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HIV/AIDS

HIV/AIDS is chronic potentially life-threatening condition caused by Human immune deficiency virus (HIV). After infection, the virus invades and damages the immune system making susceptible for various infections.

Causes:

HIV/AIDS is a sexually transmitted infection and transmits through blood and body fluids. Therefore, the other modes of transmission can be by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding.

Four Phases of HIV infection:

An individual after infection with HIV will pass through 4 phases/stages of disease

  1. Early HIV infection phase/primary HIV infection phase/acute retroviral syndrome
  2. Chronic HIV phase / Clinical latent infection
  3. Symptomatic HIV infection
  4. AIDS

When does the early symptoms of HIV appear?

Usually the symptoms of primary HIV infection appear in 2 weeks to a month or two months after infection/contact.

What are early symptoms of HIV?

Early symptoms of HIV resembles any of the viral infections like

  1. Fever
  2. Headache
  3. Generalized body ache, joint pain and weakness
  4. Sore throat
  5. Enlarged lymph nodes and rashes

The symptoms are body’s natural response to virus infection and often very difficult to distinguish from any other viral infection.

How long chronic HIV or clinical latent infection will last.

Usually the second phase lasts for about a decade if an infected individual is not on treatment.

What are the symptoms in clinical latent infection phase?

As the name indicates, the individual may not have any specific signs and symptoms. Some individuals may develop persistent lymph node swelling.

What are the symptoms of symptomatic HIV infection?

  1. An individual in this phase will present with mild infections and chronic signs and symptoms like
  2. Oral thrush (yeast/oral fungal infection/oral candidiasis)
  3. Repeated shingles (herpes zoster)
  4. Chronic diarrhoea.
  5. Swollen lymph nodes
  6. Fever and fatigue
  7. Weight loss

AIDS

Untreated HIV infection will typically progress to acquired immune deficiency syndrome. However, with better antiviral treatment this phase of infection is delayed or may not be seen. Untreated HIV will progress to AIDS in about 10 years.

Common signs and symptoms of AIDS are:

  1. Weight loss
  2. Chronic Diarrhoea
  3. Night sweats
  4. Recurring fever and unexplained fatigue
  5. Skin rashes
  6. Persistent white spots or lesions on tongue

Diagnosis:

Diagnosis done based on history of exposure to infected body fluid, signs and symptoms and blood tests

  1. HIV Tridot test/ card method – watch this video to know more on how to do this test
  2. PCR test
  3. Once confirmed other tests performed to identify the level of infection and secondary infections like
  4. CD4 T cell count: HIV infection progresses to AIDS when the CD4 cell count dips to 200 and below
  5. Tests to identify viral load or load of HIV RNA
  6. Tests to identify drug resistance of HIV
  7. Other tests include tests for STDs, hepatitis, TB etc.

Treatment

There is no cure for HIV; however, it can be controlled using anti-retroviral therapy (ARV). There are about five classes of ARV. As recommended three drugs from two classes are used to avoid drug-resistant strains of HIV. The five classes of ARV are:

  1. NNRTIs: Non-nucleoside reverse transcriptase inhibitors blocks protein needed for HIV replication. Examples: nevirapine, etravirine etc.
  2. NRTIS: Nuceloside reverse transcriptase inhibitors are faulty versions of building blocks that HIV needs for its replication. Examples: Zidovudine
  3. Protease inhibitors: Example darunavir, indinavir and fosamprenavir.
  4. Integrase inhibitors: Example raltegravir and dolutegravir
  5. Fusion inhibitors: Example enfuvirtide and maraviroc

How to check treatment response?

Monitoring CD4 T Cell count every 3 to 6 months Viral load test: Viral load with treatment may reach undetectable levels. This does not mean that that HIV is cured. It only means the load is so low to be detected

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