Human Immunodeficiency Virus (HIV)

Overview

HIV stands for Human Immunodeficiency Virus which's a virus that targets the immune system of the body. HIV can develop to AIDS if it is not treated (acquired immunodeficiency syndrome).

The virus is classified into two types: HIV-1 and HIV-2. HIV-2 is most typically found in West Africa, however it is also present in other parts of the world. HIV tests typically look for both types.

When certain body fluids are shared, such as during vaginal or anal sex, or when injecting drugs, the virus spreads from person to person. It can also be transmitted through contaminated tattoo and body piercing needles. It can also be transmitted during oral sex, however the likelihood is low.

Mothers can spread HIV to their children after birth, when the newborn comes into contact with their infected blood, or through breast milk. However, in some parts of the developing world, it is safer for HIV-positive mothers to breastfeed for a few months rather than giving a newborn formula made from potentially contaminated water, especially if they are undergoing HIV treatment.

Because HIV does not exist in saliva, tears, pee, or sweat, it cannot be transmitted by casual contact with these bodily fluids.

There is no effective treatment available at the moment. People who contract HIV are infected for life. HIV, on the other hand, may be controlled with good medical care. HIV patients who get good HIV therapy can live long, healthy lives and protect their relationships.

HIV Definition

Human immunodeficiency virus (HIV) is a retrovirus that infects immune system cells and destroys or impairs their function. The immune system weakens as the virus continues, making the person more susceptible to infections. Acquired immunodeficiency syndrome is the most advanced stage of HIV infection (AIDS). An HIV-infected person may not acquire AIDS for 10 to 15 years.

HIV infection in humans was caused by a sort of chimp in Central Africa. The chimp variant of the virus (known as simian immunodeficiency virus, or SIV) was most likely passed on to humans when humans hunted these chimpanzees for meat and came into touch with their contaminated blood.

HIV spread slowly across Africa and then to the rest of the world over decades. We know that the virus has been present in the United States since at least the mid to late 1970s.

Worldwide Facts About HIV/AIDS

According to some researchers, HIV/AIDS is a worldwide epidemic. As of 2016, over 36.7 million individuals worldwide have HIV, with roughly 1.8 million new infections that year. This is a decrease from the 3.1 million new infections recorded in 2001. Women account for somewhat more than half of the afflicted population, while children account for 2.1 million. It led in around 1 million fatalities in 2016, down from 1.9 million in 2005.

In the United States in 2008, around 1.2 million people were living with HIV, resulting in roughly 17,500 fatalities. Since the beginning of the HIV pandemic in 1981, about 675,000 persons in the United States have died as a result of HIV/AIDS. As of 2015, there were roughly 101,200 cases in the United Kingdom, with 594 fatalities.

What are the Stages of HIV?

When HIV patients do not get therapy, they normally move through three phases. However, HIV medication can halt or stop the growth of the illness. With advances in therapy, progression to Stage 3 is less prevalent now than it was in the early days of HIV.

Stage 1: Acute HIV Infection:

• People have a high level of HIV in their blood. They are extremely infectious.
• Some people are experiencing flu-like symptoms. This is the body's normal reaction to infection.
• Some people, however, may not feel unwell soon after or at all.
• If you experience flu-like symptoms and believe you may have been exposed to HIV, get medical attention and request an acute infection test.
• Acute infection can only be diagnosed by antigen/antibody testing or nucleic acid tests (NATs).

Stage 2: Chronic HIV Infection:

• This is sometimes referred to as asymptomatic HIV infection or clinical latency.
• HIV is still alive and well, although it reproduces at a very low rate.
• During this stage, people may not have any symptoms or become ill.
• Without HIV medication, this stage might span a decade or longer, but some people may proceed quicker.
• During this stage, people can spread HIV.
• At the end of this phase, the amount of HIV in the blood (known as viral load) increases as the CD4 cell count decreases. As the virus levels in the body rise, the person may experience symptoms and progress to Stage 3.
• People who take HIV medication as directed may never get to Stage 3.

Stage 3: Acquired Immunodeficiency Syndrome (AIDS):

• The most severe stage of HIV infection.
• People with AIDS have such weakened immune systems that they are susceptible to an increasing number of serious diseases known as opportunistic infections.
• When a person's CD4 cell count falls below 200 cells/mm or if they get specific opportunistic illnesses, they are diagnosed with AIDS.
• People suffering from AIDS may have a high viral load and be highly contagious.
• Without therapy, persons with AIDS have a three-year survival rate.

Transmission of HIV/AIDS

The majority of persons who get HIV do so through anal or vaginal intercourse or by sharing needles, syringes, or other drug injection equipment (for example, cookers). However, there are potent technologies available to aid in the prevention of HIV transmission.

The following are the most frequently asked questions concerning the risk of HIV transmission for various forms of intercourse, injectable drug use, and other behaviours. Here is the most common questions asked:

Can I get HIV from anal sex?

If you have anal intercourse with someone who has HIV and do not use protection, you can catch HIV (like condoms or medicine to treat or prevent HIV).

Anal intercourse is the most hazardous kind of sex for acquiring or transferring HIV.Being the receptive (bottom) partner is riskier than being the insertive (top) (top).The danger is higher in the bottom because the rectum lining is thin and may allow HIV to enter the body during anal intercourse.

The top is also under danger. HIV can enter the body through the hole at the tip of the penis (urethra); the foreskin if the penis is not circumcised; or any minor scrapes, scratches, or open sores on the penis.

Can I get HIV from vaginal sex?

If you have vaginal intercourse with someone who has HIV and do not use protection, you can get HIV (like condoms or medicine to treat or prevent HIV).

Vaginal intercourse is less likely to transmit HIV than receptive anal sex.

HIV can be transmitted through the hole at the tip of the penis (urethra); the foreskin if the penis isn't circumcised; or minor wounds, scratches, or open sores anyplace on the penis.

Can mother transmit HIV to her baby?

During pregnancy, delivery, or nursing, a mother's HIV might be passed on to her infant. However, due to breakthroughs in HIV prevention and treatment, it is becoming less prevalent.Perinatal transmission, often known as mother-to-child transmission, occurs in this manner.

The most prevalent route for children to get HIV is through mother-to-child transmission. Recommendations to screen all pregnant women for HIV and begin HIV treatment immediately have reduced the number of HIV-infected newborns delivered.

Can sharing needles, syringes transmit the virus?

You are at high risk for getting HIV if you share needles, syringes, or other drug injection equipment (for example, cookers) with someone who has HIV. Never share needles or other equipment to inject drugs, hormones, steroids, or silicone.

People who inject drugs are also at risk for getting HIV (and other sexually transmitted diseases) if they engage in risky sexual behaviors like having sex without protection (such as condoms or medicine to prevent or treat HIV).

How HIV/AIDS Affects Your Endocrine System?

1. Adrenal insufficiency:

One of the earliest endocrinopathies identified in HIV-infected individuals was adrenal insufficiency. Although clinically substantial adrenal dysfunction is uncommon in AIDS patients, modest adrenal reserve deficits may be observed.

Opportunistic infections, the most prevalent of which is cytomegalovirus (CMV), are the leading cause of decreased adrenal function in individuals with advanced HIV illness. At autopsy, CMV adrenalitis is found in around 40% to 90% of CMV-infected AIDS patients. However, CMV damage of adrenocortical tissue is often less than 50%, making adrenal insufficiency improbable. CMV infection is now uncommon in people receiving effective ART.

2. Gonadal Dysfunction:

• Male hypogonadism:

A common question is how HIV/AIDS affects men's gonads and what the symptoms of HIV in males are. Early in the HIV epidemic, hypogonadism was identified in HIV-infected males. Despite enhanced HIV treatment efficiency, the frequency of hypogonadism, particularly secondary hypogonadism, is greater in HIV-infected males than in non-infected controls, ranging from 9 to 16 percent, according to recent research.

The impact of acute sickness, weight loss, and malnutrition on gonadotropin production are the major causes of gonadal dysfunction in HIV-infected males. Age, obesity, and insulin resistance are risk factors, especially in males with visceral adiposity.

In addition to low testosterone levels, androgen deficiency symptoms such as erectile dysfunction, reduced libido, exhaustion, and muscle atrophy should be assessed. Male hypogonadism in HIV-infected males is treated using the same methods as in the general population.

HIV-infected males who appear with weight loss and muscular weakness due to low testosterone levels should be given special treatment. In these individuals, short-term testosterone therapy has been demonstrated to improve muscular strength while also increasing body weight and lean body mass.

• Female hypogonadism:

Hypogonadism manifesting as amenorrhea is frequent in HIV-infected women, affecting roughly 25% of patients. Anovulation can occur in up to 50% of HIV-infected women with low cluster of differentiation 4 (CD4) levels. The most likely cause is a decrease in gonadotropin synthesis and release as a result of illness-related stress. Early menopause has been recorded in up to 8% of HIV-positive women.

HIV-infected women frequently have low testosterone levels. In the setting of HIV, the etiology of androgen shortage may be explained in part by intra-adrenal shunting toward cortisol production and away from androgen production, particularly in the presence of weight loss.

3. Bone disorders:

Multiple studies have found that HIV-infected people had a greater incidence of osteoporosis and a higher risk of fragility fractures than healthy subjects. Current evidence suggests that immunologic variables such as T-cell activation, low CD4 cell count, and hepatitis B and C coinfection are substantially related with decreased bone density, particularly in women.

Hypogonadism, relative GH deficit, and vitamin D deficiency may also contribute to decreased bone density in HIV-infected individuals.

In view of the aforementioned, dual-energy X-ray absorptiometry screening in HIV-infected individuals is advised sooner (postmenopausal women and males >50 years of age) than in the general population (>65 for men and >70 years of age for women).

4. Thyroid Dysfunction:

Thyroid function tests are often altered in HIV-infected individuals. Thyroxin binding globulin (TBG) levels are higher in HIV patients and have an inverse relationship with CD4 counts. Abnormal thyroid function tests, as observed in other individuals with "euthyroid sick syndrome," may be noted in advanced disease. Asymptomatic HIV-infected individuals with stable body weight have normal thyroid function in general.

Thyroid dysfunction may result from opportunistic infections in HIV-infected people. Pneumocystis thyroiditis has been associated  with painful thyroiditis-like symptom.

5. Dyslipidemia:

The prevalence of cardiovascular disease (CVD) is greater in HIV-infected individuals than in HIV-uninfected controls. This may be due to an increase in the prevalence of classic CVD risk factors, as well as the consequences of chronic inflammation. Dyslipidemia has been found in up to 54% of HIV patients.

6. Diabetes mellitus:

Insulin resistance and diabetes are frequent in HIV-infected people. The reported prevalence of diabetes ranges from 2% to 14%. Insulin resistance is thought to be the major cause of reduced glucose tolerance and diabetes in these people. Increased BMI, lipodystrophy, low CD4 counts, and use of older ARTs are all risk factors for diabetes in this patient population.

What Are the Signs and Symptoms of HIV?

Nobody with HIV has the same symptoms, and others don't have any at all. However, the infection might result in several typical alterations over time.

During the initial weeks: These initial flu-like symptoms occur as a result of your body's reaction to HIV. Your immune system is attempting to combat it. At this point, you may experience the following symptoms:

• Fever
• Headache
• Upset stomach
• Sore throat
• Swollen glands
• Rash
• Aches and pains in muscles and joints

Keep in mind that just because you experience these symptoms does not guarantee you are HIV-positive. These issues can be caused by a variety of diseases. If you suspect you are infected with HIV, consult a doctor or an HIV testing facility.

It's vital to understand that at this early stage of HIV infection, an HIV test may not provide reliable findings. It can take 3-12 weeks for adequate evidence of the virus to appear on conventional HIV testing that assess antibodies against HIV. A new type of screening, known as a nucleic acid test, can identify the virus itself at this early stage, but it is costly and is not typically used for regular HIV testing.

Months to years after infection: Most HIV patients will begin to feel better once the initial stage has ended. However, this does not imply that the infection has been eradicated. Other symptoms may not appear for a decade. If your HIV infection is untreated at this point, the virus is continually attacking new cells in your body.

After years of untreated HIV, you're more likely to get infections caused by bacteria, viruses, or fungus that your body can no longer resist. They may indicate that your HIV infection has progressed to AIDS. You might have:

• Fever
• Weight loss
• Diarrhea
• Frequent infections
• Serious illnesses or diseases
• A cough that won’t go away
• Night sweats
• Mouth and skin problems

Again, these symptoms might be the result of different conditions and do not always indicate that you have HIV or AIDS. Get tested to find out for certain.

The key to surviving and living with HIV is to get treatment as soon as possible. Survival rates among individuals sick and adhering to treatment have grown dramatically in the 20 years after combination therapy was introduced. According to studies, depending on how early the infection is treated, the life duration of HIV patients receiving regular therapy may be substantially the same as that of someone who does not have HIV.

Could a Vaccine Fight HIV?

HIV medications have significantly improved the quality of life for persons living with HIV and AIDS, but they are not yet capable of curing the illness. Someone who is at high risk for HIV can take a tablet to help prevent infection, but they must do it every day. This approach, known as PrEP, is not completely successful.

That is why scientists are striving so hard to develop an HIV vaccine. A vaccination prevents or manages an illness by conditioning the body's immune system to fight it. Vaccines for illnesses such as typhoid, measles, polio, influenza, and smallpox have been developed over the years. More money has been spent on HIV vaccine research than on any other vaccine in history.

An HIV vaccine is even more difficult because:

• Many types of HIV exist, and new types keep forming.
• HIV has clever ways of "outwitting" the immune system.
• Scientists still don’t completely understand what parts of the immune system work against HIV.

Types of HIV Vaccines

A preventative vaccination would train your immune system to "recognize" and fight HIV before it infects you and makes you ill. They would be for HIV-negative persons. A vaccination may one day be able to prevent HIV infection in all, most, or some persons.

A prophylactic vaccination cannot infect you with HIV since it contains no live virus. However, it may stimulate your immune system to produce antibodies that would appear on a blood test and give you a false positive result.

A therapeutic vaccination would aid in infection control and illness progression. They operate by boosting your immune system's ability to detect and kill HIV-infected cells, as well as by inhibiting or restricting HIV's ability to replicate itself. They are being tested on persons who are HIV-positive but have healthy immune systems.

Best Ways to Treat HIV Symptoms

There is currently no cure, nor an effective HIV vaccine. Treatment consists of highly active antiretroviral therapy (HAART), which slows progression of the disease. As of 2010, more than 6.6 million people were receiving HAART in low- and middle-income countries. Treatment also includes preventive and active treatment of opportunistic infections. As of March 2020, two people have been successfully cleared of HIV. Rapid initiation of antiretroviral therapy within one week of diagnosis appear to improve treatment outcomes in low and medium-income settings.

1. Antiviral therapy:

Current HAART options include combinations of at least three drugs from at least two categories of antiretroviral agents. Treatment usually begins with a non-nucleoside reverse transcriptase inhibitor (NNRTI) followed by two nucleoside analog reverse transcriptase inhibitors (NRTIs). Zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine are two common NRTIs. As of 2019,

 the World Health Organization recommends dolutegravir/lamivudine/tenofovir as the first-line therapy for adults, with tenofovir/lamivudine/efavirenz as an option. If the above mentioned regimen is no longer successful, combinations of drugs that include protease inhibitors (PI) are utilized.

2. Diet:

The World Health Organization (WHO) has established nutritional guidelines for HIV/AIDS patients. It is encouraged to have a healthy diet in general. The WHO recommends that HIV-infected individuals consume micronutrients at RDA levels; however, increased intake of vitamin A, zinc, and iron can have negative consequences in HIV-positive adults and is not suggested unless there is a confirmed deficit.

Dietary supplements for HIV-infected patients with poor nutrition or dietary deficits may improve their immune systems or aid in the recovery from infections; nevertheless, data demonstrating an overall advantage in morbidity or mortality reduction is inconsistent.

3. Alternative medicine

In the United States, roughly 60% of persons living with HIV utilize complementary or alternative medicine, the usefulness of which has not been proven. There is insufficient data to back up the usage of herbal medications. There is not enough data to suggest or support the use of medicinal cannabis to improve appetite or weight gain.

How Can You Prevent an HIV Infection?

More than one in every five young individuals between the ages of 18 and 30 is concerned about their HIV risk. You may be especially concerned if you recently had unprotected intercourse with an HIV-positive person.

Sometimes the risk isn't as serious as it appears. A woman who engages in unprotected vaginal intercourse with an HIV-positive man, for example, has an 8 in 10,000 risk of contracting the virus. However, if they engage in unprotected anal intercourse, their chances increase dramatically. Other factors, including as sharing needles, enhance the risk. However, if you drink from the same glass as someone who has HIV, there is almost little danger.

Here’s what you need to know to protect yourself:

1. Have Safe Sex:

Condoms are the most effective method of HIV prevention since the virus cannot pass through the barrier. However, you must use them appropriately every time you have sex. Latex condoms provide the most protection. If you're allergic to these, stick to polyurethane (plastic) or polyisoprene (synthetic rubber). Avoid condoms with a natural membrane, such as lambskin. Because they have little holes in them, they are unable to stop HIV.

To reduce the likelihood of a condom breaking during sex, use a water- or silicone-based lubrication. Use no oil-based lubricants such as Vaseline, mineral, or massage oils. They can weaken the condom and increase its likelihood of breaking.

Unless you have an open sore in your mouth, such as an ulcer or bleeding gums, giving oral intercourse to your partner is unlikely to result in HIV infection. To be safe, have your partner use a condom or dental dam, which is a small, square piece of latex or silicone that is put over your partner's vulva or anus during oral sex.

2. Stay Away From Illegal Drugs:

If you share needles or syringes with others, you are at high risk of HIV Infection. The safest course of action is to avoid sharing needles. Only use fresh, sterilized needles. Some shops even offer them without requiring a prescription. If you can't acquire new needles, you can disinfect used ones with bleach, but you still risk acquiring HIV from them. Though injectable illicit narcotics are the most deadly, any recreational drug usage might increase your risk. This is because they decrease your inhibitions and increase the likelihood of having unprotected sex. This increases your chances of contracting HIV. If you do use drugs, always keep condoms on hand.

3. Protect Yourself With PrEP (Pre-Exposure Prophylaxis):

You might be in a scenario that makes you more vulnerable to HIV. You could be sharing needles or in a relationship with someone who is HIV-positive. If your spouse is taking HIV treatment and has an undetectable infection, he or she is unlikely to pass it to you. However, you may be at danger if they do not take their medicine on a regular basis or do not know what their viral load is.

To avoid infection, you can protect yourself by taking a daily tablet. It's known as PrEP (pre-exposure prophylaxis). There are several alternatives. Truvada is a tablet that comprises two drugs: emtricitabine and tenofovir. These are antiretrovirals, which means they prevent the virus from taking hold and spreading throughout your body.

Conclusion

Human immunodeficiency virus (HIV) infection causes a complicated illness pattern that eventually leads to chronic immunodeficiency. HIV can be passed on by sexual activity, parenteral contact, or vertical contact (e.g., peripartum from mother to child).

Infection is most frequent in young adults between the ages of 20 and 30. The virus infects macrophages and other CD4+ cells, causing CD4 T cells to be destroyed, which is one of the primary mechanisms of cellular immune protection. Acute infection, clinical latency, and acquired immunodeficiency syndrome are the three primary phases of HIV infection (AIDS).

Using antigen/antibody-based testing, HIV infection may be consistently identified. Treatment with a combination of antiretroviral drugs (ART) is initiated as soon as feasible in individuals with proven infection.

The treatment's efficacy is assessed by frequent assessments of CD4 count and viral load. Patients with advanced HIV infection may also require therapy for HIV-associated illnesses as well as prevention against opportunistic infections.

Because of major advances in therapy, the average life expectancy of HIV patients on ART is nearing that of the general population. Partners of HIV-positive persons and people at high risk of HIV infection might lower their chances of catching the virus by taking ART before (preexposure prophylaxis) or after (postexposure prophylaxis).