HIV

HIV

HIV is a sexually transmitted infection that can spread through infected blood, sharing needles, and illegal drug use. It can also be spread vertically during pregnancy, breastfeeding, and childbirth from the mother to child. Without medications, it takes years for HIV to weaken the immune system to an extent that you have AIDS. HIV/AIDS has no cure. However, medications can be used to control infection and prevent the progression of the disease.

Antiviral treatments for HIV have resulted in a decrease in deaths due to AIDS around the world and international organisations are working to increase the preventive measures and treatment in countries that are poor in resources.

The symptoms of AIDS depend on the phase of the infection the patient is going through.

Primary infection (Acute HIV)

Some patients who have been affected by AIDS go through a flu-like illness within 2-4 weeks after the entry of the virus into the body. It is called acute or primary infection and lasts for a few weeks. The possible signs and symptoms of the infection in this phase include fever, muscle aches and joint pain, headache, rash, swollen lymph glands, mainly on the neck, painful mouth sores and sore throat, diarrhoea, cough, weight loss, and night sweats.

These symptoms are sometimes so mild that you might not even notice them. However, the amount of virus your bloodstream has might be quite time even with these mild symptoms. Therefore, the infection tends to spread quite easily during this stage than during the next stage.

Clinical latent infection (Chronic HIV)

During this stage, the virus is still present in the white blood cells of the body but many people are asymptomatic at this stage. It can last for many years if you are receiving antiretroviral therapy (ART). Some patients may develop a more severe disease much sooner than this.

Symptomatic HIV infection

As the virus keeps on multiplying and the immune cells (the cells in the body that keep off infections) keep on getting destroyed, you may develop mild infections and chronic symptoms like fatigue, fever, swollen lymph nodes - often one of the first signs of HIV infection, weight loss, diarrhoea, shingles, oral yeast infection, and pneumonia.

Progression to AIDS

The advent of better and more efficient antiviral treatments has decreased the deaths due to AIDS worldwide dramatically, even in developing countries. Because of these life-saving treatments, most people with HIV don’t develop AIDS. If left untreated, HIV typically develops into AIDS in a matter of 8-10 years.

Your immune system is severely debilitated when AIDS occurs. You will be more susceptible to developing diseases that usually wouldn’t cause illness in a normal person with a healthy immune system. These infections are referred to as opportunistic infections. The possible signs and symptoms of these infections may include chills, sweats, chronic diarrhoea, recurring fever, swollen lymph nodes, persistent, unexplained fatigue, persistent white spots or unusual lesions on your tongue or in your mouth, weight loss, weakness, skin rashes or bumps, and weight loss.

If you think you have HIV infection or are at a high risk of developing the infection, you must see a doctor as soon as possible. If you are located in Indore, you can visit the Kokilaben Dhirubhai Ambani Hospital, Indore and book an appointment with an expert who will guide you to the next step.

Causes of HIV

HIV infection is caused by a virus and it can spread via illicit injection drug use, sexual contact with an infected person, sharing needs, contact with infected blood, or from mother to the baby during childbirth, pregnancy, or breastfeeding.

HIV virus damages the CD4 T cells - the white blood cells that play an important role in helping the body fight germs and infections. The fewer the number of CD4 T cells your body has, the weaker your immune system is.

You can be infected with HIV and have very few or no symptoms for years before it develops into AIDS. AIDS occurs when the CD4 cell count drops below 200 or if you have an AIDS-defining complication like a serious infection or cancer.

HIV infection spreads via infected blood, vaginal secretions, and semen. This can occur in different ways such as:

  • By having unprotected sex
  • By sharing needles
  • Unsafe blood transfusions
  • Vertical transmission during pregnancy or delivery or through breastfeeding

You can’t be exposed to the virus via ordinary contact, which means that you can’t develop AIDS by kissing, hugging, dancing, or shaking hands with an infected person. Also, HIV isn’t spread via water, air, or insect bites.

Risk factors of HIV

Any person of any race, age, or sexual orientation can develop HIV infection. However, the risk is higher if:

  • You have unprotected sexual intercourse.
  • You have multiple sexual partners.
  • Have a sexually transmitted infection.
  • You use illicit injection drugs.

Complications

The HIV virus weakens a person’s immune system, making him more susceptible to developing infections and certain types of cancers.

Infections common to HIV/AIDS

  • Pneumocystis pneumonia (PCP)
    It is a fungal infection that may cause severe illness.
  • Candidiasis (thrush)
    It is a common infection related to HIV that causes inflammation and a thick, white coat on the tongue, mouth, vagina, or the oesophagus.
  • Tuberculosis (TB)
    It is a common opportunistic infection related to HIV/AIDS. It is also a leading cause of death in AIDS patients.
  • Cytomegalovirus
    It is a herpes virus that can be transmitted via body fluids like blood, saliva, semen, urine, and breast milk. The virus is inactivated by a healthy immune system and it remains dormant in the body.
  • Cryptococcal meningitis
    Meningitis is the inflammation of the fluids and the membranes surrounding the brain and the spinal cord and is usually associated with HIV infection.
  • Toxoplasmosis
    It is a potentially life-threatening infection that occurs in AIDS patients and is caused by a parasite called Toxoplasma gondii that primarily spreads by cats. Infected cats transmit the parasites in their stools which may then spread to humans and other animals.

Cancers common to HIV/AIDS

  • Lymphoma
    It is a cancer that originates in the white blood cells. The most common early sign of the disease is a painless swelling of the lymph nodes of the armpit, neck, or groin.
  • Kaposi's sarcoma
    It is a tumour that arises from the walls of the blood vessels. It usually appears red, pink, or purple in colour on the skin and mouth. This condition may also affect the internal organs like the lungs and the digestive tract.
  • HPV-related cancers
    These cancers are caused by human papillomavirus (HPV) infection. They include oral, anal, and cervical cancer.

Other complications

  • Wasting syndrome
    Untreated HIV infection can lead to significant weight loss that is often associated with chronic weakness, diarrhoea, and fever.
  • Neurological complications
    HIV can lead to neurological symptoms like forgetfulness, confusion, anxiety, depression, and difficulty in walking. HIV-associated neurocognitive disorders (HAND) can range from mild behavioural change symptoms and reduced mental functioning to severe dementia too.
  • Kidney disease
    HIV-associated nephropathy (HIVAN) refers to the inflammation of the tiny filters inside the kidneys that are responsible for removing excess wastes and fluids from the blood and passing them to the urine.
  • Liver disease
    Liver diseases are also a major complication of HIV infections, especially in people with Hepatitis B or C infections.

Prevention of HIV

No vaccine is yet available for the prevention of HIV infection and no definitive cure is currently available. However, you can take certain steps to protect yourself and others from the infection.

  • Consider pre-exposure prophylaxis (PrEP)
    Certain drugs can reduce the risk of sexually transmitted HIV infections in high-risk individuals. PrEP can reduce this risk from sexual intercourse by around 99% and by around 74% from intravenous drug use.
  • Use treatment as prevention (TasP)
    If you are someone who has HIV, taking regular medications can keep your partner from getting infected with the virus. If you ensure that your viral load remains undetectable and the blood test doesn’t reveal any viral load, the virus won’t be transmittable via sexual route.
  • Use post-exposure prophylaxis (PEP) if you suspect exposure to HIV
    If you think you have had sexual exposure via sexual contact or needles in the workplace, you must contact your healthcare provider or the emergency department in your nearest hospital. If you are located in Indore, you can visit Kokilaben Dhirubhai Ambani Hospital, Indore and seek immediate medical care and attention. Your risk of contracting the virus greatly reduces if you take post-exposure prophylaxis within the first 72 hours of infection with HIV. You will be required to continue taking the medications for 28 days.
  • Use a new condom every time you have sexual intercourse
    Females can use a female condom. If you are using lubricant, you must ensure that those are water-based as oil-based lubricants can result in weakening of the condoms and result in their breakage.
  • Use a clean needle
    If you are using needles to inject illicit drugs, you must ensure that those are sterile and you are not sharing them.

Diagnosis

HIV can be diagnosed via saliva or blood testing. Following are the tests available:

  • Antigen/antibody tests
    These tests usually involve taking blood from a vein. Antigens are agents on the HIV virus that are detectable and can give a positive test on blood testing within a few weeks post-exposure. Antibodies are produced and released by the immune system when the body is exposed to the HIV virus.
  • Antibody tests
    These tests are used to detect antibodies to HIV in saliva or blood. Most rapid tests done for HIV including self-tests performed at home are antibody based tests. These can take around 3-12 weeks to become positive post-exposure.
  • Nucleic acid tests (NATs)
    These tests look for the viral load and involve blood drawn from a vein. If you might have had HIV exposure within the past few weeks, you might be recommended q NAT. It will be the first test to become positive after HIV exposure.

Discuss with your doctor regarding which HIV test is the right one for you. If any of these tests show negative results, you may still require a follow-up test weeks to months after to confirm the results.

If you have been diagnosed as having HIV, consult HIV specialists in Indore for further treatment. They will help:

  • Determine which HIV antiretroviral therapy (ART) will be most suitable for you.
  • Determine whether or not you require additional testing.
  • Monitor your progress and manage your health.

Tests for complications

Your doctor might also order some laboratory investigations to check for other complications or infections, including:

  • Hepatitis B or hepatitis C virus infection
  • Tuberculosis
  • Liver or kidney damage
  • STIs
  • Cervical and anal cancer
  • Urinary tract infection
  • Toxoplasmosis
  • Cytomegalovirus

Receiving a diagnosis of a life-threatening illness like AIDS can be devastating. The social, emotional and financial consequences of a disease like HIV/AIDS can make coping with this illness especially challenging - not only for you but also for your family members. Consult specialists at our HIV Clinic in Indore for the best possible treatment.