AIDS (Acquired Immunodeficiency Syndrome)

Introduction:

AIDS is defined by the presence of at least one major and two minor infections and is not related to CD4 (clusters of differentiation 4) count. Human immunodeficiency virus (HIV) causes HIV and AIDS. AIDS (acquired immunodeficiency syndrome) is the most advanced stage of HIV infection. If HIV infection is left untreated, it gradually affects the immune system, which results in AIDS as the body becomes susceptible to infections. Without treatment, 50 % of people with HIV develop AIDS within ten years. Since the first documented case of AIDS in 1981, nearly 35 million people have died due to conditions resulting from this disease. But now, with the help of combination antiretroviral drugs, HIV infection has been converted into a chronic disease that people live with. With proper treatment and care, people with HIV infection can expect a near-normal life expectancy. Once HIV progresses to AIDS, the patient typically survives for about three years without treatment. But if the patient is infected with some dangerous opportunistic infection, then life expectancy falls to about a year.

What Are the Types of HIV?

There are two types of HIV, which are HIV-1 and HIV-2, both of which can cause AIDS. The only difference is that HIV-2 cannot be transmitted easily, and once infected, it takes time for HIV infection to lead to AIDS.

What Are the Factors Responsible for the Rapid Progression of HIV to AIDS?

The progression of HIV to AIDS depends on a lot of factors like:

1. Age of the patient.

2. The condition of the immune system to fight against HIV.

3. Availability of high-quality healthcare.

4. The presence of other diseases and infections.

5. Strains of HIV that are resistant to drugs.

6. The patient's genetic resistance to some of the HIV strains.

What Are the Symptoms of AIDS?

The symptoms of AIDS are:

• Persistent and chronic diarrhea.

• Blurred vision.

• Dry cough.

• Long-lasting fever.

• Night sweats.

• Dyspnea (difficult breathing).

• Swollen lymph nodes.

• Weight loss.

• Persistent white spots on the tongue and mouth.

• Extreme tiredness.

• Opportunistic infections.

• Skin rashes.

What Are the Opportunistic Infections of HIV?

As HIV weakens the immune system, the normal flora of the body and commensal organisms (organisms that help the body in the day-to-day life) become overactive and attack a person's body, causing opportunistic infections. It takes the opportunity and feeds on the person's body, causing multiple infections. Some of the commonly seen infections are:

• Candidiasis - Candidiasis is a fungal infection that is caused by the fungi Candida. It usually causes white patches in the tongue, skin, mouth, and vagina. In HIV patients, it causes lesions in the esophagus, bronchi, trachea, and lungs.

• Cryptococcosis - Cryptococcal meningitis is the inflammation of the membranes around the brain and spinal cord that results from inhalation of the fungus Cryptococcus. This fungus is found in soil, bird droppings, and areas surrounding trees. This fungus, when inhaled, enters the lungs and causes pneumonia.

• Coccidioidomycosis - It is a fungal disease caused due to the inhalation of the fungus Coccidioides immitis.

• Cryptosporidiosis - It is a parasitic infection caused by the protozoan Cryptosporidium, which results in severe watery diarrhea and stomach cramps.

• Cytomegalovirus (CMV) Disease - Cytomegalovirus causes infections like pneumonia, gastroenteritis, and brain infection (encephalitis). In HIV patients, it causes an infection of the retina called CMV retinitis, which can cause blindness and is a medical emergency.

• Herpes Simplex Virus (HSV) Infection - In HIV patients, HSV infection causes painful cold sores in the mouth, vagina, and anus, which do not resolve. This virus also infects the breathing tube, lungs, and esophagus of HIV patients.

• Pneumocystis Jirovecii Pneumonia (PJP) - The fungus Pneumocystis jirovecii causes pneumonia and symptoms like dry cough, fever, and breathlessness, which can be fatal.

• Tuberculosis - The bacteria Mycobacterium tuberculosis causes severe lung infection and gets transferred in droplets when the infected person sneezes, coughs, or speaks. Tuberculosis can cause tiredness, weight loss, and persistent cough and can also spread to the lymph nodes, bones, brain, and kidneys.

• Mycobacterium Infections - Mycobacteria occurs naturally in the environment and does not affect healthy individuals much. However, in HIV patients, it causes symptoms like fever and diarrhea and is generally not fatal.

• Toxoplasmosis - Toxoplasmosis is caused by the parasite Toxoplasma gondii, found in the feces of cats and rodents. It enters the human body through contaminated food and dust. This parasite causes severe infections in the retina, lungs, colon, pancreas, testes, and brain.

• Salmonella Septicemia - The bacteria Salmonella enters the body through contaminated food and water and causes infection of the intestines. It can spread to other organs through the blood.

How Can Opportunistic Infections Be Prevented?

HIV patients can prevent the disease from progressing to AIDS by preventing opportunistic infections by:

• Take antiretroviral medicines as suggested by the doctor.

• Take preventive medicines and get vaccinations on time.

• Always use condoms during sex.

• Avoid getting infected with cats and other animal feces.

• Avoid contact with people who are sick.

• Do not consume contaminated food and water.

• Maintain good hygiene.

• Wash hands properly after touching raw meat.

How to Diagnose HIV or AIDS?

The diagnosis of HIV or AIDS can be made through saliva or blood tests. The recommended tests are:

• Antibody or Antigen Test - This test involves taking a sample of blood from a vein. Antigens are part of HIV and are generally detectable in the blood after exposure to HIV within a few weeks. Antibodies are produced by the immune system in response to HIV and take weeks and months to become detectable. The combination antibody or antigen tests may take two to six weeks after exposure for HIV to become positive.

• Nucleic Acid Test (NAT) - This test checks for the presence of actual viruses in the blood. If a person has been exposed to HIV in the past few weeks, it is recommended to go for a nucleic acid test. It is the first test to become positive after HIV exposure.

• Antibody Test - It involves most rapid HIV tests and self-tests done at home. This test checks for HIV antibodies in saliva or blood. It takes up to three to twelve weeks after HIV exposure to become positive.

How Can AIDS Be Treated?

• Once the disease has progressed to AIDS, only symptomatic treatment is given. Depending on the cause and type of opportunistic infection, antibiotics and antiviral medicines are used. Adhering to a strict antiretroviral regimen, most HIV patients lead a near normal life. Avoid getting infected by taking some precautionary measures. Patients with AIDS can revert the condition to HIV by sticking to proper treatment.

• There is no permanent cure for HIV infection currently. HAART (highly active antiretroviral therapy) will stop the replication of the virus, so further damage to CD4 cells will be prevented. This can be seen as a “target not found” in plasma viral load, which is used to monitor treatment. HIV, once positive, will remain positive lifelong.

Conclusion:

AIDS is a potentially life-threatening disease caused by the human immunodeficiency virus. This virus damages the immune system and interferes with the body’s ability to fight infection. There is no cure for AIDS, but medications can prevent the progression of the condition. Antiviral medications for HIV have shown reduced mortality around the world.