Acquired Immunodeficiency Syndrome (AIDS) is the terminal clinical stage of the infection caused by the Human Immunodeficiency Virus (HIV). It is a virus that belongs to a specific viral family, known as Retroviruses, which has a truly unique replicative mechanism. Retroviruses are viruses that have as their main characteristic the possession of the “reverse transcriptase” enzyme, which allows them to create a double-stranded DNA copy from their RNA genome. The main target cells of HIV are CD4 lymphocytes, a type of cells that make up a part of white blood cells in the blood, responsible for the immune response of the body. HIV infection causes a progressive weakening of the immune system, leading to a complete failure in fighting off any type of virus (bacteria, protozoa, fungi, and tumors).
HIV transmission routes
HIV infection does not have its own specific manifestation, but it reveals itself through the effects it has on the immune system. It is possible to live for years without any symptoms and only become aware of the infection when an opportunistic infection occurs. HIV is transmitted only through biological fluids: blood and its derivatives such as plasma and platelets, pre-ejaculatory fluid, semen, vaginal secretions, vertical transmission from mother to child during pregnancy, childbirth, and breastfeeding. Infection occurs when the virus, present in one of these fluids from an infected person (who is not on antiretroviral therapy), enters the body of another person through wounds or skin lesions.
How HIV is NOT Transmitted
HIV infection, on the other hand, CANNOT be transmitted through normal daily contact with HIV-positive individuals, such as handshakes, hugs, and kisses (except in cases where the HIV-positive person has visibly noticeable oral mucosal lesions and bleeding, thus making blood contact likely). There is no risk in sharing items such as clothing, glasses, cutlery, plates, towels, bed sheets, and toilet seats; with the exception of those that may have had occasional contact with blood, such as razors and toothbrushes. Additionally, there is no transmission through saliva, coughing, tears, sweat, mucus, urine, feces, bites, scratches, and insect bites.
Symptoms: from early clinical stage to advanced stage
The manifestation of the HIV virus is generally characterized by distinct stages:
STAGE 1: ACUTE INFECTION
The first stage of infection occurs within 2-4 weeks after exposure. HIV infection is often nonspecific, sometimes presenting symptoms similar to a common influence, such as weakness, fever, difficulty swallowing, lymph node pain, muscle and joint pain, nausea, headache, and skin rashes. This symptomatology, which can be absent or underestimated by the patient due to its similarity to a common flu, tends to regress within a few weeks, leaving the individual apparently in perfect health.
STAGE 2: CLINICAL LATENCY
The second phase continues with a clinical latency period that can last for several years, during which people may not show symptoms and appear to be healthy. However, the virus continues to replicate and affect the immune system.
STAGE 3: AIDS
In the final stage, the disease is clinically evident due to the onset of one or more so-called “AIDS-defining illnesses.” A drastic immune depression is observed, resulting in the emergence of opportunistic diseases such as pneumonia, esophageal candidiasis, stomatitis, toxoplasmosis, encephalitis, meningitis, enteritis, significant weight loss, and neoplasms. Progression to this stage can be prevented if HIV is detected and treated in a timely manner.
HIV Testing: ELISA and Western Blot
Undergoing the examination to detect anti-HIV antibodies is the only way to discover the infection. The ELISA test, which is performed anonymously and rapidly by law, involves a simple blood sample, painless, quick, and free in public healthcare facilities. To obtain a reliable result, the test should be performed three months after possible exposure since the virus may still be undetectable. If the ELISA test is positive, a second-level examination called the Western Blot Test is performed to confirm the infection definitively.
HIV prevention strategies
There are essentially a few simple precautions that can reduce or even eliminate the risk of HIV infection, both through blood contact and sexual intercourse:
1. Use condoms, either male or female, and dental dams (latex barriers) to protect against vaginal, anal, and oro-genital sexual activities from start to finish.
2. During pregnancy planning or during pregnancy itself, undergo an HIV test, and in case of a positive result, receive antiretroviral treatment and follow specific protocols to prevent mother-to-child transmission.
3. Adhere to pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PeP) correctly.
4. Avoid sharing needles, syringes, and other injection equipment.
5. Receive injections, acupuncture, mesotherapy, tattoos, and piercings only at specialized centers that use only disposable equipment.
Living with HIV: treatments
Scientific advancements have resulted in numerous improvements in the lives of people living with HIV. In Western countries, the primary goal for HIV-positive individuals is no longer mere survival but rather the ability to lead a normal daily life, fulfilling emotional, occupational, and well-being needs. Although there is no definitive cure to completely eliminate the virus from the body, there are currently available antiretroviral drugs (ART – Antiretroviral Therapy). These therapies involve taking combinations of medications orally that, through different mechanisms of action, aim to suppress the replication of the HIV virus, reducing the viral load to undetectable levels in laboratory tests. The therapies are most effective when initiated as early as possible. Once started, they should be taken regularly and continuously, allowing for a lifestyle and life expectancy similar to that of a person who is not HIV-positive.
The third installment dedicated to sexually transmitted infections will continue in January with an article focused on Human Papillomavirus (HPV) infection, including causes, symptoms, prevention, diagnosis, and treatments.
The contents of this page are for informational use only and in no case should they replace the opinion, diagnosis or treatment prescribed by your doctor. The response to the same treatment can vary from one patient to another. Always consult with your doctor on any information relating to diagnosis and treatment and scrupulously follow his instructions.