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HIV/AIDS - Causes, Symptoms, Tests, Treatment & More

A lot of people are misinformed about HIV/AIDS. Here is a megaguide that will tell you everything you need to know about the disease.

AIDS MegaguideDecember 1 is World AIDS Day. The theme is Getting to Zero: Zero Discrimination, Zero New Infections and Zero AIDS-related deaths.

Understanding HIV/AIDS

HIV/AIDS has claimed over 25 million lives in the last 30 years. It's estimated that over 34 million people are living with HIV. One of the biggest problems associated with HIV/AIDS is misinformation. Here is a mega guide that will answer most questions that you might have about the disease.

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What is HIV?

The human immunodeficiency virus (HIV) is a retrovirus that destroys or impairs the function of the body's immune system making the person more susceptible to infections. Unless treated, it develops into full-blown acquired immunodeficiency syndrome (AIDS). The virus infects humans when it comes in contact with tissues lining the vagina, anal area, mouth and eyes, or through a break in the skin. There are two main types HIV-1 and HIV-2. HIV-2 is typically found in Africa and parts of Asia. HIV-2 is typically found in Africa and parts of Asia. Asia can thus no longer be considered free of HIV-2, and testing for HIV-2 appears mandatory, at least in India. Worldwide, when people refer to HIV they are usually referring to HIV-1.

What is AIDS?

Acquired immune deficiency syndrome (AIDS) isn't a disease in itself. It is a condition in caused by HIV in which the body's immune system fails to battle foreign microorganisms. This leads to various opportunistic infections and/or certain cancers. It is the most advanced stage of HIV infection.

How long does it take for HIV infection to develop into AIDS?

The time taken for HIV infection to develop into AIDS varies widely between individuals. The majority of HIV infected people will develop signs of HIV related diseases within 5 to 10 years, if left untreated. However, HIV infection can take 10 15 years or longer to progress into AIDS. Antiretroviral therapy (ART) can slow down the process even further.

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Causes

HIV infection is spread from person to person when human blood and sexual fluids (semen and vaginal secretions) are shared. HIV can be transmitted through:

  • Unprotected sexual intercourse (vaginal, anal or oral*)
  • Transfusion of contaminated blood
  • Sharing of contaminated needles used for injectable drugs
  • Sharing infected needles for tattoos and body piercing
  • Oral sex (the risk is small, though)
  • From HIV infected mother to her child during pregnancy, child birth or breast feeding

* The chances of HIV transmission through oral sex are low but it can't be completely ruled out.

The virus cannot survive for long outside the human body and dies quickly when the body fluid in which it is contained dries up. This is why it can't be spread by insects, can't spread like the flu virus (public surfaces, coughing, sneezing, etc.) The virus does not live in saliva, tears, urine or perspiration. Hence, casual contact with these body fluids does not be spread HIV. Hugging, shaking hands, or sharing personal objects, food or water does not transmit HIV.

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Symptoms

HIV symptoms vary from person to person. Some people experience a flu-like illness such as fever, headache or sore throat in the first few weeks after which the symptoms vanish. A person can have HIV for many years before developing any symptoms.

As the infection gradually progresses the person's immune system weakens and they might experience persistent yeast infections on the tongue (thrush). Women may develop severe vaginal yeast infections as well. Some of the other signs and symptoms are frequent fevers, diarrhoea, cough, swollen lymph nodes, persistent skin rashes, lack of energy, weight loss, mouth, genital or anal sores from herpes infections, short-term memory loss, etc.

Opportunistic infections are common in people with AIDS which affects nearly every organ system. Some of the signs that HIV is turning into AIDS include:

  • Persistent fever
  • Extreme fatigue not related to stress or lack of sleep
  • Persistent diarrhoea
  • Severe malnutrition, losing weight
  • Swollen glands in the neck, groin, etc.
  • Difficulty in swallowing
  • Oral thrush
  • Headache, confusion and forgetfulness
  • Increased risk of developing various cancers like Kaposi sarcoma, lymphomas, cervical cancer, etc.

Diagnosis

The only way to diagnose HIV is to take a test which looks for signs of the virus in the blood. Presence of the virus in the blood is termed as HIV positive (HIV+). If no signs of the virus are found in the blood, the result is considered negative. It is diagnosed on the basis of positive results from two different HIV tests.

The plasma HIV RNA test (a viral load test) is recommended when recent infection is suspected. The test detects the virus in the blood within 9 days of infection; before the body develops detectable antibodies to it.

Antibody tests: The antibody tests check for HIV antibodies that the body produces in response to the infection. In most people, antibodies to the virus are not detectable during a window period of 3 to 12 weeks after infection. Hence, a HIV antibody test is not useful during this period. Retesting should be done after three months to confirm the test results. Some of the antibody tests are as follows:

  • Rapid HIV antibody test, the most common HIV test, is done using blood, urine or saliva and can produce results within an hour.
  • Enzyme-linked immunosorbent assay (ELISA) is an antibody test that is usually the first one used to detect HIV infection. If the result is positive, the test is usually repeated to confirm the diagnosis.
  • Western blot test is one of the oldest but most accurate confirmatory antibody tests. It is done to confirm the results of two positive ELISA tests

Polymerase chain reaction (PCR, a viral load test) test finds either the RNA or the DNA of the HIV in white blood cells even if other tests are negative for the virus. The PCR test is very useful to find a very recent infection, screen blood for HIV before donation and in babies born to mothers infected with the virus.

Protein p24, the antigen on HIV that produces an antibody response in the body is produced in excess early in the infection. Antigen p24 tests detect these proteins in the blood. This test is usually not used for general HIV diagnostic purposes.

HIV-infected people may not have any symptoms of disease for eight to ten years or longer (asymptomatic period). Their CD4 (T-cell) count should be watched closely during this time. If they have a CD4 count below 200 and/or if AIDS-related conditions appear, then they are considered to have AIDS.

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Prevention

By limiting exposure to risk factors, a person can reduce the risk of HIV infection. The preventive measures include:

  • Correct and consistent use of condoms can protect against the spread of HIV.
  • Antiretroviral drugs taken by the HIV-negative partner can be effective in preventing acquisition from an infected partner. This is called pre-exposure prophylaxis (PrEP) - WHO recommends that countries implement demonstration projects on PrEP for serodiscordant couples and men and transgender women who have sex with men.
  • Health care workers with needle prick injuries in the workplace are recommended post-exposure prophylaxis (PEP). Antiretroviral drugs are used within 72 hours of exposure to HIV in order to prevent infection. Counselling, first aid care and HIV testing are also done. A 28-day course of antiretroviral drugs with follow-up care is advised depending on the level of risk.
  • People exposed to any of the risk factors are strongly advised to test for HIV and other STIs.
  • Mother-to-child transmission (MTCT) during pregnancy, delivery or breastfeeding can be fully prevented if both the mother and the child are provided with antiretroviral drugs
  • Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.
  • Use sterile needles and syringes for each injection.
  • Antiretroviral therapy decreases the HIV concentration (viral load) in the blood and in genital secretions. According to a new trial the risk of transmitting the virus through sexual contact can be reduced by 96% if an HIV-positive person follows an effective antiretroviral therapy regimen.

Treatment

The two main goals of HIV treatment are

  • to prevent the virus from damaging the immune system
  • to halt or delay the progress of the infection

Antiretroviral (ARV) drugs are used for treating and preventing HIV infection. They stop or interfere with the reproduction of the virus in the body.

HIV therapy includes combinations of drugs. Antiretroviral therapy (ART) consisting of combination of three or more antiretroviral drugs to suppress the virus. ART does not cure HIV infection. It controls replication of the virus thereby strengthening an individual's immune system to fight off infections. These drugs must be taken at the right time every day. Incorrect or inconsistent therapy can mutate the virus causing resistance to treatment. In such cases, other medication options must be used. The amount of the virus in the blood (viral load) is measured to monitor the efficacy of the treatment. The goal of treatment is to get an undetectable viral load in lab tests.

People with HIV need counselling and psychosocial support in addition to antiretroviral treatment. A high quality of life needs to be maintained with basic hygiene, adequate nutrition and safe water.

Cure for HIV/AIDS

Even though, the cure for HIV/AIDS hasn't yet been found, there might be a cure on its way. Here are some of the advances made in the direction.

The Berlin Patient Case Leukaemia

For a long time researchers believed there was no cure. Even five years ago, a scientist who wanted to work on HIV cure research was laughed at. But all that changed with Timothy Brown aka the Berlin Patient. Brown an HIV-positive man who developed leukaemia. After first-line cancer treatments failed, a bone marrow transplant procedure was done. Two transplants later, not only was his leukaemia in remission, his immune system actually managed to ward off HIV. Brown no longer takes antiretroviral drugs or tests positive for HIV. Essentially, he was cured. Read more

Bee venom to cure HIV?

A study suggested that bee venom might have the potency to kill the human immunodeficiency virus (HIV). Researchers at the Washington University School of Medicine had demonstrated that a toxin called melittin which is found in bee venom is the reason for this. The researchers used nanoparticle technology to target the virus. Particles smaller than HIV were infused with bee venom and since HIV cells are smaller than normal body cells the nanoparticles only targeted HIV.

'Melittin on the nanoparticles fuses with the viral envelope,' said research instructor Joshua L. Hood, MD, PhD. 'The melittin forms little pore-like attack complexes and ruptures the envelope, stripping it off the virus.' Adding, 'We are attacking an inherent physical property of HIV. Theoretically, there isn't any way for the virus to adapt to that. The virus has to have a protective coat, a double-layered membrane that covers the virus.'

Stem cell therapy to overcome HIV?

In a path-breaking breakthrough two American were believed to have overcome HIV after undergoing stem-cell therapy! The news has met with widespread elation with experts believing that a cure might be on the cards. Doctors from the Brigham and Women's Hospital in Boston announced on Wednesday night that two previously HIV-positive patients no longer had detectable virus levels in their blood or tissue after having bone marrow stem-cell transplants to treat cancer between two and four years ago, the Age reported. (Read more )

Aggressive antiretroviral treatment the Mississippi baby case

There were reports in March 2013 of a toddler who was completely cured of the virus after being born of it. She has been cured of the disease after following an aggressive regime of drugs. This was the second documented case of a person being completely cured of the virus after an adult known as the Berlin Patient was cured as a result of bone-marrow transplant. This startling piece of information was discovered when the baby's mother stopped treatment and doctors lost track of the baby who was given a bout of heavy drugs (current procedure suggests only a modest daily dose of antiretroviral treatment) about 30 hours after she was born at a rural Mississippi hospital, doctors said at a medical meeting in Atlanta. However, a doctor poured cold water on cold water on what was termed 'the greatest medical breakthrough of the century'.

In his piece, Dr Siedner pointed out in his column, exposure to HIV doesn't mean that the baby will have HIV. 'We will likely never know if those cells were from the child or maternal cell that has been transmitted during pregnancy or birth.' When a child is born, he or she has some maternal cells in his system so it's impossible to tell whether the child actually had HIV or not, or the tests detected the maternal HIV positive cells.

The MX2 gene

According to a study published in the journal Nature, scientists have discovered a new gene which can inhibit the HIV virus from spreading after it has entered the body. The study was led by Dr Caroline Goujon and Professor Mike Malim at the Department of Infectious Diseases, King's College London. It was conducted by introducing the virus to two separate lines of human cells. On one line, they introduced the MX2 gene along with the virus, while on the other they didn't. The line on which the MX2 gene was introduced, it was seen that the virus had stopped replicating. (Read more.)

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Complications

People with AIDS are extremely susceptible to infection. Some of the following conditions are commonly associated with AIDS:

  • Tuberculosis (TB) a bacterial infection that primarily infects the lungs. It is a leading cause of death in people living with HIV. Nearly a quarter of a million fall prey to it each year.
  • Herpes Simplex - a virus that causes cold sores or genital herpes (painful blisters in the genital area). Severe HSV lesions are common in the advanced stages of AIDS.
  • Kaposi's sarcoma a skin tumour with purple blotches on the skin or in the mouth. It is caused by herpes virus.
  • Lymphoma tumours develop from white blood cells in the lymphatic system. A common disease associated with AIDS in which cancer cells are found in the lymph systems of AIDS patients.
  • Pneumocystis pneumonia (PCP) an infection that causes inflammation and fluid build-up in the lungs. It is the most common opportunistic infection in HIV infected people.
  • Oral thrush an infection of the mouth caused by the fungus candida. Candida infection is more likely to develop in HIV infection.
  • Cytomegalovirus infection cytomegalovirus (CMV) causes HIV-associated infections. The virus usually remains dormant in a healthy person. The most common illnesses that CMV causes in a HIV infected person are blindness, pneumonia, liver disease, etc.
  • Toxoplasmosis a parasitic disease which rarely causes any symptoms in healthy adults. But it can be a serious disorder for people with HIV/AIDS. It causes brain lesions in HIV infected people.

Myths

Many people are gravely misinformed about the disease and how it spreads and this often leads to stigmatisation of the HIV positive. To commemorate World AIDS Day we bust some of the most common myths about the condition:

Myth 1: One can get HIV by being around people who are HIV+.

The disease can only be transmitted through body fluids like blood, semen or breast milk. HIV cannot be spread through saliva, sweat or by touching. The virus finds it hard to survive when it isn't living in bodily fluids. So you cannot catch HIV by:

  • Breathing the same air as someone who is HIV+
  • Hugging, kissing, or shaking hands with someone who is HIV+
  • Touching a toilet seat or doorknob handle after an HIV+ person
  • Sharing food with an HIV+ person

Myth 2: One can get HIV from mosquitoes.

There's no way you can get HIV from a mosquito. Technically, even if a mosquito which has bit an HIV positive person were to bite you there's no chance of the virus being transmitted because mosquitoes don't inject any blood into your system. Academically speaking you could get the virus, if a mosquito which has bit an HIV positive person were to bite you and you killed the mosquito over broken skin allowing its blood to enter your system through the broken skin. But this is just theoretical and it has never been recorded in real life.

Myth 3: A person who is HIV+ or has AIDS is easy to spot.

No. Symptoms vary from person to person. In most cases, after contracting the virus people experience some flu-like symptoms which then disappear. The condition can lay dormant for years without people realising they have the disease.

Myth 4: HIV will progress to AIDS and the person will die soon

HIV only progresses to AIDS if left untreated. Antiretroviral treatments can stop the various AIDS-like conditions from manifesting for years. If the drug procedure is continued the viral load in the blood is undetectable and the person will not exhibit any AIDS-like diseases. Regular medication will prevent the HIV strain from affecting the resistance of the body.

Myth 5: The only people who get HIV are homosexuals, sex workers and intravenous drug users. I don't need to worry.

There's a common misconception that unless one falls in the above group they can't get HIV. It was particularly bolstered because the aforementioned groups are high-risk groups who are more exposed to the virus. The fact remains that anyone can get HIV. For example, a normal person can get it from a faulty blood transfusion procedure and everyone needs to remain vigilant.

Myth 6: Drugs are so powerful that you can stop taking them after some time

Sometimes the medical treatment can be extremely agonising for patients because the drugs are quite strong. But stopping the procedure will again make the person vulnerable to the virus which can then allow opportunistic infections to attack the body. It's vital not to stop the medication procedure.

Myth 7: One can't get HIV from oral sex

While it's true that HIV is harder to transmit through oral sex than anal or vaginal intercourse, there still remains some chance of the virus being transmitted. For example, a person's genitals could have cuts and bruises which could cause the virus to be transmitted.

Myth 8: Only people from the lower socio-economic class are affected by HIV/AIDS.

HIV knows no class. Anyone can fall prey to the condition. Participating in risky sexual behaviour like unprotected sex with strangers, unhygienic use of syringes and needled and transmission from an HIV positive mother to child are all possible scenarios.

Myth 9: HIV and AIDS are only caused through sex.

The viral strains can also spread through unsafe and unhygienic usage of needles. This can occur in hospitals, tattoo parlours and in individuals taking intravenous drugs. Also, breast milk from an HIV infected mother can cause HIV in the new born, if breast fed unknowingly. Very rarely, HIV can also spread through deep kissing if either of the persons are HIV+ and have bleeding gums.

Myth 10: The baby of a HIV+ pregnant mother will also have the infection.

There are less than two per cent chances of the baby being infected with HIV. If the condition of the mother is previously known, ART can prevent the unborn baby from being infected. Whether an HIV mother can or cannot breastfeed is still in a grey research area. One research in South Africa found that babies who were breastfed by their HIV positive mothers showed a lesser likelihood of mother-to-child transmission HIV than the ones who were breastfed and also given additional solids. Others state that HIV positive mothers shouldn't breastfeed. For the record, the WHO endorses breastfeeding among HIV positive women who are undergoing antiretroviral treatment.

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What caregivers should do

The infections or illnesses that come in the wake of AIDS can be treated to a certain extent. Though, it is more like buying time. The patient can take care of themselves by being regular with their medication, proper nutrition, therapy to deal with the illness and an attempt to live as normally as then can. And all that you can do for someone whom you know has AIDS, is to support them.

You can start by

  1. Accepting abandoning the person or being judgmental is the worst thing you can do when they have shared this private information with you. This will break the morale of the patient and make them feeldiseased. Accept the information and the person and help them deal with the condition with your support.
  2. Talking talk to the patient. Share your thoughts and feelings. They, too, may be feeling that way or ten times more. Sharing will help you understand each other's' fears and doubts. It will also let the patient know that they are not alone and you are there with them.
  3. Being well-informed read up literature to understand the facts about the illness. No one dies because of AIDS. People die because of the infections and secondary diseases that are caused due to a weak immune system. The body's defense system collapses and leaves it susceptible to attacks from any form of infection to any part of the body.
  4. Hand holding the patient remember that the patient is traumatized with the infection. They require emotional support and understanding from their loved ones. This will give them the boost they require to keep their spirits up.
  5. Joining support groups this helps in coping with the illness not just for the patient but also for the close ones of the patient. It helps you better in dealing with the situation mentally and emotionally. To have a support system to fall back onto makes it a little easier to cope with what the illness brings.
  6. Getting self-therapy having your loved one suffering with AIDS would take a toll on you. There may be a wide range of emotions felt including anger and shame. Because of the stigma associated with AIDS, you may not be comfortable sharing the news of the illness with other friends something which you may have done in case of another life threatening illness like cancer. Visiting a psychotherapist will help you understand and manage yourself better. (Read more: If you know someone who has AIDS, support them!)

AIDS in India

The fact is that for a nation of India's size with its unique set of healthcare issues and complete refusal to talk about sex, we've done well in our battle against HIV/AIDS. Here are five things you ought to know about HIV/AIDS in India:

2.4 million people are HIV positive in India

India has 2.4 million HIV positive people. It's estimated that out of these 61% are male, 39% are female and 3.5% are children. As of 2009, the adult prevalence is believed to be 0.31%. Despite, the huge number the prevalence of HIV is low when compared to our today population. On the other hand, HIV epidemic regions like South Africa have over 5 million cases with a prevalence of 18% in adults.

Source: AIDS Alliance

India has reduced new HIV infections by 57% since 2001

The recently released UNAIDS Report 2013 claims that India has managed to reduce new HIV infections by a staggering 57% since 2001. To put this in perspective, in the same time frame, our neighbours Pakistan have seen an eight-fold increase in the number of cases. A major reason for this a concerted effort by the Central government to tackle the ailment head on through information dissemination, education and communication. Also there has never been a case of AIDS denialism in India like there was in other epidemic countries which prevented the disease from spreading far and wide.

Drug addicts, men who have sex with men (MSM) and female sex workers are the high risk groups

In India, HIV is mainly concentrated among high risk groups who are 15-30 times more likely to contract HIV than non-high risk groups. The main high risk groups are intravenous drug users,men who have sex with men andfemale sex workers. Getting treatment for high risk groups is even harder because of the stigma attached to each of the aforementioned activities. If we're to contain the spread of HIV, then we must figure out a way to help people from these groups find proper rehabilitation and drugs.

Not enough ART anti-retroviral therapy: Less than 10% people getting drugs

The reason HIV has become a more manageable disease instead of a death knell is because of something called anti-retroviral therapy in which a cocktail of drugs are given to HIV positive people which helps them manage their condition and prevents HIV from becoming AIDS. In fact, a study in India showed that early treatment not only prevents HIV from becoming AIDS but also lowers the chance of transmitting the virus. This has been observed in HIV discordant couples (one positive, one negative) and also mother-to-child transmission. Sadly, not enough people are getting treatment. India remains one of the countries where less than 10% HIV positive people receive ART and there are frequent cases of drug shortage.

Still need to fight the stigma

The biggest challenge in India after the lack of drugs is the stigma attached to the ailment. When HIV was rife in the US, most people thought it was a disease that afflicted people who had it coming the homosexuals, the drug users and the sex workers. While this view has changed over time, the stigma issue remains a problem in many parts of the world including India. We keep on coming across news items which talk about HIV positive families being ostracised, or an HIV positive people losing their jobs. It's been often said that stigma of the ailment makes it much harder to deal with than the ailment itself. We need strict laws to curb anti-HIV discrimination and need to provide sensitisation to people to deal with people who suffer from the condition.

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