AIDS and HIV: description, symptoms, treatment
AIDS is an acquired immunodeficiency disease. It is the final stage of HIV infection. The HI virus attacks certain cells of the immune system. It is mainly transmitted through unprotected sexual intercourse. An HIV infection is not yet curable, but can now be treated well. Read here what AIDS and HIV mean exactly, which symptoms occur and how to treat them.
AIDS: short overview
- Description: AIDS is the final stage of HIV infection. HI viruses attack cells of the immune system and weaken the body’s defences. Result: extreme susceptibility to infections
- Symptoms: early symptoms similar to influenza, later severe weight loss, night sweats, diarrhoea, immune deficiency consequences such as pneumonia, yeast infections, tuberculosis, Kaposi’s sarcoma
- Treatment: Drugs that prevent the reproduction of the virus, relieve symptoms, strengthen the immune system
- Infection: unprotected sex, infected drug paraphernalia, stab wounds, especially with medical equipment
- Diagnosis: Blood test for HIV antibodies, HIV antigens, safe diagnosis only possible three months after infection
- Prognosis: discovered early well treatable, but not curable
AIDS and HIV: Description
AIDS is an acquired immune deficiency disease. The trigger is the HI virus, which attacks certain cells of the immune system.
However, the clinical picture of AIDS only occurs in the final stage of HIV infection. While many HIV-infected persons have not yet developed symptoms or can avert them with medication, patients in the AIDS stage suffer from various typical, often life-threatening secondary infections and tumours due to their pronounced immune deficiency.
Most patients become infected with HIV during unprotected sexual intercourse. However, drug users have the highest risk of infection if they use syringes that have already been used by infected persons.
In countries with good health care systems, modern medicines today make it possible for AIDS to often not break out at all and for patients to lead a largely normal life. However, the infected persons must take medication for the rest of their lives, otherwise the viruses will quickly take over again.
Unfortunately still a long way to go, even if research has recently made some progress. HIV is a very mutable virus. It is difficult to develop a vaccine that works for all HIV variants. But there is already the HIV prophylaxis PrEP. HIV-negative people take HIV medication and can then no longer become infected.
Everyone should know With HIV you can grow old and live like everyone else today. Whether job, sexuality, family planning or leisure time – the infection no longer has to mean a restriction. HIV drugs prevent the virus from multiplying in the body, so you stay healthy. HIV is then also no longer transmissible. Important: The infection should be diagnosed and treated as early as possible. If in doubt, it is better to have an HIV test.
What is HIV?
HIV stands for “human immunodeficiency virus”, translated: human immunodeficiency virus. It multiplies in special immune cells, so-called T-helper cells of the type C4. To do this, it channels its genetic blueprints into the cell and uses its reproduction structures. The T-cells are destroyed.
However, T-helper cells play a central role in immune defence: In the defence against pathogens they coordinate other cells of the immune system.
For a while, the body manages to fend off the HI viruses. For this purpose, he forms, among other things, special antibodies that detect the HI virus. This so-called latency phase can last for years. Although the patient is then infected and can infect others, he does not feel any symptoms of the disease.
At some point, however, not enough T-helper cells are available. Then other viruses as well as bacteria and fungi have an easy time.
As the disease progresses, certain infectious diseases and tumours often emerge which are otherwise rare but which are life-threatening if the immune system is weakened. Then the AIDS stage is reached.
When infected with the HI virus, T helper cells are forced to produce new HI viruses. The immune system is thus weakened more and more.
What is AIDS?
In the final stage of HIV infection, patients develop an AIDS syndrome. The abbreviation AIDS stands for “acquired immune deficiency syndrome”. This means “acquired immune deficiency syndrome”.
At this stage the immune defence is severely weakened. The patient then falls ill with infections that are otherwise rare but can be dangerous for him. In addition, patients develop a so-called wasting syndrome with fever, diarrhoea and severe weight loss.
Often the viruses now also attack the brain, resulting in a so-called HIV-associated encephalopathy. This brain disease is associated with motor disorders and cognitive impairment. It can lead to dementia. Specific malignant changes such as Kaposi’s sarcoma are also typical of AIDS.
HIV and AIDS: symptoms
The stages of HIV infection are divided into three classes A, B and C, depending on the symptoms.
Incubation period of HIV and AIDS
The first symptoms of HIV appear in the first weeks after infection. However, the time span between HIV transmission and the outbreak of AIDS is several years. Ten years after HIV infection, about half of all infected people are ill.
HIV stage A
Stage A is divided into two phases: The first early symptoms are followed by a symptom-free period.
The first symptoms of HIV infection appear within six days to six weeks, but most often two weeks after infection. They resemble a flu-like infection or a mildly running whistling glandular fever. Therefore, HIV infection often remains undetected in the early stages. First signs are:
- Sore throat
- swollen lymph nodes
Another early sign of HIV is a typical skin rash. HIV causes slight skin changes on the trunk of some patients. Doctors then speak of a discrete HIV exanthema on the body stem. One also speaks of HIV rash and HIV spots.
Take early symptoms seriously!
If you have reason to believe that you have become infected with HIV through unprotected sex or a torn condom, you should take such symptoms seriously. Even when the symptoms subside, the virus can still damage your body and your immune system. Early therapy protects against this. You could also infect other people. Let us test you!
Symptom-free latency phase
After the first HIV symptoms have subsided, the virus infection sometimes remains symptom-free for years. However, the virus is still active and damages the immune system. This silent phase of the infection (also called the latency phase) ends with swelling of the lymph nodes throughout the body. This condition can last for several months.
In stage B the immune system is weakened to such an extent that various diseases occur. Doctors call this “AIDS related complex”. Typical in this phase:
- long-lasting diarrhoea (over four weeks)
- unintended heavy weight loss
- prolonged fever
- Night sweat
- pneumonia or meningitis caused by bacteria
- bacterial blood poisoning (sepsis)
- Pulmonary tuberculosis
- Shingles (Herpes zoster)
- oral hair leukoplakia (whitish changes on the lateral edge of the tongue)
- Vagina inflammation caused by fungi, malignant changes in the cervix
Stage C: AIDS
In the advanced stage, HIV infection leads to AIDS. In AIDS patients, the severely weakened immune system can no longer withstand many pathogens.
The patients then fall ill with so-called opportunistic infections. This means that the pathogens use the immune deficiency to multiply. While such infections are rare in people with a healthy immune system and are well controlled by the immune system, they can be life-threatening in AIDS patients. Doctors refer to them as AIDS-defining diseases:
- Pneumonia caused by Pneumocystis jirovecii
- Candida fungal infections of the oesophagus and the deep respiratory tract
- Encephalitis caused by toxoplasmosis
- Cytomegalovirus infections in eye, lung, brain, intestine
- Kaposi’s sarcoma caused by Herpes 8 virus (malignant new formation of blood vessels visible as brown-red spots; colloquially known as AIDS spots)
- active tuberculosis
- progressive multifocal leukoencephalopathy caused by infection of the nervous system with the JC virus
- Retinitis caused by the cytomegalovirus
Among the AIDS-defining diseases is the so-called wasting syndrome. It is characterized by:
- a strong weight loss of about ten percent of the body weight in six months
- persistent diarrhea
Other AIDS-defining diseases are malignant lymphomas. This is a cancer of the B lymphocytes.
HIV infections are still not curable. However, modern drugs enable many patients to lead a largely normal life with an average life expectancy. However, this only applies if the disease is detected and treated early. Additional diseases such as hepatitis can make treatment more difficult.
HIV & AIDS: Drugs
The HIV therapy is individually adapted to each patient. In the laboratory, the exact type of the HI virus is determined in order to select the appropriate medication. The treatment is only successful if the patient takes it regularly throughout his or her life.
The drug-based HIV therapy aims at this,
- to relieve the symptoms,
- to prevent the transition to a higher disease stage,
- to rebuild a stable immune system,
- prevent a harmful, permanent activation of the immune system and
- to reduce infectivity, i.e. the risk of infecting others.
HIV patients receive highly active antiretroviral therapy, HAART for short. It consists of an individually adapted combination of different drugs. There are currently more than 20 drugs used for HIV treatment, and it is important to combine at least three drugs in order to prevent the HIV virus from developing resistance. The following medicines are available:
- Reverse transcriptase inhibitors (RTI): They prevent the HI virus from multiplying by inhibiting the enzyme “reverse transcriptase” which is necessary for this. Examples of active ingredients: Lamivudine, tenofovir, emtricitabine, efavirenz.
- Protease inhibitors (PI): They prevent virus replication by inhibiting the recomposition of virus particles. One of these substances is Atazanavir.
- Integrase inhibitors (INI): They prevent the virus from inserting its genetic information into the human genome of the host cell. Then no new viruses can be created. A representative of the INI is Raltegravir.
- Fusion inhibitors (FI): They prevent the virus from infiltrating a human cell. Enfuvirtid is one of them.
Why HIV is not yet curable
Researchers are constantly adapting the available drugs and thus improving the treatment of HIV more and more. However, the disease cannot be cured with any of the current active ingredients, as none of them can kill all viruses.
Reasons for this include the fact that the virus entrenches itself in the patient’s cells and that some organs, such as the central nervous system, are not easily accessible for drugs.
AIDS treatment: criteria for therapy
When and to what extent a HAART is initiated must be decided for each patient individually. Decisive factors are, for example, the current symptoms and the possible side effects of HIV treatment.
However, there are rough guidelines as to when HAART is generally advisable. This is the case if the HIV patient suffers from symptoms of category B or C.
Laboratory criteria are also taken into account when deciding on a therapy, for example the number of remaining T-helper cells (CD4 cells): If their value is below 350 cells per microliter (µl) of blood, a drug therapy is often initiated.
AIDS treatment: check-ups
To determine whether HAART is successful, blood is drawn from the patient every two to four months. It is examined for the number of HI viruses (viral load) and T helper cells.
No later than six months after the start of therapy, the virus load should be below 50 per microliter of blood. If it is higher, you may need to try a different combination of drugs.
HIV and AIDS – what you can do yourself
Drug treatment is the basis of AIDS therapy. Furthermore, as a patient you can do even more for your health:
- Find a doctor who is an AIDS specialist and whom you find sympathetic. You will be treated by him for a long time.
- Follow the instructions of your doctor. Take your medication according to the prescribed schedule. If you do not tolerate the preparations, do not simply stop taking them, but ask your doctor for advice.
- Get vaccinated against diseases that could weaken you further or make you more difficult to treat because of HIV infection, such as influenza (influenza vaccination) or pneumonia (pneumococcal vaccination).
- Do not smoke and do not take drugs. That would further weaken your body.
- Eat plenty of fruit and vegetables and wholemeal products. This strengthens your immune system. If you have problems with the gastrointestinal tract, talk to a nutritionist.
- Avoid foods that may contain pathogens. This includes unpasteurised dairy products, raw eggs, oysters, raw fish and raw meat. Wash raw fruit and vegetables thoroughly before eating them!
- Exercise regularly. Not only will this make your body fitter, but you can also partially prevent depression, which is common among people infected with HIV.
- Get enough sleep – this strengthens your immune system.
- Be careful with pets. Always wash your hands after petting animals and wear gloves when cleaning the litter box or rodent pen (to protect against toxoplasmosis).
- Relax regularly. Any kind of relaxation like progressive muscle relaxation or autogenic training is good for your immune system.
- Wash your hands regularly. This is especially important when you prepare or eat meals.
- Visit an AIDS advice centre to get comprehensive information about living with HIV, support options and help for self-help.
AIDS: examinations and diagnosis
If you fear that you have been infected with the HI virus, consult your family doctor. He may refer you to an AIDS specialist, such as an internist with experience in infectious diseases.
First your doctor will ask you in detail about your medical history (anamnesis). He will ask you the following questions, among others:
- Have you had unprotected sex?
- Are you injecting drugs?
- Did you get into a medical profession?
- Have you been to Southeast Asia or the Sub-Sahara and had physical contact with locals there?
- Have you had flu-like symptoms in the last few weeks?
Your doctor will then examine you. In order to confirm or rule out an infection with the HI virus, blood is taken from you for an HIV test.
The HIV test, colloquially called AIDS test, is a blood test. To be on the safe side, testing is always done twice:
Test for antibodies
The first test looks for antibodies against HIV. Antibodies are components of the immune system that are formed in response to the pathogen. They fit exactly to protein structures on the surface of the viruses and can thus locate them.
This test is effective at the earliest three weeks and at the latest three months after infection. The result is then available within a few days. This is why the procedure is also known as an HIV rapid test.
Test for antigens
The second test detects these same antigens of the virus in the blood of the patient. It does not work until about six weeks after infection.
How safe is the test?
Only when both tests provide evidence, i.e. the test result is “positive”, is a diagnosis of HIV infection made.
However, even a negative test result does not guarantee that you are not infected. Since it can take up to three months before antibodies against HIV can be detected in the blood, the test only provides reliable results for the time before three months ago.
When can you get tested?
If one fears that one has been infected at a certain point in time, a test is only useful three weeks after this event. This is because it is at this point that antibodies are formed at the earliest.
HIV test for home use
Since October 2018, it has been possible to carry out an HIV test at home. It is just as conclusive as an HIV test at the doctor’s. However, if the test result is positive, you will lack a competent contact person who can advise you in this difficult situation. Then contact your doctor or a counselling centre as soon as possible.
Further information on this topic can be found in the article HIV-Test
AIDS: infection and risk factors
The cause of HIV infection and AIDS is the HIV virus. The HI-Virus belongs to the family of retroviruses. The HI virus consists essentially of genetic information that is packaged in a protein capsule, encapsulated by a membrane. It is about 80 to 100 nanometers in size. Like all viruses, it depends on the cells of organisms to multiply. Host cells of the HI virus are T-helper cells of type D4. It introduces genetic information in the form of a single RNA strand. Before it can be amplified, it must first be converted to DNA. An enzyme required for this, the reverse transcriptase, is also supplied by the virus.
HIV – how do you get infected?
Only those who know about the ways of HIV transmission can protect themselves effectively against the AIDS pathogen.
HIV transmission: sex without a condom
Both partners can become infected if they have unprotected sexual intercourse. In heterosexual relationships the woman is more vulnerable than the man.
The risk of HIV/AIDS infection for the receiving partner is particularly high in the case of unprotected anal sex. On the one hand, small injuries can occur in the anal region, which allow blood contact. On the other hand, the liquid film on the intestinal mucosa facilitates the absorption of the HI viruses. HIV is also easily released from the intestinal mucosa, so that the invading partner can also become infected.
Transmission of HIV during oral sex
HI viruses are found mainly in ejaculate and blood. If sperm or menstrual blood enters the mouth during oral sex, HIV can therefore be transmitted. In the vaginal secretion or desire drops of the man the virus is found only in small quantities.
Accordingly, the risk of HIV transmission through oral sex is less if only the pleasure drop or vaginal secretion enters the mouth. Nevertheless, experts recommend safer sex even during oral sex: AIDS (or HIV) is not the only venereal disease that can be transmitted.
HIV infection: Will you remain infected forever?
Thanks to modern drugs, it is possible in many cases to drastically reduce the so-called viral load. If it is below the detectability limit, it is highly unlikely that others can be infected. However, it is necessary to have this checked regularly, because the virus load can change again at short notice. The prerequisites are
- successful treatment for more than six months
- medical checks every three months
- no infection with other sexually transmitted infections
AIDS – who is at risk?
Some groups of people are particularly at risk of contracting HIV. You should take special care to protect yourself.
- People who have sex with many different people naturally have an increased risk of contracting HIV and AIDS. Men who are sexually active with men are particularly at risk.
- If someone already suffers from a venereal disease such as Chlamydia or syphilis, the risk of contracting HIV is also increased. The reason for this is that the immune cells that take up HIV are more present in the genital tract in such infections.
- People who inject drugs have the highest risk of HIV infection. If one uses the same drug kit as an infected person, the HI virus can be easily transmitted.
- Medical staff: Medical staff is another risk group. Physicians carry an increased risk of infection from needle injuries or stab wounds during surgical procedures. HIV is transmitted in about one in 330 medical stab wounds.
In principle, HIV can also be transmitted via blood transfusions and organ transplants. However, since 1985 blood products and donor organs have been tested for HIV in the Western world. HIV transmission by this route is therefore highly unlikely today. The risk is below 1 in 3 million. However, people who received blood transfusions before 1985 are counted among the HIV risk group.
HIV transmission during pregnancy
If an HIV-positive or AIDS-suffering woman becomes pregnant, the child is at risk of HIV transmission. This risk is particularly high during birth, as injuries at birth can bring maternal and infant blood directly into contact.
However, the risk is less than one percent if:
- the mother is consistently treated with medication against HIV during pregnancy
- the child is delivered by cesarean section
- the child receives chemotherapeutic prophylaxis (HIV-PEP) after birth
Without these measures, the probability of infection for the child is between 15 and 20 percent.
HIV transmission during breastfeeding
HIV transmission during breastfeeding is possible. HIV-positive mothers are therefore advised not to breastfeed their children but to use a bottle instead. In third world countries with poor food supply, children should still be breastfed. That risk of malnutrition and related diseases and death is rated higher.
Protection against HIV transmission
To protect yourself from HIV transmission, you should minimize the risk factors mentioned above:
- Use condoms: Always use a condom during sexual intercourse. Safer sex is especially important with a new or unknown partner. In this way, you not only protect yourself from HIV transmission, but also from other sexually transmitted diseases such as syphilis.
- Inform the partner: If you are HIV-positive, you should inform your partner about it and use a condom during sex! This reduces the risk of infecting your partner.
- Use prophylaxis: However, a transmission of HIV despite a condom is possible, for example if it tears or slips off. In such cases you should consult a doctor and discuss the necessity of chemotherapeutic prophylaxis.
- Pre-exposure prophylaxis (PrEP): Certain HIV drugs are now also prescribed for prevention. They intercept the viruses in the blood before they can implant themselves. They are considered to be about as safe as the use of condoms.
- Protect during oral sex: To prevent HIV transmission during oral sex, condoms or dental dams should be used.
- Use your own drug cutlery: If you use drugs, you should always use your own sterile drug cutlery! This not only reduces the risk of AIDS transmission, but also the risk of hepatitis C. So do not borrow drug paraphernalia from acquaintances.
- Wearing gloves in medical operations: If you work in the medical sector, you should always wear gloves when handling infectious material. Safety glasses, face protection and disinfectants also reduce the risk of HIV infection.
When do you not have to be afraid of HIV infection?
Overall, in everyday, normal – not sexual – contact with relatives, friends or colleagues who are HIV-positive or have AIDS, HIV transmission is almost impossible.
- A transmission of HIV through kissing is not possible.
- Even when shaking hands and hugging, there is no HIV transmission.
- Nor can HIV/AIDS be passed on through the sharing of swimming pools, toilets, towels or bed linen.
- Even contact with sweat or tears of an infected person does not lead to HIV/AIDS transmission.
- It is also impossible to become infected via insect bites, even if the insect in question has previously sucked blood from an infected person.
Post-exposure prophylaxis (PEP)
If you fear that you have been infected with the HI-Virus, consult a doctor immediately and discuss with him the possibility or necessity of a PEP and its possible side effects. Medical personnel who have been pricked or have had contact with blood while caring for HIV-infected and AIDS patients can also notice a PEP.
You will then receive HIV medication for four weeks, which will reduce the likelihood of infection. A triple combination of the active ingredients Raltegravir, Tenofovir and Emtricitabine is often prescribed. However, other combinations can also be used.
Narrow time window:PEP should be started within 24 hours of the possible infection, preferably within two hours. You will be tested for HIV at the time you first take the medication and after six weeks, three months and six months.
Pre-exposure prophylaxis (PrEP)
HIV-negative persons who are at high risk of becoming infected can be prevented with a so-called pre-exposure prophylaxis. The patients take a drug that is also used for the treatment of HIV and contains the active ingredients emtricitabine and tenofovirdisoproxil fumarate.
Its effectiveness is proven in homosexual men with risky sex lives and is similar to that of condoms. However, the drug does not protect against other sexually transmitted diseases.
The prophylaxis is usually well tolerated, but can damage the kidneys. Users must have their kidney function checked regularly and have an HIV test every three months to rule out infection.
Since September 2019, the costs for the drugs have been covered by the health insurance companies in the European Union. Application of this law is now mandatory and started in March 2020.
AIDS: course of the disease and prognosis
The course of HIV is divided into different stages:
- Acute infection: From the sixth day after infection up to six weeks as febrile infection
- Unobtrusive persistence: The infection can remain asymptomatic for years.
- Lymphadenopathy: swelling of the lymph nodes that persists for several months.
- AIDS related complex (ARC): Patients suffer from diseases that are due to a weakened immune system.
- AIDS: AIDS-defining diseases such as pneumonia or tuberculosis occur (sometimes decades after infection with HIV)
The individual HIV stages can be very diverse. In all patients, however, the cellular immune defence system is weakened and destroyed.
With current treatment options, the life expectancy of HIV-positive people in Germany is approximately the same as that of healthy people. However, this only applies to younger people who are otherwise healthy and start therapy around the age of 25.
Life expectancy for HIV and AIDS
In contrast, patients with other diseases such as hepatitis B or C, elderly people or drug addicts have a limited life expectancy. In other countries with less good health care, the survival time of people with AIDS is significantly shorter.
Even if intensive research is being done on it: An HIV vaccination has not yet been given. The most important protective measure against HIV and AIDS is therefore to prevent infection.