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HIV

HIV/AIDS – Risk Factors, Causes, Diagnosis and its Treatment

 

Introduction

Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS). HIV/AIDS weakens the immune system, making a person unable to fight off infections that would normally be easily overcome . The development of opportunistic infections in a susceptible person eventually causes death. While plenty of research has resulted in treatment options that help slow the course of the disease, there is no cure yet for AIDS.

Cause

HIV is a retrovirus that attaches to specific immune cells in the body called CD4 T cells. It enters the cell, uses the host cellular machinery to replicate, infects nearby T cells and spread throughout the body. Targeted CD 4 cells meanwhile reduce in number because of the viral infection as well as through the process of apoptosis (programmed cell death).  The destruction of these immune cells lowers the body’s immune response significantly making one susceptible to opportunistic infections.

Since HIV is present in the bodily fluids of a person such as blood, semen, pre-cum and breast milk , the virus enters the body though any contact with mucous membrane or broken skin or direct injection into the bloodstream. Therefore transmission of the virus can happen viavaginal, anal or oral sex, blood transfusions or exposure to hypodermic needles contaminated with the virus. It can also be passed on from an HIV infected mother to her offspring during pregnancy, labor or while breast feeding.

HIV cannot be transmitted through casual contact such as hugging and kissing, sharing utensils, insect bites, sweat or toilet seats. While HIV is present in the saliva, it is found in extremely small quantities, which is insufficient to cause infection.

Risk Factors:

Having unprotected anal, vaginal or oral sex, having multiple sexual partners or intravenous drug use have been known to increase risk of HIV infection considerably. In addition, infection with other STIs that may produce open sores and being uncircumcised can further increase risk.

Some gender, racial and age groups are also at an increased risk because of the preponderance of an already high number of infected individuals in the population. Such groups include gay and bisexual men, pregnant women, African Americans and Asians.

Health care workers are also considered high risk because of occupational exposure to the virus.

Clinical Presentation

Many HIV infected individuals do not show any symptoms until the infection has progressed to AIDS. The symptoms also vary depending on an individual’s age, health status, stage of disease etc.

Primary HIV infection is seen at times within 2-4 weeks after infection. This stage is also termed acute retroviral syndrome and symptoms include fever, rashes, swollen glands, fatigue and muscle ache. This acute stage can last from days to weeks.

The second stage is termed clinical latency, chronic HIV infection or asymptomatic HIV infection. During this stage no HIV related symptoms may be seen but the virus continues to multiply and the person is infectious. If no treatment is carried out, the journey from chronic HIV to AIDS can take 10-12 years but the onset time tends to vary between individuals.

When left untreated, the HIV infection weakens a person’s immune system making them susceptible to serious infections. This final stage of HIV infection is known as AIDS.  Symptoms of late stage infection include frequent fevers, diarrhea, dry cough, extreme fatigue, recurrent vaginal infections, thrush (white spots covering the tongue), rapid weight loss, prolonged swelling of glands, memory loss, Kaposi’s sarcoma and frequent infections.

Differential

All the infections caused by HIV, can occur even without the presence of the virus. They mainly require immune suppression. Therefore, diagnosis of HIV infection should be done accordingly. Differential diagnosis of HIV includes herpes simplex virus, candidiasis, cytomegalovirus, toxoplasmosis, lymphomas, influenza, viral hepatitis and secondary syphilis.

Diagnosis

HIV is diagnosed by detecting the HIV virus in blood or saliva samples. One way to do this is to check for antibodies. Typically, antibodies against the HIV virus are generated 2 to 12 weeks after infection. Therefore while antibody detection tests such as ELISA and western blots are highly accurate, the delay in antibody production is a hindrance.

Testing for the HIV antigen however can help detect the virus within days of the infection. RNA tests, while expensive, also detect the virus quickly.Additional tests are done after diagnosis. These include CD4 count (when the CD4 count in the blood of an infected person is less than 200/mm3 , a person may be diagnosed as having AIDS) and viral load test.

Treatment for HIV/AIDS

Currently, there is no drug which can completely eliminate the virus from the body. Treatment depends on taking multiple antiretroviral drugs belonging to different classes, which can limit the amount of virus present and therefore protect the immune system. The classes of antiretroviral drugs are non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, protease inhibitors, entry of fusion inhibitors and integrase inhibitors. These drugs attack the virus at different points in its life cycle and choosing the right combination relies on a patient’s general state of health and ability to manage side effects.

 

High-risk individuals should get tested for HIV so as to prevent further spread.

Condom usage greatly reduces the risk of HIV. Other safe sex practices such as reducing the number of sexual partners has also been shown to lower risk.

Use only sterile needles for injections

Post-exposure prophylaxis (PEP) is the use of HIV medicine in persons not known to have the infection but who have recently engaged in high-risk sexual practices. This is done to reduce the risk of HIV infection.