HIV/AIDS: Symptoms, Stages, and Treatment

The human immunodeficiency virus (HIV) attacks the immune system, making the body vulnerable to other infections and diseases. Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV infection, where the immune system is severely compromised. With proper treatment, many people with HIV never develop AIDS.

What are HIV and AIDS?

HIV (Human Immunodeficiency Virus): A retrovirus that attacks and destroys the immune system's CD4 T-cells, which are critical for fighting off infections. Once a person is infected, the virus remains in the body for life, though it can be managed with medication. AIDS (Acquired Immunodeficiency Syndrome): The final and most severe stage of HIV infection. A diagnosis of AIDS is based on a CD4 cell count below 200 cells/mm³ or the presence of opportunistic infections that affect people with advanced HIV. 

Symptoms of HIV

Acute HIV infection (2–4 weeks after exposure) 

Many people experience a flu-like illness that lasts for a few days to several weeks. Symptoms can be mild and easily mistaken for other illnesses, but the virus is multiplying rapidly during this stage, making it highly contagious. 

Common symptoms include: 

• Fever

• Headache

• Fatigue

• Rash

• Sore throat and mouth sores

• Swollen lymph nodes

• Muscle and joint aches

• Night sweats

• Diarrhea 

Chronic HIV infection (also called asymptomatic HIV) 

Following the initial acute stage, HIV transitions to a chronic phase, where it continues to replicate at low levels and progressively damages the immune system. 

• Duration: This stage can last for 10 years or more without treatment.

• Symptom-free: Many people have no noticeable symptoms during this period, though the virus is still active.

• Transmission: The virus is still transmissible, even when no symptoms are present.

• Mild symptoms: For some, mild infections or long-term symptoms may occur, such as fatigue, persistent swollen lymph nodes, or oral thrush. 

AIDS (Stage 3 HIV)

Acquired Immunodeficiency Syndrome (AIDS) is the most advanced stage of HIV infection, occurring when the immune system is severely compromised. People with AIDS are prone to developing infections and cancers that wouldn't normally affect a healthy person. These are known as opportunistic infections. 

The symptoms of AIDS are primarily the result of these opportunistic infections and can include: 

• Rapid, unexplained weight loss

• Recurring fever or profuse night sweats

• Extreme fatigue

• Persistent diarrhea that lasts for more than a week

• White spots or unusual lesions on the tongue or in the mouth (thrush)

• Sores on the genitals, anus, or mouth from herpes infections

• Pneumonia and other recurrent infections

• Neurological disorders, such as memory loss, confusion, and difficulty walking

• Red, brown, or purplish skin blotches or bumps from Kaposi's sarcoma, a type of cancer

HIV/AIDS Treatment

Antiretroviral therapy (ART):

• Lower viral load: Suppress the virus to an undetectable level to prevent illness and transmission.

• Restore immune function: Allow the immune system's CD4 cells to increase, helping the body fight off infections and certain cancers.

• Prevent progression to AIDS: Protect the immune system from irreversible damage, which keeps the infection from advancing to acquired immunodeficiency syndrome (AIDS).

• Support a long, healthy life: Enable people with HIV to manage their condition as a chronic illness and live as long as people without HIV. 

Classes of HIV medicines

A regimen typically involves a combination of two or more medicines from different classes to effectively suppress the virus and prevent medicine resistance. Classes of antiretroviral medicines work by targeting different stages of the HIV life cycle. 

• Nucleoside reverse transcriptase inhibitors (NRTIs): Provide faulty versions of the building blocks HIV needs to make copies of itself. Eg, Abacavir, Lamivudine, Emtricitabine, and Tenofovir

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Inactivate a protein HIV needs to replicate. E.g., Efavirenz or Nevirapine.

• Integrase inhibitors (INSTIs): Block the integrase protein, which HIV uses to insert its genetic material into healthy CD4 cells.

• Protease inhibitors (PIs): Block the protease protein that HIV uses to assemble new viral particles.

• Entry/Fusion inhibitors: Prevent HIV from entering CD4 cells in the first place.

• Attachment inhibitors: Block a protein on the virus's surface, preventing it from attaching to CD4 cells.

• Capsid inhibitors: Interfere with the HIV protein shell (capsid) at multiple stages of the viral life cycle.

• Pharmacokinetic enhancers (boosters): Increase the effectiveness of other antiretroviral medicines. 

Conclusion

Understanding HIV and AIDS is crucial for recognizing the importance of early detection and effective treatment, which can prevent the progression to AIDS and enable individuals to lead healthy lives. With advancements in antiretroviral therapy, many people living with HIV can manage their condition and maintain a quality of life comparable to those without the virus.