HIV/AIDS: Definition, Cause, Symptom, Diagnosis and Treatment.

What is HIV?

HIV means Human Immunodeficiency Virus, is a disease causing microorganisms which can be transmitted from person to person, mother to child and develop to AIDS.

What is AIDS?

Acquired Immunodeficiency Syndrome caused by HIV virus, is a chronic diseases which weaken immune system and causes potentially  life threatening complications to the body.

What are the key facts about HIV?

HIV continues to be a major global public health issue, having claimed almost 33 million lives so far. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to live long and healthy.

There were an estimated 38.0 million people living with HIV at the end of 2019.

As a result of concerted international efforts to respond to HIV, coverage of services has been steadily increasing. In 2019, 68% of adults and 53% of children living with HIV globally were receiving lifelong antiretroviral therapy (ART).

A great majority (85%) of pregnant and breastfeeding women living with HIV also received ART, which not only protects their health, but also ensures prevention of HIV transmission to their newborns.

At the end of 2019, an estimated 81% of people living with HIV knew their status. 67% were receiving antiretroviral therapy (ART) and 59% had achieved suppression of the HIV virus with no risk of infecting others; about 30 million adolescent boys and men in East and Southern Africa had received VMMC services.

The number of new people starting treatment is far below expectation due to the reduction in HIV-testing and treatment initiation and ARV disruptions that occurred during the COVID-19 pandemic. By end 2020, testing and treatment rates showed steady but variable recovery.

Nevertheless, between 2000 and 2019, new HIV infections fell by 39% and HIV-related deaths fell by 51%, with 15.3 million lives saved due to ART. This achievement was the result of great efforts by national HIV programmes supported by civil society and international development partners.

But success has been variable by region, country and population; However, not everyone is able to access HIV testing, treatment and care. Notably, the 2018 Super-Fast-Track targets for reducing new paediatric HIV infections to 40 000 was not achieved. Geven prior to the COVID-19 pandemic, reduction of new infections and deaths had plateaued; global 90/90/90 targets for 2020 are at risk of being missed unless rapid action is taken.

Due to gaps in HIV services, 690 000 people died from HIV-related causes in 2019 and 1.7 million people were newly infected.

To reach the new proposed global 95/95/95 targets, we will need to redouble our efforts to avoid the worst-case scenario a half million excess deaths in Sub Saharan Africa, increasing HIV infections due to HIV service disruptions during COVID-19, and the slowing public health response to HIV.

Interventions will need to focus on the populations left-behind: Key population groups and their sexual partners accounted for over 6620% of all new HIV infections globally among the age group 15-49 years in 2019. In eastern European and central Asia, Asia and the Pacific, western and central Europe, and north America, and the Middle East and north Africa, these groups accounted for over 95% of new HIV infections in each of these regions.

WHO defines key populations as people in populations who are at increased HIV risk in all countries and regions. Key populations include: Homo sexual; people who inject drugs; people in prisons and other closed settings; sex workers and their clients; and transgender people.

Increased HIV vulnerability is often associated with legal and social factors, which increases exposure to risk situations and creates barriers to accessing effective, quality and affordable HIV prevention, testing and treatment services. Prioritising key populations in the HIV response with appropriate interventions would have the biggest impact on the epidemic and reduce new infections.

In addition, given their life circumstances, a range of other populations may be particularly vulnerable, and at increased risk of HIV infection, such as adolescent girls and young women in southern and eastern Africa and indigenous peoples in some communities.

Over two thirds of all people living with HIV live in the WHO African Region (25.7 million). While HIV is prevalent among the general population in this region, an increasing number of new infections occur among key population groups.

HIV can be diagnosed through rapid diagnostic tests that can provide same-day results. HIV self-tests are increasingly available and provide an effective and acceptable alternative way to increase access to people who are not reached for HIV testing through facility-based services. Rapid test and self-tests have greatly facilitated diagnosis and linkage with treatment and care.

There is no cure for HIV infection. However, effective prevention interventions are available: preventing mother-to-child-transmission, male and female condom use, harm reduction interventions, pre-exposure prophylaxis, post exposure prophylaxis, voluntary medical male circumcision (VMMC) and antiretroviral drugs (ARVs) which can control the virus and help prevent onward transmission to other people.

Science is moving at a fast pace, and there have been two people who have achieved a ‘functional cure’ by undergoing a bone marrow transplant for cancer with re-infusion of new CD4 T cells that are unable to be infected with HIV. However, a neither a cure nor a vaccine is available to treat and protect all people currently living with or at risk of HIV.

The human immunodeficiency virus (HIV) targets the immune system and weakens people's defense  against many infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count.

Immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off.

The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take many years to develop if not treated, depending on the individual. AIDS is defined by the development of certain cancers, infections or other severe long term clinical manifestations.

HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and delivery. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water. 

It is important to note that people with HIV who are taking ART and are virally suppressed do not transmit HIV to their sexual partners.  Early access to ART and support to remain on treatment is therefore critical not only to improve the health of people with HIV but also to prevent HIV transmission.

Causes of HIV

HIV is a variation of a virus that can be transmitted to African chimpanzees. Scientists suspect the simian immunodeficiency virus (SIV) jumped from chimps to humans when people consumed chimpanzee meat containing the virus.

Once inside the human population, the virus mutated into what we now know as HIV. This likely occurred as long ago as the 1920s.

HIV spread from person to person throughout Africa over the course of several decades. Eventually, the virus migrated to other parts of the world. Scientists first discovered HIV in a human blood sample in 1959.

It’s thought that HIV has existed in the United States since the 1970s, but it didn’t start to hit public consciousness until the 1980s.

Causes of AIDS

AIDS is caused by HIV. A person can’t get AIDS if they haven’t contracted HIV.

Healthy individuals have a CD4 count of 500 to 1,500 per cubic millimeter. Without treatment, HIV continues to multiply and destroy CD4 cells. If a person’s CD4 count falls below 200, they have AIDS.

Also, if someone with HIV develops an opportunistic infection associated with HIV, they can still be diagnosed with AIDS, even if their CD4 count is above 200.

  Risk factors to HIV

Behaviours and conditions that put individuals at greater risk of contracting HIV include:

having unprotected anal or vaginal sex;

having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea and bacterial vaginosis;

sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;

receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and

experiencing accidental needle stick injuries, including among health workers.

What are the symptoms of HIV/AIDS?

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection (Acute HIV)

Some people infected by HIV develop a flu-like illness within two to four weeks after the virus enters the body. This illness, known as primary (acute) HIV infection, may last for a few weeks. Possible signs and symptoms include:

Fever

Headache

Muscle aches and joint pain

Rash

Sore throat and painful mouth sores

Swollen lymph glands, mainly on the neck

Diarrhea

Weight loss

Cough

Night sweats.

These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.

Clinical latent infection (Chronic HIV)

In this stage of infection, HIV is still present in the body and in white blood cells. However, many people may not have any symptoms or infections during this time.

This stage can last for many years if you're not receiving antiretroviral therapy (ART). Some people develop more severe disease much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy your immune cells — the cells in your body that help fight off germs — you may develop mild infections or chronic signs and symptoms such as:

Fever

Fatigue

Swollen lymph nodes — often one of the first signs of HIV infection

Diarrhea

Weight loss

Oral yeast infection (thrush)

Shingles (herpes zoster)

Pneumonia

  Progression to AIDS

Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 8 to 10 years.

When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually cause illness in a person with a healthy immune system.

The signs and symptoms of some of these infections may include:

Sweats

Chills

Recurring fever

Chronic diarrhea

Swollen lymph glands

Persistent white spots or unusual lesions on your tongue or in your mouth

Persistent, unexplained fatigue

Weakness

Weight loss

Skin rashes or bumps.

How to diagnose HIV?

Several different tests can be used to diagnose HIV. Healthcare providers determine which test is best for each person.

Antigen/Antibody tests

Antigen/Antibody tests are the most commonly used tests. They can show positive results typically within 18–45 daysTrusted Source after someone initially contracts HIV.

These tests check the blood for antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

  Antibody tests

These tests check the blood solely for antibodies. Between 23 and 90 days after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.

These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a healthcare provider’s office or clinic.

Other antibody tests can be done at home:

  OraQuick HIV Test. 

An oral swab provides results in as little as 20 minutes.

Home Access HIV-1 Test System. After the person pricks their finger, they send a blood sample to a licensed laboratory. They can remain anonymous and call for results the next business day.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their healthcare provider to confirm.

  Nucleic acid test (NAT)

This expensive test isn’t used for general screening. It’s for people who have early symptoms of HIV or have a known risk factor. This test doesn’t look for antibodies; it looks for the virus itself.

It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.

Today, it’s easier than ever to get tested for HIV.

What’s the HIV window period?

As soon as someone contracts HIV, it starts to reproduce in their body. The person’s immune system reacts to the antigens (parts of the virus) by producing antibodies (cells that take countermeasures against the virus).

The time between exposure to HIV and when it becomes detectable in the blood is called the HIV window period. Most people develop detectable HIV antibodies within 23 to 90 days after transmission.

If a person takes an HIV test during the window period, it’s likely they’ll receive a negative result. However, they can still transmit the virus to others during this time.

If someone thinks they may have been exposed to HIV but tested negative during this time, they should repeat the test in a few months to confirm (the timing depends on the test used). And during that time, they need to use condoms or other barrier methods to prevent possibly spreading HIV.

Someone who tests negative during the window might benefit from post-exposure prophylaxis (PEP). This is medication taken after an exposure to prevent getting HIV.

PEP needs to be taken as soon as possible after the exposure; it should be taken no later than 72 hours after exposure but ideally before then.

Another way to prevent getting HIV is pre-exposure prophylaxis (PrEP). A combination of HIV drugs taken before potential exposure to HIV, PrEP can lower the risk of contracting or transmitting HIV when taken consistently.

Timing is important when testing for HIV.

  HIV testing services

HIV testing should be voluntary and the right to decline testing should be recognized. Mandatory or coerced testing by a health care provider or authority, or by a partner or family member is not acceptable as it undermines good public health practice and infringes on human rights.

New technologies to help people test themselves are being introduced, with many countries implementing self-testing as an additional option to encourage HIV diagnosis. HIV self-testing is a process whereby a person who wants to know his or her HIV status collects a specimen, performs a test, and interprets the test results in private or with someone they trust. HIV self-testing does not provide a definitive HIV-positive diagnosis, but it should be used as an initial test to be followed by confirmatory testing by a health worker.  Many countries are now using innovative approaches to develop and support HIV self-testing using digital platforms and on line support for help with the testing procedure and linkage to services

The sexual partners and drug-injecting partners of people diagnosed with HIV infection have an increased probability of also being HIV-positive. 

WHO recommends voluntary assisted HIV partner notification services as a simple and effective way to reach these partners many of whom are undiagnosed and unaware of their HIV exposure and may welcome support and an opportunity to test for HIV. Partner services can be highly acceptable and effective but should always be provided in a way that respects the choices of the people being offered these services.  It must always be voluntary and support and options provided to avoid any potential social harms.

All HIV testing services must follow the WHO-recommended principles known as the “5 Cs”:

informed Consent

Confidentiality

Counselling

Correct test results

Connection (linkage to care, treatment and other services).

What are the rashes related to HIV?

HIV makes someone more susceptible to skin problems because the virus destroys immune system cells that take measures against infection. Co-infections that can cause rash include:

molluscum contagiosum

herpes simplex

shingles.

The cause of the rash determines:

how it looks

how long it lasts

how it can be treated depends on the cause.

  Rash related to medication

While rash can be caused by HIV co-infections, it can also be caused by medication. Some drugs used to treat HIV or other conditions can cause a rash.

This type of rash usually appears within a week or 2 weeks of starting a new medication. Sometimes the rash will clear up on its own. If it doesn’t, a change in medications may be needed.

Rash due to an allergic reaction to medication can be serious.

Other symptoms of an allergic reaction include:

trouble breathing or swallowing

dizziness

fever.

Stevens-Johnson syndrome (SJS) is a rare allergic reaction to HIV medication. Symptoms include fever and swelling of the face and tongue. A blistering rash, which can involve the skin and mucous membranes, appears and spreads quickly.

When 30 percent of the skin is affected, it’s called toxic epidermal necrolysis, which is a life threatening condition. If this develops, emergency medical care is needed.

While rash can be linked with HIV or HIV medications, it’s important to keep in mind that rashes are common and can have many other causes.

  Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy, a combination of daily medications that stop the virus from reproducing. This helps protect CD4 cells, keeping the immune system strong enough to take measures against disease.

Antiretroviral therapy helps keep HIV from progressing to AIDS. It also helps reduce the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

    HIV medications

Many antiretroviral therapy medications are approved to treat HIV. They work to prevent HIV from reproducing and destroying CD4 cells, which help the immune system generate a response to infection.

This helps reduce the risk of developing complications related to HIV, as well as transmitting the virus to others.

These antiretroviral medications are grouped into six classes:

1. Nucleoside reverse transcriptase inhibitors (NRTIs)

2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

3. Protease inhibitors

4. Fusion inhibitors

5. CCR5 antagonists, also known as entry inhibitors

6. Integrase strand transfer inhibitors.

  Treatment regimens of HIV/AIDS

The U.S. Department of Health and Human Services (HHS) generally recommends a starting regimen of three HIV medications from at least two of these drug classes.

This combination helps prevent HIV from forming resistance to medications. (Resistance means the drug no longer works to treat the virus.)

Many of the antiretroviral medications are combined with others so that a person with HIV typically takes only one or two pills a day.

A healthcare provider will help a person with HIV choose a regimen based on their overall health and personal circumstances.

These medications must be taken every day, exactly as prescribed. If they’re not taken appropriately, viral resistance can develop, and a new regimen may be needed.

Blood testing will help determine if the regimen is working to keep the viral load down and the CD4 count up. If an antiretroviral therapy regimen isn’t working, the person’s healthcare provider will switch them to a different regimen that’s more effective.

   Side effects and costs

Side effects of antiretroviral therapy vary and may include nausea, headache, and dizziness. These symptoms are often temporary and disappear with time.

Serious side effects can include swelling of the mouth and tongue and liver or kidney damage. If side effects are severe, the medications can be adjusted.

Costs for antiretroviral therapy vary according to geographic location and type of insurance coverage. Some pharmaceutical companies have assistance programs to help lower the cost.

  Preventive measures of HIV/AIDS

Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key approaches for HIV prevention, which are often used in combination, are listed below.

Male and female condom use

Correct and consistent use of male and female condoms during vaginal or anal penetration can protect against the spread of STIs, including HIV. Evidence shows that male latex condoms when used consistently have an 85% or greater protective effect against HIV and other STIs.

Testing and counselling for HIV and STIs

Testing for HIV and other STIs is strongly advised for all people exposed to any of the risk factors. This enables people to learn of their own HIV status and access necessary prevention and treatment services without delay. WHO also recommends offering testing for partners or couples. Additionally, WHO recommends voluntary assisted partner notification approaches, in which people with HIV receive support to inform their partners either on their own, or with the help of health care providers.

 Programmes that offer support for testing people in social networks can also be an effective and acceptable approach for some populations. 

Testing and counselling, linkages to tuberculosis (TB) care

Tuberculosis is the most common illness among people living with HIV. Fatal if undetected or untreated, TB is the leading cause of death among people with HIV, responsible for nearly 1 in 3 HIV-associated deaths.

Early detection of TB and prompt linkage to TB treatment and ART can prevent these deaths. TB screening should be offered routinely at HIV care services, and routine HIV testing should be offered to all patients with presumptive and diagnosed TB. TB preventive therapy should be offered to all people living with HIV who do not have active TB. Individuals who are diagnosed with HIV and active TB should urgently start effective TB treatment (including for multidrug-resistant TB) and ART. 

Voluntary medical male circumcision (VMMC)

Medical male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 50% including in ‘real world’ settings where scale up occurred alongside the increasing coverage of ART with its secondary prevention effect.  In 2020, WHO updated the 2007 recommendation for VMMC to continue as an additional prevention intervention among males age 15 years and older. This is a key intervention of a combination prevention strategy in  settings with high HIV prevalence, particularly countries in eastern and southern Africa. VMMC also reduces the risk of other sexually transmitted infections. At the end of 2019,  27 million adolescent boys and men in eastern and southern Africa had been provided with a package of services. Over 15 million VMMCs were performed between 2016 and 2019. The service package, includes education on safer sex and condom use, offer of HIV testing, management of sexually transmitted infections in including links to treatment as needed, and the surgical procedure. VMMC is regarded as a good point of contact between men and adolescent boys and health services, which they often do not seek out; and other services such as hypertension screening are offered in some settings. 

Use of ARVs for prevention

Secondary prevention benefits of ART

Several studies confirmed that if an HIV-positive person is taking ART and is virally suppressed they do not transmit HIV to  their uninfected sexual partners WHO recommended that all people living with HIV should be offered ART with the main aim of saving lives and contributing to reducing HIV transmission.

Pre-exposure prophylaxis (PrEP) for HIV-negative partner

Oral PrEP of HIV is the daily use of ARVs by HIV-negative people to block the acquisition of HIV. More than 10 randomized controlled studies have demonstrated the effectiveness of PrEP in reducing HIV transmission among a range of populations, including serodiscordant heterosexual couples (where one partner is infected and the other is not), men who have sex with men, transgender women, high-risk heterosexual couples, and people who inject drugs.

WHO recommends PrEP as a prevention choice for people at substantial risk of HIV infection as part of a combination of prevention approaches. WHO has also expanded these recommendations to HIV-negative women who are pregnant or breastfeeding.  For men who have sex with men “event driven’ PrEP is also an effective PrEP option. This is taking two pills sex between two and 24 hours in before sex; then, a third pill 24 hours after the first two pills, and a fourth pill 48 hours after the first two pills.  This is often known as the 2+1+1.  Long acting PrEP products including an injection and a vaginal ring show promise and WHO will continue to review the data on these for future guidance.  

Post-exposure prophylaxis for HIV (PEP)

PEP is the use of ARVs within 72 hours of exposure to HIV to prevent infection. PEP includes counselling, first aid care, HIV testing, and administration of a 28-day course of ARV drugs with follow-up care. WHO recommends PEP use for both occupational and non-occupational exposures, and for adults and children.

Harm reduction for people who inject and use drugs

People who inject drugs can take precautions against becoming infected with HIV by using sterile injecting equipment (including needles and syringes) for each injection, and not sharing drug-using equipment and drug solutions. Treatment of drug dependence, in particular, opioid substitution therapy for people dependent on opioids, also helps to reduce the risk of HIV transmission and supports adherence to HIV treatment. A comprehensive package of HIV prevention and treatment interventions for people who inject drugs includes:

Needle and syringe programmes;

opioid substitution therapy for people dependent on opioids, and other evidence-based drug dependence treatment;

HIV testing and counselling;

HIV treatment and care;

risk-reduction information and education, and provision of naloxone to prevent opioid overdose;

access to condoms; and

management of STIs, TB and viral hepatitis.

Elimination of mother-to-child transmission of HIV

The transmission of HIV from an HIV-positive mother to her child during pregnancy, labour, delivery or breastfeeding is called vertical or mother-to-child transmission (MTCT). In the absence of any interventions during these stages, rates of HIV transmission from mother-to-child can be between 15% and 45%. The risk of MTCT can almost be eliminated if both the mother and her baby are provided with ARV drugs as early as possible in pregnancy and during the period of breastfeeding.

WHO recommends lifelong ART for all people living with HIV, regardless of their CD4 count and the clinical stage of disease; this includes pregnant and breastfeeding women. In 2019, 85% of the estimated 1.3 million pregnant women living with HIV globally received ARV drugs to prevent transmission to their children. A growing number of countries and territories  are achieving very low rates of MTCT, with some formally validated for elimination of MTCT of HIV as a public health problem (Anguilla, Antigua and Barbuda, Armenia, Belarus, Bermuda, Cayman Islands, Cuba, Malaysia, Maldives, Montserrat, Saint Kitts and Nevis, and Thailand). Several countries with a high burden of HIV infection are also progressing along the path to elimination.

Sources:

www.who.int

www.healthline.com

www.mayoclinic.org