Acquired Immunodeficiency Syndrome (AIDS): Symptoms, Treatments, Medications and Prevention

by topschoolsintheusa · September 14, 2024

Acquired Immunodeficiency Syndrome (AIDS) is a life-threatening condition caused by the human immunodeficiency virus (HIV). It weakens the immune system, making the body vulnerable to infections, diseases, and cancers that it would otherwise be able to fight off. Since its discovery in the early 1980s, AIDS has become a global epidemic, affecting millions of people worldwide. While there is no cure for AIDS, advancements in treatment have transformed HIV from a fatal diagnosis into a manageable chronic condition.

What is AIDS?

The Human Immunodeficiency Virus (HIV) and AIDS

AIDS is the final stage of HIV infection, a viral disease that damages the immune system. HIV stands for human immunodeficiency virus, and it attacks CD4 cells (also called T-cells or helper cells), which are crucial for immune function. The gradual destruction of these cells weakens the immune system and reduces its ability to fight off opportunistic infections and certain cancers.

AIDS (Acquired Immunodeficiency Syndrome) occurs when the immune system is severely compromised due to prolonged HIV infection, and the body becomes highly susceptible to opportunistic infections, cancers, and other life-threatening conditions. Without treatment, AIDS is fatal, but with modern antiretroviral therapy (ART), most individuals with HIV can avoid progressing to AIDS.

How AIDS Develops from HIV

HIV infection progresses through three stages:

1. Acute HIV Infection

This is the initial stage of HIV infection, occurring 2 to 4 weeks after exposure to the virus. During this stage, individuals may experience flu-like symptoms. The virus replicates rapidly, leading to high levels of HIV in the blood.

2. Clinical Latency Stage

Also known as chronic HIV infection or asymptomatic HIV infection, this stage can last for years or even decades with proper treatment. During this period, the virus remains active but reproduces at much lower levels. Individuals may not experience any symptoms, but HIV is still present in the body and can be transmitted to others.

3. AIDS (Acquired Immunodeficiency Syndrome)

AIDS is the final stage of HIV infection and occurs when the immune system becomes severely damaged. CD4 cell counts drop below 200 cells per cubic millimeter of blood (a healthy person typically has between 500 and 1,500 cells), and the individual becomes vulnerable to a range of opportunistic infections and cancers. Without treatment, survival time is typically around three years, but with antiretroviral therapy, AIDS can often be prevented entirely.

Who is at Risk of AIDS?

Anyone who is exposed to HIV can develop AIDS if left untreated, but certain populations and behaviors increase the risk of contracting the virus. Understanding these risk factors is essential for preventing the spread of HIV and reducing the global burden of AIDS.

High-Risk Groups for HIV/AIDS

1. Men Who Have Sex with Men (MSM)

In many parts of the world, men who have sex with men (MSM) are at a higher risk of contracting HIV. The virus is easily transmitted during unprotected anal intercourse, which is the highest-risk sexual activity for HIV transmission.

2. People Who Inject Drugs (PWID)

Sharing needles or other injection equipment is a major risk factor for HIV transmission. Blood from an HIV-positive person can be transferred to others when needles, syringes, or other drug paraphernalia are shared.

3. Heterosexuals in High-Prevalence Regions

In parts of Africa, the Caribbean, and Southeast Asia, heterosexual transmission is the leading cause of HIV infection. Women, particularly those in stable relationships, can be at risk if their partner is HIV-positive or engages in high-risk behaviors.

4. Sex Workers and Their Clients

Sex workers and individuals who engage in commercial sex are at increased risk of HIV infection due to frequent sexual contact with multiple partners. Without proper protection (such as condom use), the risk of transmitting HIV and other sexually transmitted infections (STIs) is high.

5. People with Multiple Sexual Partners

Individuals who have multiple sexual partners without consistent condom use are at greater risk of contracting HIV. The risk increases if any of the partners are HIV-positive or belong to other high-risk groups.

6. Infants Born to HIV-Positive Mothers

Without proper treatment during pregnancy, childbirth, or breastfeeding, an HIV-positive mother can transmit the virus to her baby. This is known as vertical transmission, and without antiretroviral treatment, up to 30% of infants born to HIV-positive mothers will contract the virus.

7. Individuals with Other Sexually Transmitted Infections (STIs)

Having another STI, especially those that cause ulcers or sores (such as syphilis or herpes), increases the likelihood of contracting HIV during sexual activity. STIs can create entry points for the virus and facilitate transmission.

8. Healthcare Workers

Healthcare workers are at risk of HIV exposure through needlestick injuries or contact with infected blood. While the risk is generally low with proper safety protocols, accidental exposure can still occur in clinical settings.

Symptoms of AIDS and How It Is Diagnosed

HIV progresses through several stages, with symptoms varying depending on the stage of infection. Early symptoms are often mild and flu-like, while later symptoms, associated with AIDS, are much more severe.

Acute HIV Infection Symptoms

The early stage of HIV infection, also called acute retroviral syndrome (ARS) or primary HIV infection, may present symptoms that appear 2 to 4 weeks after exposure to the virus. These symptoms can last for several days to weeks and often resemble the flu or other viral infections.

Common Symptoms of Acute HIV Infection:

Fever
Fatigue
Sore throat
Swollen lymph nodes
Muscle and joint pain
Headache
Rash
Mouth ulcers

During this stage, HIV multiplies rapidly, and individuals are highly infectious, even if they don’t show noticeable symptoms.

Chronic HIV Infection Symptoms

After the acute stage, the virus enters a latent phase, also known as the clinical latency stage, which can last for years. During this time, the virus continues to multiply but at much lower levels. People in this stage may not have any symptoms, but the virus is still active and can be transmitted.

As HIV progresses and begins to damage the immune system, individuals may experience:

Persistent fatigue
Recurrent fevers
Weight loss
Diarrhea
Swollen lymph nodes

These symptoms may persist for months or come and go.

Symptoms of AIDS

Without treatment, HIV eventually weakens the immune system to the point where it can no longer fight off infections and diseases. This is the stage known as AIDS, and it is marked by the development of opportunistic infections and certain cancers.

Common Symptoms of AIDS:

Severe weight loss (wasting)
Chronic diarrhea
Recurrent fevers and night sweats
Pneumonia
Severe fatigue
Skin rashes or sores
Memory loss or neurological issues
Frequent infections (e.g., tuberculosis, fungal infections, herpes)

Some opportunistic infections commonly associated with AIDS include Pneumocystis pneumonia (PCP), Kaposi’s sarcoma, candidiasis, tuberculosis, and cryptococcal meningitis.

How AIDS Is Diagnosed

Diagnosing HIV early is critical to preventing the progression to AIDS. Several tests are available to detect HIV infection, monitor its progression, and evaluate the health of the immune system.

1. HIV Antibody/Antigen Test

This is the most common test used to diagnose HIV. It detects both HIV antibodies (proteins produced by the immune system in response to the virus) and HIV antigens (specifically the p24 antigen, which is produced by the virus itself). This test can usually detect HIV infection within 2 to 6 weeks after exposure.

2. Nucleic Acid Test (NAT)

Nucleic Acid Testing detects the presence of HIV RNA (the genetic material of the virus) in the blood. This test can detect HIV infection earlier than antibody/antigen tests (as early as 10 days after exposure), but it is more expensive and not used for routine screening.

3. CD4 Cell Count

Once diagnosed, HIV-positive individuals undergo regular CD4 cell count tests to monitor their immune system health. A normal CD4 count ranges from 500 to 1,500 cells/mm³. When the CD4 count drops below 200 cells/mm³, a person is considered to have AIDS.

4. Viral Load Test

This test measures the amount of HIV RNA in the blood. A high viral load indicates active replication of the virus, while a low or undetectable viral load (often achieved through treatment) means the virus is under control.

5. Opportunistic Infection Tests

People with advanced HIV or AIDS may require additional tests to diagnose opportunistic infections, such as chest X-rays (for pneumonia), blood cultures, and tests for tuberculosis, toxoplasmosis, or other infections that can arise in people with weakened immune systems.

Treatments for AIDS

While there is no cure for HIV or AIDS, treatment with antiretroviral therapy (ART) can significantly prolong the lives of those living with HIV, prevent the progression to AIDS, and reduce the risk of transmitting the virus to others. Early diagnosis and consistent treatment are key to maintaining a high quality of life and avoiding complications.

Antiretroviral Therapy (ART)

Antiretroviral therapy is the cornerstone of HIV treatment. It involves taking a combination of medications that target different stages of the HIV lifecycle, preventing the virus from multiplying and damaging the immune system. With ART, many people with HIV can live long, healthy lives without progressing to AIDS.

Goals of ART:

Reduce the viral load to undetectable levels.
Increase CD4 cell count, strengthening the immune system.
Prevent opportunistic infections and AIDS-related complications.
Reduce the risk of HIV transmission to sexual partners or through childbirth.

Types of Antiretroviral Drugs

There are several classes of antiretroviral drugs, each targeting different stages of the HIV replication process. A combination of drugs from different classes is used to prevent the virus from becoming resistant to treatment.

1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

NRTIs block the action of reverse transcriptase, an enzyme that HIV uses to replicate its genetic material. These drugs are often called “nukes.”

Examples: Zidovudine (Retrovir), Tenofovir (Viread), Lamivudine (Epivir), Emtricitabine (Emtriva)

2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

NNRTIs also inhibit reverse transcriptase but in a different way than NRTIs. These drugs are often called “non-nukes.”

Examples: Efavirenz (Sustiva), Nevirapine (Viramune), Rilpivirine (Edurant)

3. Protease Inhibitors (PIs)

Protease inhibitors block the action of protease, another enzyme that HIV needs to assemble new virus particles.

Examples: Lopinavir/Ritonavir (Kaletra), Atazanavir (Reyataz), Darunavir (Prezista)

4. Integrase Strand Transfer Inhibitors (INSTIs)

INSTIs block integrase, an enzyme that HIV uses to insert its genetic material into the host’s DNA. These drugs are among the most effective for reducing viral load.

Examples: Dolutegravir (Tivicay), Raltegravir (Isentress), Bictegravir (part of Biktarvy)

5. Entry Inhibitors (Fusion Inhibitors and CCR5 Antagonists)

These drugs prevent HIV from entering CD4 cells by blocking the receptors or proteins that the virus uses to gain entry.

Examples: Maraviroc (Selzentry), Enfuvirtide (Fuzeon)

6. Fixed-Dose Combinations

Many HIV medications are available in fixed-dose combinations, which combine two or more antiretrovirals into a single pill, simplifying treatment regimens.

Examples: Atripla, Triumeq, Biktarvy

Opportunistic Infection Treatment

For individuals with AIDS who develop opportunistic infections, additional treatments may be necessary. These include antibiotics, antifungals, antivirals, and other medications to treat infections like tuberculosis, pneumonia, and fungal infections. Preventive medications may also be given to reduce the risk of certain opportunistic infections in people with low CD4 counts.

Most Common Medications for AIDS

The most common medications used to treat HIV and prevent the progression to AIDS include combinations of antiretrovirals from different classes. Below are some of the most widely prescribed drugs for managing HIV:

1. Dolutegravir (Tivicay)

Class: Integrase Strand Transfer Inhibitor (INSTI)
Use: Often combined with other drugs to reduce viral load and increase CD4 count.

2. Tenofovir (Viread)

Class: Nucleoside Reverse Transcriptase Inhibitor (NRTI)
Use: Commonly used as part of combination therapy to control HIV infection.

3. Emtricitabine (Emtriva)

Class: NRTI
Use: Frequently combined with Tenofovir as a core part of HIV treatment regimens.

4. Efavirenz (Sustiva)

Class: Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
Use: Part of combination therapy, especially in patients starting ART.

5. Raltegravir (Isentress)

Class: INSTI
Use: Highly effective at reducing viral load, used in combination with other antiretrovirals.

6. Ritonavir (Norvir)

Class: Protease Inhibitor
Use: Often used to boost the effectiveness of other protease inhibitors by inhibiting liver enzymes that break down the medication.

7. Atripla (Combination of Efavirenz, Tenofovir, and Emtricitabine)

Class: Fixed-Dose Combination
Use: One-pill, once-daily regimen for controlling HIV infection.

Where is AIDS Most Prevalent?

AIDS is a global issue, but it disproportionately affects certain regions of the world, particularly where HIV prevalence is highest. The burden of HIV/AIDS varies by region, with significant differences in access to healthcare, prevention programs, and treatment options.

High-Prevalence Regions

1. Sub-Saharan Africa

Sub-Saharan Africa remains the most affected region, accounting for approximately 70% of the global HIV/AIDS burden. Countries like South Africa, Eswatini (Swaziland), Botswana, and Zimbabwe have some of the highest HIV prevalence rates. Contributing factors include high rates of heterosexual transmission, limited access to healthcare, and social stigma around HIV.

2. South and Southeast Asia

Countries such as India, Thailand, and Myanmar also face high rates of HIV, especially among key populations like people who inject drugs, sex workers, and men who have sex with men.

3. Eastern Europe and Central Asia

HIV infections have been rising in Eastern Europe and Central Asia, particularly among people who inject drugs. Countries like Russia and Ukraine have seen increases in new infections due to a combination of factors, including the lack of harm reduction programs and stigma surrounding drug use and HIV.

4. The Caribbean

The Caribbean has the second-highest HIV prevalence rate after Sub-Saharan Africa. Haiti and the Dominican Republic are among the most affected countries in this region.

5. Latin America

In countries such as Brazil, Mexico, and Argentina, HIV is a significant public health issue, with MSM and people who inject drugs making up a large proportion of new infections.

Prevention of AIDS

Preventing the spread of HIV is the key to reducing the global burden of AIDS. Comprehensive prevention strategies involve a combination of public health interventions, education, and individual protective measures.

1. Use of Condoms

Consistent and correct use of condoms during sexual activity is one of the most effective ways to prevent the sexual transmission of HIV. Condoms reduce the risk of transmitting HIV during vaginal, anal, and oral sex.

2. Pre-Exposure Prophylaxis (PrEP)

PrEP is a preventive strategy that involves taking antiretroviral medications to reduce the risk of contracting HIV. It is recommended for individuals at high risk, such as men who have sex with men, people with HIV-positive partners, and people who inject drugs. When taken consistently, PrEP reduces the risk of HIV transmission by more than 90%.

3. Harm Reduction Programs for People Who Inject Drugs

Harm reduction programs, including needle exchange programs and access to clean injection equipment, are vital for preventing the transmission of HIV among people who inject drugs. These programs help reduce the sharing of contaminated needles, which is a major route of HIV transmission.

4. Post-Exposure Prophylaxis (PEP)

PEP involves taking antiretroviral medications after potential exposure to HIV, such as through unprotected sex or needlestick injuries. To be effective, PEP must be started within 72 hours of exposure and continued for 28 days.

5. Routine HIV Testing

Regular HIV testing is crucial for early detection and treatment. People who are sexually active, especially those in high-risk groups, should get tested regularly. Early diagnosis enables individuals to start antiretroviral therapy sooner, improving health outcomes and reducing the risk of transmitting the virus to others.

6. Treatment as Prevention (TasP)

People living with HIV who are on ART and maintain an undetectable viral load cannot transmit the virus to sexual partners. This concept, known as Undetectable = Untransmittable (U=U), underscores the importance of ART in both individual health and public health prevention efforts.

7. Safe Sex Practices and Education

Comprehensive sexual health education, including information about HIV transmission, condom use, and the importance of regular testing, is essential for preventing the spread of HIV. Targeted education programs in schools, communities, and healthcare settings can help raise awareness and reduce stigma.