HIV/AIDS Prevention and Treatment: Expert Guide

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HIV is a virus that damages the immune system. The immune system helps the body fight off infections. Untreated HIV infects and kills CD4 cells, which are a type of immune cell called T cells. Over time, as HIV kills more CD4 cells, the body is more likely to get various types of infections and cancers.

HIV is transmitted through bodily fluids that include:

­čö╗Blood
­čö╗Semen
­čö╗Vaginal and rectal fluids
­čö╗Breast milk
­čö╗The virus doesn’t spread in air or water, or through casual contact.

HIV is a lifelong condition and currently there is no cure, although many scientists are working to find one. However, with medical care, including treatment called antiretroviral therapy, it’s possible to manage HIV and live with the virus for many years.

Without treatment, a person with HIV is likely to develop a serious condition called AIDS. At that point, the immune system is too weak to fight off other diseases and infections. Untreated, life expectancy with AIDS is about three years. With antiretroviral therapy, HIV can be well-controlled and life expectancy can be nearly the same as someone who has not contracted HIV.

HIV/AIDS

WHAT IS AIDS

AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV. But just because a person has HIV doesn’t mean they’ll develop AIDS.

HIV kills CD4 cells. Healthy adults generally have a CD4 count of 500 to 1,500 per cubic millimeter. A person with HIV whose CD4 count falls below 200 per cubic millimeter will be diagnosed with AIDS.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer that’s rare in people who don’t have HIV. An opportunistic infection, such as pneumonia, is one that takes advantage of a unique situation, such as HIV.

Untreated, HIV can progress to AIDS within a decade. There’s no cure for AIDS, and without treatment, life expectancy after diagnosis is about three years. This may be shorter if the person develops a severe opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing.

If AIDS does develop, it means that the immune system is severely compromised. It’s weakened to the point where it can no longer fight off most diseases and infections. That makes the person vulnerable to a wide range of illnesses, including:

­čö╗Pneumonia
­čö╗Tuberculosis
­čö╗Oral thrush, a fungal infection in the mouth or throat
­čö╗Cytomegalovirus (CMV), a type of herpes virus
­čö╗Cryptococcal meningitis, a fungal infection in the brain
­čö╗Toxoplasmosis, a brain infection caused by a parasite
­čö╗Cryptosporidiosis, an infection caused by an intestinal parasite
Cancer, including Kaposi’s sarcoma (KS) and lymphoma
­čö╗The shortened life expectancy linked with untreated AIDS isn’t a direct result of the syndrome itself. Rather, it’s a result of the diseases and complications that arise from having an immune system weakened by AIDS. Learn more about possible complications that can arise from HIV and AIDS.

HIV and AIDS:

To develop AIDS, a person has to have contracted HIV. But having HIV doesn’t necessarily mean that someone will develop AIDS.

Cases of HIV progress through three stages:

stage 1: acute stage, the first few weeks after transmission
stage 2: clinical latency, or chronic stage
stage 3: AIDS
As HIV lowers the CD4 cell count, the immune system weakens. A typical adult’s CD4 count is 500 to 1,500 per cubic millimeter. A person with a count below 200 is considered to have AIDS.

There is no cure for HIV, but it can be controlled. People with HIV often have a near-normal lifespan with early treatment with antiretroviral therapy. Along those same lines, there’s technically no cure for AIDS. However, treatment can increase a person’s CD4 count to the point where they’re considered to no longer have AIDS. (This point is a count of 200 or higher.) Also, treatment can typically help manage opportunistic infections.

HIV and AIDS are related, but they’re not the same thing.

HIV TRANSMISSION :

Anyone can contract HIV. The virus is transmitted in bodily fluids that include:
­čö╗blood
­čö╗semen
­čö╗vaginal and rectal fluids
­čö╗breast milk

Some of the ways HIV is spread from person to person include:

Through vaginal or anal sex — the most common route of transmission, especially among men who have sex with men
By sharing needles, syringes, and other items for injection drug use
By sharing tattoo equipment without sterilizing it between uses
During pregnancy, labor, or delivery from a woman to her baby
During breastfeeding
Through “pre-mastication,” or chewing a baby’s food before feeding it to them
Through exposure to the blood of someone living with HIV, such as through a needle stick

HIV DOES NOT SPREAD THROUGH

­čö╗Skin-to-skin contact
­čö╗Hugging, shaking hands, or kissing
­čö╗Air or water
­čö╗Sharing food or drinks, including drinking fountains
­čö╗Saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
­čö╗Sharing a toilet, towels, or bedding
Mosquitoes or other insects
­čö╗It’s important to note that if a person with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

CAUSES OF HIV

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

SYMPTOMS OF AIDS

­čö╗Recurrent fever
­čö╗Chronic swollen lymph glands, especially of the armpits, neck, and ­čö╗groin
­čö╗Chronic fatigue
­čö╗Night sweats
­čö╗Dark splotches under the skin or inside the mouth, nose, or eyelids
­čö╗Sores, spots, or lesions of the mouth and tongue, genitals, or anus
­čö╗Bumps, lesions, or rashes of the skin
­čö╗Recurrent or chronic diarrhea
­čö╗Rapid weight loss
­čö╗Neurologic problems such as trouble concentrating, memory loss, and confusion
­čö╗Anxiety and depression
­čö╗Antiretroviral therapy controls the virus and usually prevents progression to AIDS. Other infections and complications of AIDS can also be treated. That treatment must be tailored to the individual needs of the person.

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.

DIAGNOSIS

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

ANTIBODY/ANTIGEN TEST

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 18–45 days 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 fight an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

ANTIBODY TEST

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.
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.

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 fight 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 infection.

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 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 spreading HIV when taken consistently.

Timing is important when testing for HIV.

EARLY SYMPTOMS OF HIV

The first few weeks after someone contracts HIV is called the acute infection stage. During this time, the virus reproduces rapidly. The person’s immune system responds by producing HIV antibodies. These are proteins that fight infection.

During this stage, some people have no symptoms at first. However, many people experience symptoms in the first month or two after contracting the virus, but often don’t realize they’re caused by HIV. This is because symptoms of the acute stage can be very similar to those of the flu or other seasonal viruses. They may be mild to severe, they may come and go, and they may last anywhere from a few days to several weeks.

TREATMENT OF 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 fight off 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. Learn more about how HIV treatments work.

HIV MEDICATIONS

These antiretroviral medications are grouped into six classes:

­čö╗Nucleoside reverse transcriptase inhibitors (NRTIs)
­čö╗Non-nucleoside reverse ­čö╗transcriptase inhibitors (NNRTIs)
­čö╗Protease inhibitors
­čö╗Fusion inhibitors
­čö╗CCR5 antagonists, also known as entry inhibitors
­čö╗Integrase strand transfer inhibitors

HIV PREVENTION

Although many researchers are working to develop one, there’s currently no vaccine available to prevent the transmission of HIV. However, taking certain steps can help prevent the spread of HIV.

GET TESTED FOR HIV-It’s important they learn their status and that of their partner.
GET TESTED FOR SEXUALLY TRANSMITTED INFECTIONS (STIs). I
f they test positive for one, they should get it treated, because having an STI increases the risk of contracting HIV.
USE CONDOMS- They should learn the correct way to use condoms and use them every time they have sex, whether it’s through vaginal or anal intercourse. It’s important to keep in mind that pre-seminal fluids (which come out before male ejaculation) can contain HIV.
LIMIOT THEIR SEXUAL PARTNERS- They should have one sexual partner with whom they have an exclusive sexual relationship.
Take their medications as directed if they have HIV. This lowers the risk of transmitting the virus to their sexual partner.
Shop for condoms.

The most important thing is to start antiretroviral treatment as soon as possible. By taking medications exactly as prescribed, people living with HIV can keep their viral load low and their immune system strong. It’s also important to follow up with a healthcare provider regularly.

Of course, many things affect life expectancy for a person with HIV. Among them are:
­čö╗CD4 cell count
­čö╗Viral load
­čö╗Serious HIV-related illnesses, ­čö╗including hepatitis infection
­čö╗Drug use
­čö╗Smoking
­čö╗Access, adherence, and response to treatment

HIV is a complicated virus. It mutates (changes) rapidly and is often able to fend off immune system responses. Only a small number of people who have HIV develop broadly neutralizing antibodies, the kind of antibodies that can fight a range of HIV strains.

While there’s still no vaccine to prevent HIV, people with HIV can benefit from other vaccines to prevent HIV-related illnesses, such as:

­čö╗ Pneumonia
­čö╗ Influenza
­čö╗ Hepatitis A and B
­čö╗ Meningitis
­čö╗ Shingles

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