HIV/AIDS: Causes, Symptoms, Diagnosis, Treatment and Prevention

HIV virus.

What is HIV/AIDS?

HIV stands for Human Immunodeficiency Virus (HIV). HIV is a virus that causes Acquired Immunodeficiency Syndrome (AIDS). It can attack the body and make it weak to fight diseases and infections. If not treated, HIV can damage the immune system of the body by destroying the cells of immune system. More specifically, HIV targets the white blood cells called CD4+ T-helper cells, also known as CD4 cells, and gradually destroys them.

CD4 cells are important cells of the immune system and are actively involved in immune response. These cells help the body fights infections and other diseases. By attacking and killing the CD4 cells, HIV can interfere and weaken the immune system, and ultimately impairing the body’s ability to fight diseases.

People infected with HIV are vulnerable and susceptible to other infections and diseases, especially when HIV advances to AIDS. Unfortunately, there is no cure for HIV but there are medicines available that can manage and control HIV infection from progressing to AIDS. Studies have shown that people with HIV/AIDS can live healthy lives if they take their medicines regularly and rightly.

Epidemiology of HIV/AIDS

HIV/AIDS is a devastating disease that has continued to claim millions of lives worldwide and is considered a major global public health problem affecting every country. However, the burden of disease for HIV/AIDS varies across countries and regions, depending on many factors. According to UNAIDS, more than 40 million people have died of HIV/AIDS since the start of epidemic, and in 2021 alone, 650,000 people died of AIDS-related diseases.

The global report on HIV/AIDS revealed that more than 38 million people were living globally with HIV/AIDS in 2021. If everyone has adequate access to HIV health education, awareness, prevention, treatment, care and support, then the world may witness HIV free society one day.

Transmission and causes of HIV/AIDS

How HIV can be transmitted from one person to another. Image adapted from the CK-12 Foundation.

HIV can be transmitted through multiple ways, but the primary mode of transmission is through infected bodily fluids, sexual intercourse, sharing needles or injecting tools, and mother-to-child transmission of HIV.

Example of ways HIV can be transmitted via infected bodily fluids are:

• • Blood

• • Semen

• • breast milk

• • Blood transfusion

• • vaginal and rectal secretions

• • Sharing needles or use of injecting tools/equipment

Examples of ways HIV can be transmitted through sexual intercourse are as follow:

• • Vaginal and anal sex

Transmission of HIV from mother to child occurs via three stages listed below:

• • During pregnancy

• • During childbirth

• • During Breast feeding

Majority of mother-to-child transmissions of HIV occurs during pregnancy and delivery although approximately 14% of mother-to-child transmissions still occur during breastfeeding. Mothers must receive proper, regular, and rightful HIV treatment before they become pregnant, which is a critical protective mechanism for their babies. 

Studies suggested that women who receive their HIV treatment and have their viral load suppressed during pregnancy until breastfeeding could give birth to HIV-negative babies even if they are HIV-positive. Treatment of HIV during pregnancy, delivery and breastfeeding is very important for the prevention of mother to child transmission of HIV.

Ways HIV cannot be transmitted to other people

Ways HIV cannot be transmitted to other people. Image adopted from CDC.

It is very important to remember that HIV virus cannot survive outside the body. Once outside, the room temperature, open air or water can destroy HIV virus.

Remember  you CANNOT GET HIV from the following:

• • Talking and shaking hands

• • Sharing things e.g., sharing dishes, room, and bathroom.

• • Eating together or kissing

• • Sweat, tears, and saliva unless if they contain infected blood.

HIV is not transmitted through other bodily fluids, unless they contain infected blood. For example, someone with HIV/AIDS can cough, sneeze, and talk to you and you will not get HIV. It is very safe to share a room with someone who has HIV/AIDS so long you do not have unprotected sexual intercourse.

Risk Factors for HIV/AIDS

HIV is more  a behavioural and lifestyle disease than genetics. Because of this, certain behaviours or situations can make people more susceptible to HIV infection. Close attention should be paid to behavioural and lifestyle factors and avoid them if necessary. The most significant risk factors for HIV infection include the following:

• • Practicing of unprotected sex with an infected HIV positive person

• • Having vaginal or anal sex without using condom

• • Sharing of contaminated needles, syringes, injecting tools, and equipment

• • Coming in contact with unsafe injections or accidental exposure to needle stick injuries

• • Unsafe blood transfusion and medical procedures including tissue transplants

• • Unsafe tattooing and body piercing

• • Engaging in multiple sexual relationships without knowing the HIV status of partners

• • Presence of other sexually transmitted infections like syphilis, gonorrhoea, and chlamydia etc

• • Engaging in harmful behaviours that put individuals at risk of unprotected sexual behaviours

Signs and symptoms of HIV/AIDS

Signs and Symptoms of HIV/AIDS. Image adopted from CDC.

The signs and symptoms of HIV infection occur in three distinct phases and may range from mild to severe. Each phase presents unique symptoms. This means that there are several symptoms of HIV that can vary across all three stages. However, many symptoms of HIV infection are very similar to those of other viral infections and can sometimes overlap. The common symptoms of HIV infection can be confused with other viral infections.

The best way to know if you have an HIV infection is to get tested immediately when you experience any of the symptoms discussed below. In addition, if you happen to engage in unsafe sexual behaviours, you must get yourself tested two to four weeks after the exposure. It is also advisable that you test yourself regularly if you live in HIV epidemic areas or if you frequently practice unsafe sexual intercourse.

Phase one: Acute HIV infection

Acute HIV Infection occurs approximately two–four weeks after contracting the infection. It is the first stage of HIV infection and can last a few days to two weeks. Approximately two-thirds of people who contract HIV develop an acute HIV infection. This phase is also called Primary HIV Infection or HIV Seroconversion Illness because HIV attacks the body’s immune system, and the incoming immune response towards HIV triggers a cascade of flu-like symptoms observed in the acute phase.

The symptoms experienced during the Acute Phase may vary from person to person as well as the severity of the infection. Nevertheless, evidence highlights that people who experience more severe symptoms during the Acute Phase are more likely to progress rapidly to HIV disease than those with mild symptoms. During the Acute Phase, the viral load is at its highest, suggesting that infected individuals can become very contagious at this stage, and the transmission of HIV can occur rapidly and easily due to the high amount of HIV in the blood.

Acute Phase Infection Symptoms:

• • Fever, chills, and night sweats

• • Lethargy and general malaise

• • Headache, diarrhoea and Muscle aches

• • Genital ulcers and oral ulcers

• • Sore throat, rash and swollen lymph nodes

• • Urethral discharge and pain during sex or with urination

Knowing your HIV status is very important. Image adopted from CDC.

Note: The symptoms observed in the Acute Phase are similar to those of many viral illnesses. Hence, no single symptom can distinguish an acute HIV infection from any other acute viral illness. These symptoms do not necessarily mean that the patient has HIV infection. On the other hand, you may have HIV but do not show any symptoms. Thus, the best way to know one’s HIV status is to test oneself. If you suspect that you may have been exposed to HIV, irrespective of the symptoms above, please get your HIV test performed immediately.

Image adopted from CDC

Phase two: Chronic HIV infection

This phase is also called the clinical latency or asymptomatic HIV Infection Phase. If HIV is not treated in the acute phase, it can progress to HIV disease and become chronic and sometimes asymptomatic. This is because the immune system amounts an immune response against HIV and may partially control HIV replication, making HIV asymptomatic and chronic.

As HIV continues to attack CD4 + cells, the immune system becomes impaired and cannot control the replication of HIV virus. In the absence of HIV treatment, HIV slowly progresses to a more chronic form. HIV becomes a chronic infection and can progress to AIDS in the absence of HIV treatment.

Although many people do not show symptoms at this stage, they can still transmit HIV to other people because the virus is still active and replicating in the body. People can remain in the Chronic HIV Infection phase for up to15 years, depending on multiple factors and the treatment administered. Some people may experience illnesses and symptoms, whereas others do not show symptoms at all.

If HIV treatment is timely and medicines are administered correctly, HIV can be controlled and maintained at an undetectable viral load. People who take their HIV medicines correctly and timely until their viral load is suppressed to undetectable levels can live healthy and normal lives. At this stage, HIV cannot be transmitted to others, including their partners, through intercourse. If the virus is still detectable in the blood in spite of HIV treatment, people with HIV can still transmit HIV to others. Nevertheless, in the absence of treatment, HIV can progress to AIDS.

Phase three: AIDS

Without treatment, HIV can progress to the last and final phase AIDS. AIDS is a disease caused by an HIV infection. This is the most severe phase of HIV infection and can be fatal. Here, the viral load becomes excessively high and can easily be transmitted to other people. According to the CDC, AIDS is characterised by a CD4 count of less than 200 cells/μl.

Because of the high viral load in the blood, CD4 cells become steadily depleted, increasing the risk of significant illness and disease. Immune dysfunction and impairment follow at this stage, and people with AIDS become more susceptible to opportunistic infections and other diseases.

The severely damaged and compromised immune system can no longer defend the body from replicating HIV virus. Hence, AIDS can lead to severe immunosuppression, and death may occur within months to three years. Most symptoms observed during the AIDS phase are due to the breakdown of the immune system and the contraction of opportunistic infections. The most severe AIDS-related symptoms, usually result from opportunistic infections. 

Symptoms of AIDS:

• • Rapid weight loss

• • Recurring fever or night sweats

• • Extreme and unexplained tiredness

• • Prolonged swelling of the lymph glands in the armpits, groin, or neck

• • Pneumonia and chronic diarrhea

• • Fatigue and weakness

• • Sores in the mouth, anus, or genitals

• • Blotches on the skin, under the skin, or inside the mouth, nose, or eyelids

• • Neurological issues e.g., memory loss, depression, and other neurologic disorders

Note: HIV treatment can prevent AIDS development. With antiretroviral therapy, people with AIDS can recover and return to stage two, the chronic HIV infection phase, and can live healthy and normal lives depending on antiretroviral therapy. Symptom progression is slow when antiretroviral treatment is administered.

Common opportunistic infections caused by AIDS

Common opportunistic infections caused by HIV/AIDS are listed above below:

• • Pneumocystis jiroveci pneumonia

• • Disseminated Mycobacterium avium complex

• • Candidiasis (thrush)

• • Diarrhoeal diseases

• • Cerebral toxoplasmosis

• • Cytomegalovirus retinitis

• • Kaposi’s sarcoma

Diagnosis of HIV/AIDS

HIV/AIDS is diagnosed by testing blood, saliva, or urine. Although HIV tests are highly accurate, no test can detect HIV infection immediately after exposure. Depending on where you live and the urgency of your need, HIV testing can be performed at home, healthcare facilities, or in the lab. Some HIV tests take longer than others. For example, a rapid test using a finger prick can take about 20 minutes to get your results, but it may take several weeks to get your results back from the laboratory.

Most HIV tests detect antibodies produced by the immune system in response to foreign substances called antigens. To test for HIV infection, HIV tests screen for antibodies expressed by the immune system or for antigens and genetic materials expressed by the HIV virus. As a result, three different types of HIV Test are available.

 

Image adopted from CDC.

Tests for HIV Infection

Antibody test is performed using a finger Prick or mouth swab. It screens for antibodies that the body produces during HIV infection. Antibodies are found in the blood or oral fluids. Antibody tests can detect HIV infection 23 to 90 days after HIV exposure. However, antibody tests that use venous blood can detect HIV earlier after exposure. The most rapid tests or at-home tests for HIV infection are antibody-only tests. For reliability of positive results, additional follow-up tests using ELISA or western blotting are recommended for individuals tested positive for HIV by an antibody-only test.

Antigen/antibody Test is a combination test that looks for both antigens and antibodies in the blood. Antigens are proteins produced by infections, such as HIV, and antibodies are proteins produced by the immune system in response to infection. Antigen/antibody tests can detect HIV infection 18 to 45 days after exposure.

Antigen and antibody HIV tests screen for both antigens and antibodies. This makes antigen/antibody tests more accurate than the antibody tests alone. It is performed using blood from the finger prick or blood drawn from the vein. It is available as a rapid test or blood can be sent to the lab which takes several days for the results to come back.

Nucleic Acid Test– is a HIV test that screens for the real HIV virus or genetic materials in the blood, and it can show the amount of HIV virus (viral load) in the blood. This test has the shortest timeframe for detecting the HIV virus, which is approximately 10–33 days. However, it can only be performed in a lab by using blood drawn from the vein. It is very expensive and can only be used for high-risk exposure.

Note: If you suspect that you have been exposed to HIV, the best option is to seek medical attention immediately. The absence of HIV symptoms does not necessarily mean the absence of HIV infection. Testing is the best way to determine the HIV status. If you think you are vulnerable to HIV or your partner may be at a high risk of HIV, you should be tested more frequently, even when you do not show any symptoms.

For women planning to become pregnant, they must undergo HIV testing before pregnancy. If you are pregnant and have not undergone an HIV test, please get tested immediately. Knowing your HIV status during pregnancy protects you and your baby. If you are HIV-positive and planning to get pregnant, start your HIV treatment immediately and take them continuously until the viral load is undetectable. Undetectable indicates untransmittable. When the viral load is undetectable, you cannot pass the HIV virus to the baby, and your baby will born HIV-negative.

Treatment of HIV/AIDS

HIV treatment involves the administration of antiretroviral medications (ART), which must be initiated immediately after diagnosis, irrespective of the viral load. These medicines are prescribed for effective treatment of HIV/AIDS. Unfortunately, there is currently no cure for HIV/AIDS. Nevertheless, antiretroviral treatment can control viral replication, reduce the amount of HIV in the blood, and allow the immune system to recover.

HIV treatment can allow people living with HIV/AIDS to stay healthy, similar to other people. When used effectively and continuously for about six months, antiretroviral treatment can suppress HIV infection to undetectable viral level, usually below the viral load of 200ul of blood. Suppressing viral load to undetectable levels means people living with HIV/AIDS cannot transmit HIV to others. However, HIV treatment is a life treatment and must be taken regularly, as prescribed by a doctor or health provider.

Image adopted from HIV gov

Sometimes, people who reached undetectable viral load may have their HIV treatment readjusted by their health provider. Taking HIV treatment regularly can prevent HIV transmission to other people. Having undetectable viral load means individuals cannot transmit HIV to their sexual partners.

People receiving antiretroviral treatments may develop drug resistance, especially if they often missed their medications or take them incorrectly. When drug resistance occurs, patients should seek medical advice from their doctor or qualified health professional immediately. Some patients undergoing antiretroviral treatment may experience side effects. When this occurs, consult your health provider as soon as symptoms of the side effects appeared.

Common side effects of HIV treatment are:

• • Nausea and vomiting

• • Diarrhea

• • Difficulty sleeping

• • Dry mouth

• • Headache

• • Rash

• • Dizziness

• • Fatigue

• • Temporary pain at the injection site (for shots)

Prevention of HIV/AIDS

There are many ways you can prevent yourselves from getting infected with HIV. HIV is transmitted through blood, semen, breast milk, or bodily fluids via unsafe sexual practices or the sharing of injectable equipment. The most effective way to stop yourself from getting HIV/AIDS is to avoid unsafe sexual practices, not share injectable tools such as needles or syringes, and use condoms during unsafe sex. You can also take HIV prevention medicines if you or your partner are at increased risk of HIV infection.

If you already have HIV/AIDS, the best way to protect yourself and others is to take HIV medicines regularly and continuously. This will reduce your risk of transmitting HIV to your partner and others. Taking your HIV medicines effectively helps you stay healthy.

Image adopted from HIV.gov

Prevention of Mother to Child Transmission of HIV/AIDS

HIV can also be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. If you have HIV and are pregnant, it is very important to take HIV medicines as prescribed by your doctor. When you take your HIV/ADIS medicines during pregnancy until your viral load reaches an undetectable level, you will not pass HIV/AIDS to your baby. Your baby will be born HIV-negative.

You must continue taking HIV/AIDS medicines for about six weeks after delivery. It is also recommended that you do not breastfeed your baby if you are HIV-positive. There may be a chance that the virus may come back during breastfeeding, and you may infect your HIV-negative baby. For the protection of your child, breastfeeding is not always recommended for HIV positive mothers even if they have reached undetectable viral load. HIV treatment does not take away the risk of transmission and precaution must be exercised always.

Voluntary Male Medical Circumcision

Evidence suggests that a penile foreskin can create a moist environment for HIV virus to enter the body. When circumcised, the foreskin is removed, which reduces the risk of HIV infection. Studies have shown that voluntary male medical circumcision is approximately 50 – 65% effective at preventing HIV infection in men. However, this strategy is less effective than a condom and cannot prevent male to female transmission of HIV/AIDS

Image adopted from CDC

HIV Prevention Medicines

Pre-Exposure Prophylaxis (PrEP)

These are a group of HIV medicines that are taken daily by HIV-negative individuals to protect them from HIV infection. PrEP is taken before a person acquires HIV/AIDS and these medicines must be taken continuously for 4 weeks. If taken regularly and constantly, PrEP is 99% effective against HIV and can prevent HIV infection.

Note: These medicines will not protect you from HIV infection if you stop taking them. You must take them daily if you are at increased risk of HIV. They can protect you from getting HIV from your partners. However, people at risk of HIV infection are advised to use condoms, even when they are taking PrEP. If your partner is at risk for HIV infection and you are not, please talk to your doctor and get PrEP.

You can take PrEP if:

• • Your partner is HIV positive, and you are HIV negative. PrEP will protect you.

• • You are planning to get pregnant from HIV-positive partner. PrEP will protect you and your baby.

Post-exposure prophylaxis (PEP)

PEP are emergency HIV medicines that must be taken within 72 hours to protect people from acquiring HIV. These are HIV medicines used by people exposed to HIV within 72 hours. The sooner you take PEP after exposure, the better the chance of not getting HIV infection. PEP are used only for emergency situations and not for long-term use.

You can take PEP if:

• • You have been exposed to HIV within 72 hours

• • You have unsafe sex and not sure of HIV status of your sexual partner

• • You have shared injectable needles or syringes with someone with HIV

• • You are a health care worker and you have been exposed to HIV infection at work

Antiretroviral Treatment as Prevention (TasP)

These are medicines taken by people with HIV/AIDS to protect them and reduce their risk of infecting other people. When antiretroviral medicines are taken effectively for at least six months, people living with HIV/AIDS can reduce their viral load to undetectable levels. They will not transmit HIV/AIDS to other people.

Support for people living with HIV/AIDS

Living with HIV/AIDS can be challenging and difficult but support is available. HIV/AIDS is similar to other diseases. This can be prevented and treated. This means that people living with HIV/AIDS can live healthy and normal lives when they are diagnosed and treated on time.

It is crucial to seek help and support when you are living with HIV/AIDS. Reach out to your doctor for mental and emotional health plans and support. Reach out to family and friends whom you can trust.

If you know someone living with HIV/AIDS, please reach out to and support them. Talk to them. Treating them with love and respect. It is just a disease and nothing more. We must not discriminate or judge people living with HIV/AIDS. Step up and say no to discrimination or stigma against people living with HIV/AIDS.

Information and fact checking were obtained from the following:

Centre for Disease Control @

https://www.cdc.gov/hiv/basics/index.html

World Health Organization @

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

UNAIDS @

https://www.unaids.org/en/resources/fact-sheet

HIV info at NIH @

https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-aids-basics

KC-12 Foundation @

https://flexbooks.ck12.org/cbook/ck-12-biology-flexbook-2.0/section/13.54/primary/lesson/hiv-and-aids-bio/