HIV (human immunodeficiency virus) is a virus(retrovirus family) that targets and damages the cells responsible for defending the body against infections, increasing susceptibility to other infections and diseases. The virus is primarily transmitted through contact with specific bodily fluids from an HIV-positive individual, often during unprotected sex (without a condom or HIV preventive/treatment medication) or by sharing injection drug equipment. Without treatment it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS)
HIV targets and infects CD4 cells, also known as helper T cells, which are white blood cells crucial to your immune system. By destroying these cells, HIV reduces your white blood cell count, weakening your immune system’s ability to combat infections, including those that typically wouldn’t cause illness.
Initially, HIV may cause flu-like symptoms. After this initial phase, it can remain dormant in your body for a long time without noticeable symptoms, gradually depleting your T-cells. When the T-cell count becomes very low or you start developing specific illnesses uncommon in individuals with healthy immune systems, HIV has advanced to AIDS.
AIDS can lead to rapid weight loss, severe fatigue, mouth or genital ulcers, fevers, night sweats, and skin discolorations. People with AIDS are also more susceptible to other illnesses and cancers, which can cause additional symptoms.
Transmission
HIV can be transmitted through the exchange of various body fluids from individuals living with the virus, including blood, breast milk, semen, and vaginal secretions. It can also be passed from mother to child during pregnancy and childbirth. However, HIV cannot be contracted through everyday interactions such as kissing, hugging, shaking hands, or sharing personal items, food, or water.
Importantly, individuals with HIV who are on antiretroviral therapy (ART) and maintain an undetectable viral load do not transmit the virus to their sexual partners. Thus, early access to ART and continuous support for adherence to treatment are crucial not only for enhancing the health of those living with HIV but also for preventing its transmission.
Signs and Symptoms
The symptoms of HIV differ based on the stage of infection.
In the initial months after contracting HIV, the virus spreads more easily, but many individuals remain unaware of their status until the infection has progressed.
In the first few weeks post-infection, some may not show any symptoms, while others might experience flu-like symptoms such as:
- Fever
- Headache
- Rash
- Sore throat
As the infection advances, it progressively weakens the immune system, leading to additional signs and symptoms, including:
- Swollen lymph nodes
- Weight loss
- Fever
- Diarrhoea
- Cough
Without treatment, individuals with HIV can develop serious illnesses, such as:
- Tuberculosis (TB)
- Cryptococcal meningitis
- Severe bacterial infections
- Cancers like lymphomas and Kaposi’s sarcoma
HIV Tests
There are three main types of HIV tests:
- Antibody Tests: Detect antibodies produced in response to HIV. Commonly used in rapid tests and is the only FDA-approved HIV self-test. Blood tests from a vein can detect HIV earlier than finger sticks or oral fluid tests.
- Antigen/Antibody Tests: Detect both HIV antibodies and the p24 antigen. Typically done in labs using blood from a vein, but rapid tests using finger stick blood are also available.
- Nucleic Acid Tests (NAT): Detect the actual virus in the blood and can determine the viral load. Performed using blood drawn from a vein, NATs can detect HIV sooner than other tests. Recommended for those with recent or possible exposure and early symptoms who tested negative with other tests.
Consult with your healthcare provider to determine the most suitable HIV test for you.
Treatment
There is no cure for HIV, but it can be managed with antiretroviral drugs, which prevent the virus from replicating in the body.
Antiretroviral therapy (ART) does not cure HIV but helps strengthen the immune system, enabling it to combat other infections. ART must be taken daily for life.
ART reduces the viral load in the body, preventing symptoms and allowing individuals to lead full, healthy lives. People on ART with no detectable virus in their blood cannot transmit HIV to their sexual partners.
Pregnant women with HIV should start ART as soon as possible to protect their health and prevent the virus from being passed to their babies during pregnancy or through breast milk.
Antiretroviral drugs can also prevent HIV in uninfected individuals. When taken before potential exposure, it is called pre-exposure prophylaxis (PrEP), and when taken after exposure, it is called post-exposure prophylaxis (PEP). People at high risk of contracting HIV should consult a clinician about using PrEP or PEP.
Prevention
HIV is a preventable disease. To reduce the risk of HIV infection:
- Use a male or female condom during sex.
- Get tested for HIV and sexually transmitted infections.
- Consider voluntary medical male circumcision.
- Utilize harm reduction services if you inject or use drugs.
Doctors may also recommend the following preventive measures:
- Antiretroviral drugs (ARVs): Including oral PrEP and long-acting products.
- Dapivirine vaginal rings.
- Injectable long-acting cabotegravir.
Additionally, ARVs can be used to prevent mothers from transmitting HIV to their children.