not exhibit symptoms as those in stage 1, they still can spread the disease to others. If left untreated at this stage, the disease is most likely to advance to AIDS, however, this typically takes 10 years or longer.

AIDS

This is the final or terminal stage of HIV infection. In this stage, the CD4 cell count falls drastically and is 200 cells/mm³ or lower. Due to a heavily compromised immune system, people in this stage are most prone to developing infection-related cancer and other opportunistic infections. People with AIDS live for about three years if they do not receive appropriate and timely treatment.

Symptoms of HIV infection differ depending on the stage of the disease. They may present as follows:

Acute HIV infection

Within the first four weeks of being infected, those in the acute stage are likely to experience:

• Flu-like symptoms.
• Headaches.
• Ulcers in the mouth.
• Loss of appetite, weight loss and fatigue.
• Rashes.
• A sore throat.
• Enlargement of lymph nodes in the groin and neck area.
  
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Symptoms in this stage are likely to subside in some time.

Chronic HIV infection

In this stage, it is common to see that the symptoms of the acute stage start to disappear, although the individual is still a carrier of the infection. Through this stage and especially at the end, the virus affects CD4 cells and eventually, the virus becomes more potent and the CD4 count drops. As the person approaches the third and final stage, symptoms start to develop.

AIDS

The body is at its weakest in this stage. Several infections called opportunistic infections start to manifest. These infections are called so because they develop as a result of a weakened immune system of the infected person and many of them usually do not cause symptoms in healthy individuals without HIV. Some of these infections are:

• Pneumonia that is accompanied by a dry cough.
• Cerebral infection, with stroke-like symptoms, called toxoplasmosis.
• Yeast infections in the throat and mouth (oral thrush).
• Fungal infections, especially by Cryptococcus, leading to meningitis.
• Viral infections that result in progressive multifocal leukoencephalopathy (progressive damage of the white matter of the brain at multiple locations) which eventually leads to death.
• Cancer of the mouth, skin, throat or nose and other body organs which are the characteristic features of a condition called Kaposi’s sarcoma.
• Lymphoma or cancer of the lymph nodes.

Causes

There are several myths surrounding the cause and spread of HIV. Although it is a communicable disease, there are certain ways in which it can be spread. It does not spread through air and water, or through touching, kissing or shaking hands.

HIV spreads through contact with infected blood, semen, rectal and vaginal fluids or breast milk of an infected person. Here are some causes:

• Having oral, vaginal or anal sex with an infected person. When blood, semen or other secretions enter the body, they can spread the disease. The virus enters the bloodstream through ulcers, sores or wounds in the mouth, or ruptures and tears in the vagina or rectum.
• Getting a blood transfusion done where the blood came from an infected person. However, since most hospitals screen all blood before transfusing, the risk of contracting HIV through infected blood transfusion is low.
• From a pregnant mother to her child, through the placenta while in the womb, during childbirth and through breastfeeding.
• Using an infected needle. This is most commonly seen in people who are drug addicts.
• A needle injury to a healthcare professional attending to an HIV patient.

Risk factors

Individuals who are at higher risk include those:

• Who have unprotected sex or sex with multiple partners.
• With sores on their genitals, which then act as entry points for the virus.
• Who inject drugs intravenously, since the exchange of needles and syringes is common.
• Healthcare workers who attend to patients with HIV infection and might come in contact with needles or blood from the patient.
• Who are uncircumcised are usually at higher risk through heterosexual transmission.

The easiest path to avoid AIDS is protection against HIV infection. Prevention against HIV infection involves the following:

• Avoid unprotected sex and sex with multiple partners.
• Use a new condom each time you have intercourse.
• Stop using drugs as you have a very high chance of getting HIV by sharing needles. Seek help from family and friends or a rehab centre to get rid of the habit. 
• Do not share razors or other instruments where blood exchange via cuts is possible.
• Male circumcision can help reduce the risk of infection.
• Seek immediate medical assistance if you are pregnant and have HIV. This will help in preventing the transmission of infection to the baby.
• Couples should get a medical checkup done before tying a knot. It may help in early diagnosis of diseases and taking necessary measures while family planning.
• Always tell your partners if you have the infection.
• Always make sure that the injection or syringe used to administer medicines is new and is opened by the healthcare professional in front of you.

The diagnosis of HIV is mainly through blood tests. Tests are run in two phases. If the initial round of screening tests is positive, a second test is done to confirm the diagnosis. The main tests include an HIV antibody test, testing for a viral protein known as p24 antigen and an RNA test. The confirmation test is called the Western Blot. Since the virus takes a couple of weeks to develop and spread, some initial tests may not be positive. In case any test results are unclear, they should be repeated after a couple of months. This is called the window period.

In addition to these tests, swabs from the mouth, vagina or urine samples may also be collected for testing. Any tests conducted must be confirmed using the Western Blot test. There may also be additional tests run to check for any complications like TB, kidney or liver damage or UTI.

Since both HIV infection and AIDS have no cure, the focus of treatment revolves around containing the virus and trying to prevent the condition from worsening. The term for this form of therapy is antiretroviral therapy (ART), which essentially involves a combination of various drugs to curb the virus and its action. Medications to aid this process are:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are drugs that help cut off certain proteins, which are required by HIV to multiply.
• Protease inhibitors are another set of drugs, which inhibit a protein called protease which also helps HIV in multiplying.
• Fusion inhibitors are drugs that prevent HIV from entering CD4 cells and thereby keep CD4 count intact.
• Integrase inhibitors prevent the genetic material of HIV from fusing with the DNA of CD4 cells by inhibiting an essential protein called integrase.

Lifestyle management

Those undergoing treatment for HIV infection/AIDS may need a lot of help from friends and family. Since treatment is prolonged and also rather draining, people may need help with:

• Travelling to and from healthcare facilities.
• Financial assistance.
• Employment support.
• Legal aid.
• Self and child care.
• Emotional support and acceptance from friends, family and society.

Changes made to the lifestyle include quitting habits like drug and alcohol abuse and making healthier eating choices. Food choices include:

• Eating more fruits, vegetables and grains.
• Avoiding eggs and raw meat, or foods that may increase the chance of acquiring any food-borne infection. Opt for cooked foods as far as possible.
• Taking timely treatment.
• Taking an alternative treatment to boost immunity.
• Immediately seeking medical assistance at the hint of a possible infection, as infections tend to flare up and become severe rapidly in people with HIV infection.

Prognosis

People with AIDS have an expected lifespan of up to 10 years. However, those who receive timely, appropriate medical help can live for up to 50 more years, as long as the conditions are optimally managed and health is maintained. 

Complications

A range of complications may arise from both the disease as well as the treatment prescribed for HIV/AIDS. These are:

• A host of side effects of medicines can be experienced. These include nausea, fatigue, diarrhoea, loss of bone density, heart disease, high cholesterol and blood sugar and loss of muscle tissue.
• Complications arising from the condition itself are many, considering the weakened immune system. TB, hepatitis, sexually transmitted diseases, liver and kidney damage and UTI are some complications associated with the disease.
• Increased risk of cancer in people who are either in or approaching stage 3 of the disease.
• Risk of organ failure, which may affect people at any stage. 

AIDS is among the most serious and widely researched and discussed diseases. Although it only came to be understood recently, it has affected a significant percentage of the population and proves to be a potential global health hazard unless addressed appropriately.

AIDS is the disease caused by the HIV or human immunodeficiency virus. Once the body is affected by this virus, the immune system is compromised, as is the ability of the body to fight diseases. Thus, the person doesn’t live with the symptoms of the infection, but with the symptoms of the other infections and diseases that attack the body due to a weak immune system. HIV infection is most commonly spread sexually. It can be life-threatening and chronic since it has no permanent cure.

AIDS is the most advanced stage of HIV infection. It stands for acquired immunodeficiency syndrome. When untreated, HIV infection gradually progresses to AIDS, which is fatal.