AIDS / HIV: Overview, Symptoms, Diagnosis, Treatment & Complications

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The abbreviation HIV stands for "Human Immunodeficiency Virus" - a term that can be translated as "human immunodeficiency virus". HIV is therefore first and foremost the name of the pathogen of an infection that leads to a weakening of the human immune system. The full picture of this disease is called "Acquired Immune Deficiency Syndrome" (AIDS).

How many people are affected?

That the first AIDS cases occurred in the USA and that the HI virus was discovered almost simultaneously by two research groups was only a little more than 30 years ago. Since then, HIV infection has developed into a disease that spans countries and continents and is one of the greatest medical problems of our time.

According to UNAIDS (United Nations Joint Programme to Reduce HIV/AIDS), at least 36.9 million people worldwide were infected with HIV in 2017, including 1.8 million children under 15. In Europe, 397 new HIV-positive diagnoses were registered in 2018. This figure is similar to that of recent years. This means that at least one person is infected with HIV every day.

How is infected with HIV?

Infection occurs exclusively through body fluids containing viruses, such as blood, sperm and vaginal secretions. By far the most common way to transmit the HIV virus is during unprotected sexual intercourse with an infected partner. Homosexual intercourse between men is responsible for the majority of HIV infections, followed by heterosexual intercourse between men and women.

A not inconsiderable percentage of those affected are drug addicts who have been infected by intravenous drug administration through contaminated syringes. In addition, HIV-positive mothers can transmit the virus to the child during pregnancy and childbirth. Infection via breast milk is also possible.

What are the effects of HIV infection?

The HIV virus belongs to the so-called retroviruses. In order to multiply, this virus type integrates its genetic material into that of the host cell. The host cell is reprogrammed in such a way that it produces the components for new virus particles itself. The HI virus attacks T-helper cells, in particular CD4 lymphocytes or CD4 cells.

CD4 lymphocytes are white blood cells (leukocytes) and play a crucial role in the coordination of immune defence. The HI virus directly destroys a certain proportion of T-helper cells and also impairs their functions. The less functional CD4 cells are found in the blood, the more severely the immune system is affected.

As the disease progresses, the number and functionality of the helper cells decrease, resulting in the immune system's inability to protect the organism from disease. As a result, the patient's health deteriorates dramatically and, in the absence of treatment, he or she dies.

How can HIV infections progress?

An HIV infection can be divided into three phases.

Phase 1: Acute HIV disease and latency phase

When the HIV virus enters the body, it triggers a defensive reaction. However, the immune substances (antibodies) formed in the process are not able to eliminate the virus because, on the one hand, they cannot penetrate the host cell and, on the other hand, the virus constantly changes its surface structure as it multiplies, so that it no longer recognises the antibodies. Thus, the HI virus remains in the body for life.

After infection, the pathogen initially multiplies explosively. This early phase of the disease often goes unnoticed by those affected. In 40-90 percent of cases, the so-called acute HIV disease develops a few days to weeks after infection.

The most common symptoms are:

  • Fever
  • Headaches
  • Joint pain
  • Fatigue & exhaustion
  • Swelling of the lymph nodes
  • Loss of appetite
  • Inflammations in the mouth & throat
  • Diarrhoea
  • Sometimes a fleeting skin rash

After about two weeks these complaints disappear again. At the end of this phase, the number of T-helper cells has recovered and the amount of virus in the blood has decreased considerably.

This is followed by the latency phase. Without therapeutic intervention, it lasts on average about ten years. In this phase, those affected are free of HIV-related symptoms because the body's own defence system can keep the virus under control to a large extent. Nevertheless, the immune system has to deal with the HI viruses on a daily basis and at some point it loses this battle: the viral load increases and the number of T-helper cells decreases.

Phase 2: Symptomatic phase

This increasing weakening of the immune system heralds the symptomatic phase. First, the dwindling ability of the immune system to function becomes apparent in the form of complaints such as night sweats, fever attacks and diarrhoea. Many of those affected also suffer from fungal infections of the mucous membranes (e.g. oral cavity), other skin symptoms (e.g. shingles) and swelling of the lymph nodes.

Phase 3: AIDS

If the immune system is further weakened, it is no longer able to defend itself against pathogens that do not pose any danger to healthy people. Then the affected persons develop so-called AIDS-defining diseases. Acquired Immune Deficiency Syndrome" is a defined group of diseases that are characteristic of an advanced stage of HIV infection.

These include pneumocystis pneumonia (a form of pneumonia), fungal diseases or infections with viruses such as herpes zoster or herpes simplex. Cancer diseases are also favoured by immunodeficiency.

In addition, HIV also damages the brain and nervous system, which leads to brain performance disorders that begin slowly and inconspicuously. Once the full picture of AIDS has been reached, those affected die sooner or later without therapy from one or a combination of these diseases.

How is HIV infection diagnosed?

The most important diagnostic tool to detect an infection with the virus is the HIV test. In this procedure, antibodies against the HIV virus are sought in the blood.

Therapy of HIV

HIV can now be successfully treated with a range of drugs. The so-called antiretroviral therapy (ART) is a combination of several active substances that contain the multiplication of the pathogen.

An effective HIV therapy lowers the virus below the detection limit, which also significantly reduces the risk of sexual transmission of HIV. However, a residual risk cannot be ruled out.

In this way, the outbreak of diseases caused by the virus's weakening of the immune system can be largely avoided or delayed. By gradually improving HIV therapy, it is now possible to carry out long-term to lifelong effective treatment with good tolerability.

Mark Riegel, MD

Quick snapshot

Can it be cured?

No. Viruses don't have cures, but symptoms can be controlled with proper treatment.

Type of Infection

Viral. AIDS is caused by HIV (Human Immunodeficiency Virus).

How is it treated?

Antiviral Medication. HIV/AIDS is treated with a variety of antiviral medications: fusion inhibitors, protease inhibitors and RT inhibitors are the most common.

Recovery Time

AIDS / HIV is Incurable. HIV/AIDS is incurable; as such treatment is aimed at slowing progression and treating symptoms.

Can I have sex?

Yes. Partners should be informed of your condition and condoms/dams should be used consistently.

Can I get re-infected?

No. HIV is incurable; once you are infected, you will carry the disease with your for life.