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Human Immunodeficiency Virus (HIV): Signs And Symptoms - Health

Human immunodeficiency virus (HIV) can move through stages: acute HIV (stage 1), clinical latency (stage 2), and AIDS (stage 3). The symptoms of each stage can look different. Those in an early stage of HIV can have flu-like symptoms, while those in an advanced stage can have severe infections.

HIV affects the immune system's ability to fight infections. You can get HIV or pass HIV to someone through blood, semen and pre-seminal fluid, rectal fluid, vaginal fluid, and breast milk that contains the virus. The virus is transmitted from person to person when these body fluids come into contact with your body's tissue, blood, or broken skin (e.G., open wounds).

The method of transmission of HIV can vary. You may get or pass HIV through:

Perinatal transmission from birth parent to child (i.E., through pregnancy, childbirth, or breastfeeding)

Sharing needles, syringes, and other drug injection equipment

Unprotected vaginal or anal sex

Acute (sudden) HIV starts two to four weeks after you get the virus. Acute HIV is also known as primary HIV. The virus multiplies very quickly in the immune system during this stage. Two-thirds of people in this stage experience flu-like symptoms, while some people don't have symptoms at all. Symptoms in the acute stage can last a few days to several weeks and may include: Chills Fatigue Fever Mouth ulcers Muscle aches Night sweats Rash Sore throat Swollen lymph nodes Symptoms can last a few days to several weeks. Acute-stage HIV symptoms can mimic other conditions, like the flu or common cold. It's important to not assume that you have HIV. You may consider getting tested for the virus if you think you may have been exposed to HIV. The clinical latency stage, or chronic HIV, is the second stage of HIV. The virus continues to multiply but much more slowly than in the acute stage during this stage. You might not experience any symptoms as a result. You can still transmit the virus to someone else even if you have no symptoms if you are not taking any treatment for HIV. People can stay in the clinical latency stage for an average of 10 years without treatment. Symptoms and disease progression vary from person to person. You can move through this stage more quickly or slowly than the average time. You can decrease your viral load (the amount of HIV that you have that you can transmit to someone else) to an undetectable level if you are taking treatments. This stage can last for several decades while you're on treatment. HIV can continue to slowly multiply and weaken your immune system over time and without treatment. This can result in the third and final stage of HIV: acquired immunodeficiency syndrome (AIDS), also known as late-stage HIV. AIDS symptoms include: Colored blotches or patches on or under the skin and inside the mouth, nose, and eyelids Depression Diarrhea that lasts for more than seven days Feeling extremely tired Memory loss Pneumonia Rapid weight loss (sometimes called wasting) Recurring fever Sores on the mouth, buttocks, and genitals Swollen lymph nodes in the armpits, neck, and groin that last a long time You may receive an AIDS stage diagnosis if: The number of CD4 cells in your blood falls below 200 cells per cubic millimeter of blood (200 cells/mm3). You develop one or more opportunistic infections regardless of how many CD4 cells you have. AIDS symptoms are often related to opportunistic infections (OIs) or an AIDS-defining illness. Certain illnesses occur more frequently and severely in people with AIDS. OIs occur when HIV has caused too much damage to the body's immune system and can no longer fight off infections. Some OIs include: Taking HIV medications as prescribed can slow disease progression and prevent AIDS. You can live with AIDS for about three years without treatment. Your life expectancy can shorten to one year if you develop an OI and are not taking treatment. Deciding whether to take treatment or not isn't always a choice. Not everyone has access to necessary healthcare services. This can be due to poverty, lack of insurance, racial disparities in the healthcare system, cultural stigma about HIV, and other factors. The only way to know if you have HIV is to get tested. Knowing your HIV status is a powerful way to help take care of yourself and your partners. Keep in mind: Don't rely only on symptoms as a way to tell if you are living with HIV. HIV symptoms can mimic other conditions. You might not have any symptoms at all. Reach out to a healthcare provider or local clinic to learn more about testing if you think you may have been exposed to HIV. You can get a test for HIV at a healthcare provider's office, local health department, and family planning clinics, among others. You can also test for HIV at home. Testing is available for free if you have health insurance. Some testing sites still offer tests for free or on a sliding scale based on your income if you do not have insurance. Please visit HIV.Gov's testing overview here for more information about testing. Use the CDC resource here to find an HIV testing site near you. HIV is a serious and chronic (long-lasting) condition that attacks and destroys CD4 cells in your immune system. HIV can progress through three stages: the acute stage, the clinical latency stage, and the AIDS stage. Your symptoms may change depending on your HIV's current stage. It's good practice to get tested if you think you may have been exposed to HIV. Testing is the only way you can confirm a diagnosis and rule out other conditions. Thanks for your feedback!

HIV/AIDS: Symptoms, Stages, Causes, And Treatments

HIV (human immunodeficiency virus) is a viral infection transmitted through the sexual route. Intravenous needle sharing, infected blood transfusions and transmission from mother to child during birth and breastfeeding can also cause HIV infection. The symptoms become manifest two to four weeks after HIV infection. Symptoms can also be delayed for as long as ten months. HIV causes acquired immunodeficiency syndrome (AIDS) and can cause complications. Treatment of HIV / AIDS comprises antiretroviral drugs and lifestyle management. The patient may suffer from opportunistic infections, which are usually fatal. Hence control of infection in an HIV positive patient is a crucial part.

Types

HIV is classified into two different types:

HIV-1: HIV-1 is commonly found all around the world

HIV-2: HIV-2 is prevalent in Western Africa. It is uncommon elsewhere.

Stages

The stages and progression of HIV infection is as following:

Asymptomatic phase: HIV infection initial stages without any significant symptoms. However, changes in the immune system are noted. This phase can last up to 3 months. Primary infection to develop into HIV disease and immunosuppression takes many years.

Primary infection: The patient replicates the HIV in his bloodstream and lymph nodes in this phase of the disease.

Symptomatic stage: this is known as the late phase of HIV disease, also known as acquired immunodeficiency syndrome. The patient is at risk of developing opportunistic infections such as tuberculosis, candidiasis during this phase of infection.

Symptoms

Patients may remain asymptomatic initially after infection. Symptoms progress over two to three weeks after infection, the delay in symptoms for ten months has also been noted in many patients. Non-specific symptoms of HIV may occur during the Acute retroviral phase of the illness. Symptoms pointed out during this phase are as following-

Headache

Diarrhoea

Swollen lymph nodes

Fatigue

Skin rash

Night sweats

Sore throat

Joint pain

Muscle pain

The symptoms during chronic HIV infection symptoms of the following disease can be observed:

Chronic HIV infection without AIDS

Vaginal candidiasis

Herpes zoster

Thrush

Cervical dysplasia

Bacillary angiomatosis

Cervical carcinoma in situ

Chronic HIV infection with AIDS

Candidiasis

Recurrent Pneumonia

Chronic ulcers

Herpes simplex

HIV related encephalopathy etc.

Risk Factors

Following are the routes of acquiring HIV/AIDS infection:

Sexual transmission is a primary route of getting HIV infection

Blood transfusions from infected individuals

Needle sharing with an infected individual.

Transmission from an infected mother to child.

Prevention

The following measures can prevent the spread of HIV infection:

Sharing needle should be avoided. Discard it after using it once.

Use a clean condom; discard the used condom.

A pregnant female with HIV infection should be treated.

It is essential to inform the sexual partner if the individual is HIV positive.

Diagnosis

Screening test and confirmatory test are the mainstays for the diagnosis of HIV infection. A complete blood count is performed to assess thrombocytopenia, leukopenia or anaemia. CD4 cell count and viral load are also essential in the diagnosis of HIV infection. Differential diagnosis also plays a significant role in testing for HIV infection. For example, considering cardiovascular disorders, order cardiac biomarkers.

In the case of acquired immunodeficiency syndrome, pneumonia is a significant complication. Planning of chest X-Ray may be valuable to detect pulmonary infiltrates. Arterial blood gases provide essential information about an HIV infected person. Tuberculosis testing should be done. Sputum cultures are necessary for detecting bacterial infections. Other diagnostic tests such as CT scan may be crucial if disseminated TB is a possible diagnosis, especially in patients with acquired immunodeficiency syndrome. Individual with AIDS and decreased cd4 cell counts are at risk for pancreatitis and cholecystitis. Industries diagnostic tests such as bilirubin, transaminase and light base are functional.

Esophagogastroduodenoscopy is essential in patients with dysphagia. Diarrhoea is a common symptom in patients with AIDS. In these patients testing for bacteria, parasite, and ova should be performed. In severe refractory cases, colonoscopy is essential. Neurological complaints of HIV and AIDS should be detected using CT scan, CSF analysis, and lumbar puncture.

Treatment

Antiretroviral drugs: Antiretroviral drugs are the mainstay of treatment in HIV infected patients. Nucleoside/ nucleoid reverse transcriptase inhibitors in many combinations available. Along with this, CCR5 inhibitors and protease inhibitors are also used in the treatment of HIV infected patience.

Highly active antiretroviral therapy (HAART) is a vital part of HIV treatment.

Single tablet regimens of tenofovir disoproxil 245mg, Rilpivirine 25mg and Emtricitabine 200mg are used in a frequency of once daily. Associated side effects can be insomnia, flatulence, diarrhoea, nausea, vomiting, rash, weakness, fatigue, etc.

Elvitegravir 150mg/emtricitabine 200mg/cobicistat 150mg/tenofovir 245mg is given as once a day single tablet. Side effects such as fatigue, dizziness, flatulence, rash, sleepiness, and diarrhoea are associated with this drug.

Dolutegravir 50mg/abacavir 600mg/lamivudine 300mg is used as a single tablet daily. Side effects such as itching, depression, muscle pain running nose, indigestion, nausea, vomiting, fatigue loss of appetite can occur.

Nucleoside/ nucleotides reverse transcriptase inhibitors (NRTIs)

Abacavir in the dose of 300 MG tablet is given two times a day. Associated side effects can be abdominal pain, headache, tiredness, fever, nausea and vomiting.

Emtricitabine in the doze off of 200 mg capsule should be given once daily. Associated side effects can be diarrhoea, nausea, high creatinine kinase levels, headache, and dark skin.

Lamivudine tablet with a dose of 150 and 300 mg two times a day should be prescribed. Hair loss, nausea, vomiting, diarrhoea and joint pain are some Ill effects that can occur.

Zidovudine which comes in 100 and 250 mg capsules, should be given two times a day. Muscle pain, headache, nausea and vomiting, loss of appetite, fever, and fatigue are possible effects of the drug.

Tenofovir disoproxil 245 mg should be given once a day. Side effect such as rash, weakness, dizziness, headache for fatigue and stomach pain are associated with this drug.

Fixed-dose combinations of NRTI

Abacavir 600mg/Lamivudine 300mg once a day should be taken.

Abacavir 300mg/ Lamivudine 150mg/Zidovudine 300mg is another Fixed-dose combination used.

Emtricitabine 200mg/tenofovir disoproxil 245mg is available.

Lamivudine 150mg/Zidovudine 300mg once daily is another fixed-dose combination available to treat HIV.

Integrase inhibitors

Dolutegravir 50mg once or twice a day, Raltegravir 400mg tablet twice a day should be taken.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs):

Ultrafine 100/200mg tablets and Rilpivirine 25mg tablets are taken.Maraviroc 150mg and 300mg tablets twice a day.

Protease Inhibitors

Atazanavir 150,200 and 300mg capsules once a day.

Darunavir 600 and 800 mg tablets once a day.

Lopinavir 20mg /ritonavir 50mg tablet twice a day.

Atazanavir 300mg/cobicistat 150mg taken once a day.

Lifestyle Management

Inform your sexual partners about your HIV status.

You must use clean needles for injecting drugs; dispose of them after use.

Circumcision reduces the risk of HIV infection.

Use of condoms containing a water-based lubricant that is more protective.

Pregnant women can take the treatment.

Prognosis And Complications

Prognosis

The progress of a patient suffering HIV with CD4 count greater than 500 lives a normal life compared to a person with a low CD4 level. Patients with AIDS who have untreated opportunistic infections have a low life expectancy.

Complications

A major complication to HIV is its progression to AIDS. It can be recognised when there is a low CD4 count with signs of opportunistic infections.

AIDS usually occurs when the lymphocyte count is below a specific level, and one of the following infections is present:

Tuberculosis

Cytomegalovirus

Candidiasis

Lymphoma

References

Stat Pearls. Acquired Immunodeficiency Syndrome. [Internet] [Updated on Sept 8, 2020] Available at https://www.Ncbi.Nlm.Nih.Gov/books/NBK537293/.

Stat Pearls. HIV disease current practice. [Internet] [Updated on Dec 30, 2020] Available at https://www.Ncbi.Nlm.Nih.Gov/books/NBK534860/.

Infectious disease reports. Pathogenesis of HIV Infection. [Internet] Available at https://www.Ncbi.Nlm.Nih.Gov/pmc/articles/PMC3892619/.

HHS Public Access. Barriers and facilitators to engagement in lifestyle interventions among individuals with HIV.[Internet] Available at https://www.Ncbi.Nlm.Nih.Gov/pmc/articles/PMC4130780/.

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