HIV infection

Risk factors are conditions or behaviors that increase the likelihood of contracting a disease. Certain lifestyle choices are associated with a higher risk of HIV infection. By modifying these factors, the chance of contracting HIV can be significantly reduced. The most common risk factors include:

Unprotected Sexual Contact:

The majority of HIV cases are transmitted through unprotected sexual activity. HIV can enter the body through the rectum, mouth, and genitals during sexual intercourse. Using protection, like condoms, can greatly reduce the risk of sexually transmitted infections (STIs). The risk is even higher among men who have sex with men and those with multiple sexual partners.

Drug Use:

Sharing needles or syringes can expose individuals to HIV due to the potential for blood contamination. Even a small amount of infected blood can transmit the virus.

Certain Health Conditions:

People with other sexually transmitted infections (STIs) such as gonorrhea, syphilis, genital warts, and herpes are more susceptible to HIV.

Blood Products:

HIV transmission can occur through contaminated blood transfusions, especially in places where blood banks do not test for HIV.

Occupational Exposure:

Individuals working in healthcare settings or laboratories, where they come into direct contact with blood and bodily fluids, are at higher risk for HIV.

For pregnant women, certain factors increase the risk of transmitting HIV to the child via breastfeeding, including:

• Detectable HIV levels in breast milk
• Mastitis (inflammation of the breast tissue)
• Low maternal CD4+ T cell count
• Vitamin A deficiency in the mother

To confirm whether someone has HIV, various tests are conducted, as symptoms may take years to appear. Testing is the only way to be certain of an HIV diagnosis.

Clinical History

A healthcare provider will review your symptoms and health history. A physical exam may help identify risk factors that increase the likelihood of infection. If HIV is suspected, confirmatory tests are necessary to begin treatment promptly.

Laboratory Tests (Nucleic Acid Testing and Antigen/Antibody Tests)

Tests to confirm HIV infection include:

• HIV 1 and HIV 2 Antibody Test: This test detects antibodies to HIV-1 and HIV-2, with HIV-1 being more common. It checks for viral presence and p24 antigen, which usually increases within the first week of infection.
• CD4 Count: CD4 cells, a type of white blood cell, are targeted and destroyed by HIV. A healthy individual typically has a CD4 count of up to 1000. As HIV progresses to AIDS, the count drops below 200.
• Enzyme-Linked Immunosorbent Assay (ELISA): ELISA detects HIV antibodies and proteins produced during infection. It is one of the most commonly used methods for diagnosing HIV.
• Western Blot: This is a confirmatory test following a positive ELISA result.
• Rapid Antibody Screening: This test is typically done with a finger-prick or oral fluid and provides results within 30 minutes.
• Rapid Antigen/Antibody Test: This immunoassay uses blood or oral fluids to check for HIV antibodies and provides results in about 30 minutes. Positive results require further confirmation.
• Oral Fluid Antibody Self-Test: The OraQuick in-home HIV test is a self-administered, over-the-counter test that checks for antibodies to HIV-1 and HIV-2 using oral fluid.

Note:

No test can detect HIV immediately after exposure. This period, called the "Window Period," varies for each person and depends on the test type. Nucleic acid tests can detect HIV 10-33 days after exposure, while antigen/antibody tests can detect it after 18-45 days. Rapid tests may take 18-90 days, and antibody tests typically detect infection after 23-90 days.

There is no vaccine for HIV, and no cure has been found. However, several measures can help prevent the spread of HIV:

• Spreading Awareness: Educating the public on HIV transmission and prevention.
• Safe Blood Transfusion: Ensure that blood is tested and screened by accredited blood banks to prevent transmission.
• Get Tested: Get tested for HIV before engaging in sexual activity and encourage partners to do the same.
• Use of Condoms: Condoms provide protection against HIV and other STIs. They should be worn before any sexual contact.
• Avoid Sharing Needles: Always use sterile needles and never share them to inject drugs.
• Limit Sexual Partners: Having fewer sexual partners reduces the risk of exposure to HIV, especially if one partner is HIV-positive.
• Get Tested and Treated for STIs: People with other STIs are at a higher risk of contracting or spreading HIV. Regular testing and treatment can help reduce this risk.
• HIV Prevention Medication: Pre-exposure prophylaxis (PrEP) is a medication for HIV-negative individuals who are at higher risk of exposure, such as those with HIV-positive partners. It helps reduce the risk of infection.
• Preventing Mother-to-Child Transmission: Pregnant women with HIV should take HIV medications to protect their health and prevent the transmission of the virus to the baby.

Specialist to Visit

A general physician is usually the first point of contact for an HIV diagnosis. Additionally, HIV specialists help monitor treatment and provide guidance on managing the condition. Most people with HIV should visit their healthcare provider every six months, although some may need more frequent visits in the first two years of treatment. Regular lab tests are necessary for those on medication to monitor viral load.

There is no cure for HIV yet, but there are highly effective treatments that allow individuals with the virus to live long, healthy lives.

A. Antiretroviral Therapy (ART)

ART is the primary treatment for HIV, and it reduces related health complications, lowers HIV transmission, and helps maintain viral suppression. The goal of ART is to achieve an undetectable viral load within six months of starting treatment. There are different classes of ART, including:

1. Entry Inhibitors: These drugs prevent HIV from entering human cells. Common examples include Maraviroc, Enfuvirtide, and Fostemsavir.
2. Integrase Inhibitors: These block the integrase enzyme, preventing HIV from integrating its genetic material into the host's DNA. Examples include Raltegravir and Dolutegravir.
3. Protease Inhibitors: These inhibit the protease enzyme, preventing the virus from replicating. Drugs in this class include Ritonavir and Atazanavir.
4. Fusion Inhibitors: These block HIV from entering the host's cells. Enfuvirtide is a widely used fusion inhibitor.

B. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

NRTIs block reverse transcriptase, an enzyme HIV needs to replicate. However, they can have side effects, including mitochondrial dysfunction. Examples include Lamivudine and Zidovudine.

C. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

NNRTIs prevent HIV from converting its RNA into DNA. Examples include Efavirenz and Nevirapine.

D. Multi-Drug Combinations

Combining different types of antiretroviral drugs can improve the effectiveness of treatment. Common combinations include Dolutegravir, Tenofovir, and Emtricitabine.

These treatments do not cure HIV but help manage the virus, prevent its progression to AIDS, and allow people to lead a relatively normal life.

If left untreated, HIV can significantly impact a person's health, leading to various complications:

Neurological Impact

Though HIV doesn’t directly infect neurons, it affects glial cells, which support them. This triggers inflammation that can damage the brain and spinal cord, causing symptoms like difficulty concentrating, headaches, mood changes, anxiety, depression, and problems with coordination and walking.

Brain Shrinkage

HIV can cause a reduction in brain size, particularly in areas involved in learning and memory processing.

Nervous System Issues

Pain, seizures, strokes, vision loss, and even coma can occur due to the combined effects of HIV and certain medications.

HIV in Children

In children, HIV can lead to developmental delays, growth issues, nerve pain, eye complications, and brain lesions.

HIV-Associated Dementia

This occurs in the late stages of HIV, marked by cognitive decline, memory loss, trouble concentrating, and motor dysfunction.

Peripheral Nerve Damage

HIV can damage peripheral nerves, leading to weakness and loss of sensation in the arms and legs.

Cardiomyopathy

In the advanced stages of infection, HIV can cause heart muscle disease, leading to heart failure.

Liver and Gallbladder Diseases

HIV-infected individuals often experience liver issues, including granulomatous hepatitis and AIDS-related cholangiopathy.

Kidney and Urinary Tract Disorders

HIV-associated nephropathy is common in patients with HIV, impacting kidney function.

Arthropathy

HIV-related arthritis, known as AIDS-associated arthropathy, manifests as joint issues, often involving multiple joints and lasting several weeks to months.

Increased Risk of Genitourinary Infections

HIV-positive individuals are more susceptible to infections in the reproductive and urinary systems.

Immune Reconstitution Inflammatory Syndrome (IRIS)

Following the initiation of antiretroviral therapy (ART), IRIS may occur, where pre-existing infections flare up or new infections emerge due to immune recovery.

Many individuals with HIV explore complementary therapies alongside their prescribed medical treatments. Here are some common options:

Physical Therapies

Physical therapies such as yoga, massage, and acupuncture are used to alleviate stress and promote overall well-being.

• Yoga: This practice helps with flexibility, fitness, and stress reduction. It’s especially beneficial for relaxation and mental clarity.
• Massage: It can relieve stress, back pain, headaches, and muscle soreness.
• Acupuncture: Tiny needles are used to treat various symptoms like fatigue, nausea, and neuropathy.
• Aromatherapy: This therapy uses scents to reduce stress and enhance relaxation.

Relaxation Therapies

Techniques like meditation and visualization can significantly reduce stress, improve relaxation, and promote overall health.

• Meditation: Helps calm the mind and relax the body.
• Visualization: Uses mental imagery to reduce anxiety and stress.

Herbal Remedies

Herbal medicines, derived from plants, roots, and flowers, are sometimes used to manage symptoms of HIV. While they may offer some relief, they do not cure HIV.

Living with someone diagnosed with HIV can be a transformative experience for both the individual and their family. Since HIV symptoms vary from person to person, the care needed also differs. However, a few essential tips can guide how to support someone living with HIV.

Open Communication

Engage in open, honest conversations about HIV. Continue enjoying activities together as you did before the diagnosis. This will help the person feel valued and remind them they are the same person they’ve always been.

Be a Good Listener

Receiving an HIV diagnosis can be life-altering. Listen to your loved one, offering reassurance that HIV is manageable with the right treatment.

Educate Yourself

Learn about HIV, from transmission to treatment. Understanding the virus is a crucial step in being a supportive presence for your family member.

Encourage Treatment

Starting treatment early, adhering to it, and providing support will help control the viral load and prevent the progression of HIV to AIDS.

Support Medication Adherence

Encourage the person with HIV to stick to their medication schedule. Help them establish a routine and stay on track with their treatment.

Join Support Groups

Being part of a group of people facing similar challenges can uplift the person and boost their morale. Many organizations in India offer support to individuals with HIV, providing a safe space for interaction with others in similar situations.

Taking care of yourself when living with HIV:

1. Adhering to Antiretroviral Treatment (ART) If you’ve been diagnosed with HIV, it’s crucial to start antiretroviral treatment (ART) as soon as possible. Although ART isn’t a cure, it helps manage HIV by controlling the virus and protecting your immune system, allowing you to live a long and healthy life.
2. Maintaining a Healthy Diet HIV weakens the immune system, so individuals living with HIV need to prioritize their health by maintaining a balanced diet. A nutritious diet that includes a variety of foods—such as fruits, vegetables, grains, protein, and dairy—helps maintain a healthy weight and supports overall well-being.
3. Regular Exercise Along with ART, regular physical activity is essential for boosting immunity. Though there is no cure for HIV, a combination of ART and exercise helps people live a healthy, fulfilling life for many years.
4. Limiting Alcohol and Drug Use Excessive alcohol consumption can harm the liver, which plays a key role in processing HIV medications. It’s important to stay within the recommended limits for alcohol and avoid recreational drugs, as they can weaken the immune system, making it harder to recover from infections.
5. Managing Stress and Seeking Support Stress-management practices like yoga, meditation, cognitive restructuring, and interpersonal skills training can help alleviate anxiety, depression, and social isolation among people living with HIV. These techniques reduce physical tension and enhance emotional well-being, promoting a sense of control.
6. HIV and Pregnancy Women living with HIV who become pregnant or acquire the virus during pregnancy are at risk for both maternal and perinatal complications, especially if the virus is not well-controlled. There’s a potential for the virus to be transmitted to the baby during pregnancy, delivery, or breastfeeding.

Breastfeeding can also be a source of transmission. Proper management, including preconception counseling, is crucial for minimizing the risk of transmission. During pregnancy, a combined antiretroviral (cART) regimen is necessary, along with close monitoring of viral load. Special care must be taken to reduce the risk of transmission to the baby, particularly if the mother’s viral load is not controlled or unknown during delivery.