What is HIV, and How Is It Different From AIDS? Overview, Signs and Symptoms, Complication, Causes and Risk Factors, Diagnosis, Treatment, Prevention - Page 8 of 8

Sexually-transmitted diseases have been around for thousands of years, but they weren’t always taken seriously until HIV made its first appearance in the 20th century. Now, HIV is one of the most feared sexually-transmitted diseases, and even though new treatment strategies give these patients quality of life, a cure has not yet been found.

In this article, we’re covering what you need to know about HIV and AIDS, how are the infection and the disease suspected and diagnosed, and what you can do about it.

What is HIV, and how is it different from AIDS?

HIV is short for Human Immunodeficiency Virus. It is a retrovirus, and there are two strains, HIV-1 and HIV-2. The virus is transmitted through blood contact, sexual intercourse, or mother-to-child transmission during birth and breastfeeding. Depending on the country, one or the other route of infection will be more prevalent. Being a sexually-transmitted disease, HIV infection is often accompanied by other diseases transmitted by sexual intercourse, especially herpes virus, hepatitis B, and hepatitis C.

Despite having two main species of HIV and each one with multiple subtypes of the disease, all of them cause similar signs and symptoms. What is different is the distribution of the subtypes worldwide and their response to a future vaccine. HIV-1 has a higher transmission risk and progresses more rapidly into acquired immune deficiency syndrome or AIDS.

AIDS is the manifestation of HIV, which only shows up when the virus has infected the patient for some time. After this latency time in which the virus replicates, the patient’s immune system is affected by the disease and only then is he diagnosed with AIDS. So, a patient can have an HIV infection without AIDS. But patients with diagnosed AIDS are always infected with one of the HIV viruses.

Read Also:

Once inside the body, HIV causes depletion of white blood cells, especially CD4 cells known as helper T lymphocytes. These cells are fundamental to fighting infections and destroying cancer cells. Thus, HIV patients will have a higher risk of opportunistic infections that other patients do not catch and will have a higher risk of different cancer types.

Causes and risk factors

The cause of HIV and AIDS is the Human Immunodeficiency Virus, which breaks down into 2 species and several subtypes. According to the latest statistics, this virus infected nearly 38 million people worldwide by age 2018. They are males and females of all ages, but if we consider the number there’s an evident prevalence of the disease in males. According to data from 2015, 81% of the diagnoses came from males in the United States, and it is higher in this country among African American people.

We could say that the main risk factors of HIV and AIDS are:

Unprotected penetrative sex: This is the most common risk factor, and both vaginal and anal sex has a similar risk, but the infection in the latter is faster because there is more contact between the penis and micro-abrasions in the anal cavity. Unprotected penetrative sex is less risky in monogamous relationships, but nothing should be taken for granted, even in these cases.
Having sexually transmitted infections: Statistics show that most patients with HIV infections are coinfected with other sexually transmitted diseases. In many cases, they increase the likelihood of infections. For example, individuals with herpesvirus have genital sores easily infected by contact with blood or semen.
Sharing injecting equipment: Outside of the sexually-transmitted HIV, drug addiction and sharing needle equipment is another common route of infection. These individuals also tend to lose control over their own actions after getting high and are more likely to practice unprotected sex with multiple sexual partners.
Medical procedures without sterile materials: Besides sharing needles and injecting equipment, anything that pierces the skin and is not sterile can potentially pass down the disease to another person. In medical facilities, there’s a protocol to follow to avoid this. However, there’s still a significant risk after piercing, getting a tattoo, or visiting an unlicensed doctor if they don’t use sterile materials.
Accidental pricks in healthcare workers: Healthcare workers are significantly at risk of accidental pricks. They are always in contact with needles and anonymous patients in the emergency room, and accidents can happen, especially if they are not following security protocols.

As noted, being gay is not listed among the risk factors, and HIV stopped being a disease that only affects gay men for many years. However, as noted above, the rate of men with HIV is higher than females, and in heterosexual relationships, it is more likely that a man infects a woman with HIV than vice versa.

Signs and symptoms

The signs and symptoms of HIV infection are highly variable and depend on the stage of the disease. In the initial phase, there is a prodromal syndrome, and it can be totally asymptomatic. But some patients experience symptoms in this stage a few weeks after being infected. These symptoms are unspecific and similar to those experienced in influenza, including:

Headache: This is a common symptom closely after being infected, but it is usually a very mild headache and improves after using over-the-counter anti-inflammatory drugs.
Mild fever: Fever is the immune system’s initial response trying to fight the infection, but it is very mild and self-limited at first. Since HIV replicates inside of the cell, the immune system can’t reach the virus, and it goes unnoticed during the latency period.
Sore throat: It is a likely symptom closely after being infected, but the soreness is usually not severe and goes unnoticed. The symptoms are unspecific if any, and it is difficult to trace the source of the infection.
Skin rash: Some patients experience a skin rash, which is usually a physical sign that the immune system was temporarily activated. The rash in this initial stage is unspecific and does not follow a traceable pattern.
Fever: In this initial stage, it would be mild fever easily controlled by over-the-counter drugs and often goes unnoticed. It could be accompanied by malaise and a sensation of being sick that is common in influenza infections.

As the disease progresses, it starts affecting the immune system, and patients start developing certain signs and symptoms. For example:

Swelling lymph nodes

This is one of the earliest manifestations of HIV when it affects the immune system. At first, it only takes a few lymph nodes, and it is easy to disregard the symptoms.

Weight loss: Patients may start losing some weight, especially when another disease is also beginning to affect their health. Weight loss might not be noticeable until the onset of AIDS.
Cough and diarrhea: The patient may start experiencing more frequent respiratory and gastrointestinal infections. Catching flu more often is not particularly worrisome, and most patients disregard their problem in this initial stage.

Finally, when the immune system alteration is severe, patients with Acquired Immunodeficiency Syndrome (AIDS) experience symptoms such as:

Rapid weight loss

Unlike the symptoms above, rapid weight loss is very noticeable, especially when the patient is not doing anything to lose weight. This is called unintended weight loss, and losing more than 5% of your weight in 6 months should prompt you to action if you’re not changing your physical activity levels or dietary patterns.

High and recurrent fever episodes: These patients have a very high infection rate because the first line of defense against opportunistic infections is not working correctly. Thus, they often have infections and high fever with chills. Some of them wake up at night drenched in sweat or have distressing new infections symptoms every time.
Weakness and fatigue: The disease creates significant metabolic stress in the body and the sensation of unexplained tiredness and muscle weakness. The immune system tries to fight off disease but has important fails in some cell lines and works double, consuming double resources in the process.
Chronic diarrhea: These patients are often affected by opportunistic infections in the gastrointestinal tract. Healthy bacteria start to cause gastrointestinal problems, and they could begin experiencing diarrhea for a very long time and without a traceable cause.
Generalized lymphadenopathy: One or two swollen lymph nodes suddenly turns into many enlarged lymph nodes, especially in individuals infected by mononucleosis and similar diseases. This is generalized lymphadenopathy and can be painful or not.
Sores in the skin and mucosa: Many patients with AIDS develop sores in the skin and mucosa, especially the mouth’s mucosa. In the mouth, they also start growing white or yellowish patches when infected by candida.
Pneumonia: Many patients with AIDS are initially diagnosed due to opportunistic infections that cause atypical pneumonia.
Kaposi’s sarcoma: It is one of the most common types of cancer in patients with HIV. They look like violet, reddened, or brownish patches in the skin.

Diagnosis

The diagnosis of HIV has two stages. In the first stage, ELISA tests are used to detect whether or not the virus is present in the blood. This test is also helpful to screen for HIV in high-risk patients. Only when this test is positive, the diagnosis needs to be confirmed with a Western Blot assay, which is more specific. The results can be positive or negative, but they are sometimes indeterminate, and the exam needs to be repeated.

After confirming a case of HIV or AIDS, the next step would be differentiating what species of HIV is infecting the patient, his viral load, and his CD4 count. All of this is useful to know the stage of the disease and what to do next.

Several evaluations and laboratory studies can be performed in patients depending on their condition, symptoms, and likely infections.

Treatment options

Depending on the stage of the disease and the coexisting infections, doctors can recommend one course of action or the other. The goal of medical therapy is to achieve an improvement in the immune system’s capability to fight disease and prevent it from deteriorating further.

HIV is treated with drugs under the category of Highly Active Antiretroviral Therapy, or HAART. This treatment is held in the long term, and doses can be changed according to how the body responds, the viral load, and the CD4 count.

Primary care interventions and other treatments are also essential to solve opportunistic infections and prevent disease complications.

How to prevent HIV infections?

HIV is not curable, and prevention is the only way to be free from disease. Limiting exposure to the risk factors listed above is essential for prevention. Prevention would be easier if we could easily identify infected individuals, but there’s a latency period in which they have no idea that they’re spreading the disease. And even infected patients with ongoing AIDS may not be easy to differentiate from the rest.

Read Also:

Thus, the recommendations include exercising caution at all times:

Protected sex: Condom use is essential in males and females to reduce the transmission of HIV. Condoms have a protective effect of over 85%, but this efficacy can change depending on how you use them. For maximum protection, condoms should be used from the start of penetrative sex.
Using sterile needles: In many countries, injected drug users are given sterile syringes to prevent the spreading of HIV in this high-risk population. Even better, people who use injected drugs would be safer if they quit using them or turn to another option that does not involve needles.
Counseling and testing: Counseling high-risk individuals about the risk factors and preventing HIV is essential to stop the disease’s spread. Frequent testing is also recommended if you have multiple sexual partners and before establishing sexual contact with a new monogamous partner.
Pre-exposure prophylaxis (PrEP): Many studies are being made to evaluate oral PrEP as a way to prevent infection in HIV-negative patients. There are currently open-label trials going on, and it is in the process of regulatory approval.