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In 2020, there were 37.7 million people living with human immunodeficiency virus (HIV). The most advancing stage of HIV infection, acquired immunodeficiency syndrome (AIDS), has disproportionately affect vulnerable populations, such as those in the poorer countries and sex workers. While access to HIV treatment has improved over the past few years, many continue to live with the complications caused by HIV/AIDS.

In conjunction with World Aids Day on 1st of December, we would like to shed light on life after developing AIDS.

HIV, the AIDS virus (yellow), infecting a human cell. Photo by National Cancer Institute on Unsplash

But first, what’s exactly HIV/AIDS?

While the term ‘HIV’ and ‘AIDS’ are almost inseparable, they mean different things. Human immunodeficiency virus (HIV) is a type of virus that targets the human’s immune system by destroying CD4 T cells, a type of white blood cell that helps our body fight infection. This puts us at higher risks for serious infections and certain cancers which would otherwise rarely happen in individuals with a healthy immune system.

On the other hand, acquired immunodeficiency syndrome (AIDS) is the final stage of infection with HIV. It happens when the body's immune system is badly damaged because of the virus. Not everyone with HIV develops AIDS.

HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. A common transmission method is through sexual intercourse. HIV can also be transmitted from a mother to her child during pregnancy and delivery.

The first signs of HIV infection may not look like a big deal— characterized by flu-like symptoms:

Fever
Chills
Rash
Night sweats
Muscle aches
Sore throat
Fatigue
Swollen lymph nodes
Mouth ulcers

These symptoms may come and go within two to four weeks.

If HIV is not treated at this stage, it may develop into chronic (i.e. long term) HIV infection. While the individuals may not have any symptoms at the chronic stage, the virus continues to grow and slowly ‘eats away’ the CD4 T cells. This period is known as the latency period. The majority of people remain in this disease stage for about 10 years in the absence of treatment, and most people with treatment access do not progress beyond this stage.

Those who did not receive treatment, however, can progress to AIDS when their blood CD4 T cells level drop below 200 per microliter, and the amount of HIV in the body increases rapidly. The immune system is so depleted in this phase that a number of infections and cancers can emerge that are normally well-controlled by an intact immune system.

Complications of AIDS

Opportunistic infections

One of the most common complications of AIDS is opportunistic infections. Some examples of opportunistic infections are:

Candidiasis — An infection caused by a fungus called Candida, which primarily affects the mouth, food tract and vagina.
Cytomegalovirus (CMV) — CMV can infect multiple parts of the body and cause pneumonia (inflammation in lung), gastroenteritis (especially abdominal pain caused by infection of the colon), encephalitis (infection) of the brain, and retinitis (infection of the retina at the back of eye). CMV retinitis is a medical emergency because it can lead to blindness if left untreated.
Pneumocystis pneumonia (PCP) — PCP is a lung infection caused by the fungus Pneumocystis jirovecii, which can lead to difficulty breathing, high fever and dry cough. Doctors sometimes may prescribe an antibiotic called Bactrim to AIDS patients as a prevention against PCP.
Tuberculosis (TB) — A lung infection caused by Mycobacterium tuberculosis.
Kaposi’s sarcoma (KS) — KS is caused by a virus called Kaposi’s sarcoma herpesvirus (KSHV) or human herpesvirus 8 (HHV-8). KS causes small blood vessels to grow abnormally and can occur anywhere in the body. KS can be life-threatening when it affects organs inside the body, such as the lung, lymph nodes, or intestines.

Image credit: OpenStax College, CC BY 3.0 , via Wikimedia Commons

With an effective HIV treatment, the risk of opportunistic infections can be significantly reduced.

Neurologic issues

Although HIV infection and AIDS primarily affect the immune system, they also disturb the nervous system and can lead to a wide range of severe neurological disorders, particularly if HIV goes untreated and progresses to AIDS. Some symptoms include:

confusion and forgetfulness
inability to concentrate
behavioral changes
headaches
mood disorders (anxiety disorder and depression)
movement problems (loss of movement control) including a lack of coordination and difficulty walking
progressive weakness and loss of sensation in the arms and legs

If the neurological disturbances are milder, it is typically known as HIV-Associated Neurocognitive Disorder (HAND). In severe cases, however, HIV-associated dementia (HAD) can happen to younger people with HIV.

Higher risk of cardiovascular diseases

HIV/AIDS can affect our heart as well?!

Indeed, studies demonstrated higher rates of heart attack and atherosclerosis in patients with HIV infection. The reason appears to be due to elevated cytokine levels, chronic vascular inflammation, and endothelial dysfunction in HIV patients, as well as higher prevalence rate of smoking. It was also found that HIV treatment may raise blood pressure. Other cardiovascular conditions such as heart failure, myocarditis and pericarditis are still reported among HIV patients, although their incidence has decreased, thanks to HIV treatment.

Others

HIv/AIDS patients are also at increased risk for:

Osteopenia, osteoporosis, and higher fracture rate
Cancer
Diabetes
High blood cholesterol and lipids

Therefore, if you’re a HIV/AIDS patient, it’s important that you adhere to your HIV and other medical treatments strictly, and always attend follow-up sessions with your doctor. Your doctor would monitor your clinical progress and health status from time to time to check your risks of developing these complications.

Prevention is better than cure

Needless to say, nobody wants to get HIV, and prevention is always better than cure! Let’s spread awareness about HIV/AIDS and educate the people around you to prevent HIV infection.

Image credit: CDC HIV

A word from DOC2US

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Cover image credit: Photo by National Cancer Institute on Unsplash

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But first, what’s exactly HIV/AIDS?