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Human Immunodeficiency Virus (HIV) is a virus that attacks key parts of the immune system. It attacks the T-cells also known as CD4 cells, which normally fight infections and disease. HIV invades these cells, uses them to self-replicate, and then destroys the host cells. Over time, HIV can destroy enough of the CD4 cells that the body can no longer fight infections or diseases. At that point, HIV infection can lead to Acquired Immunodeficiency Syndrome (AIDS).
AIDS is the final stage of HIV infection. People with AIDS have compromised immune systems, which put them at increased risk of opportunistic infections. AIDS is diagnosed when the patient has one or more specific opportunistic infections, certain types of cancers, or a very low number of CD4 cells.
HIV is spread via bodily fluids, such as: blood, semen, rectal fluids, vaginal fluids, or breast milk. The fluids of an infected individual must come into contact with mucous membranes, damaged skin, or directly into the bloodstream to pass the infection to another person. HIV is contracted via intercourse or sharing needles. HIV cannot be spread in the air, water, insects, casual contact, toilet seats, saliva, tears, or sweat. HIV that infects humans can also not be carried by animals.

Signs and Symptoms
It is not uncommon for people who are in the early stages of HIV to have no symptoms until they begin to progress towards AIDS. The virus itself rarely causes infected individuals to feel sick, but rather the secondary infections due to decreased immune function cause the patient to feel symptoms.

Early Stage:
As early as 2-4 weeks after exposure, people can experience an acute illness. This is often described similarly to a bad case of the flu. The symptoms people experience during this time can mimic what a person would experience during a cold, flu, or “stomach bug”. This is known as the primary HIV infection, which is the body’s natural response to HIV. At this time there are higher levels of virus circulating in the blood.

Symptoms include:

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

Chronic Stage (Latency Stage):
After the initial infection, the virus becomes less active in the body, though it is still present. This is known as the latency stage. During this period, many people do not have any symptoms of the HIV infection.

When HIV progresses to AIDS, many people being to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome (decrease in overall body mass or muscle mass). Many of these signs and symptoms come from opportunistic infections which occur in patients because of the weakened immune system.

Diagnosis and Testing
It is recommended that all individuals between the ages 13-64 get tested for HIV at least once in their lifetime and more often if they are at higher risk. Your healthcare provider can diagnose HIV by testing for the presence of antibodies to HIV. It may take up to 6 months post infection for enough antibodies to be present for an accurate positive test, so scheduling follow-up tests is important.
It is important to get tested by a healthcare professional if you think you have been exposed to HIV. Also if you have done an at home HIV test it is important to follow-up with your doctor so they can verify these results with a blood test, especially if the result of the at home test was positive.

There are many different treatment options from multiple different classes of HIV medication. Each class works slightly differently during different parts of the HIV production cycle and therefore combining agents from multiple classes usually results in the best viral suppression. This is often referred to as Highly Active Antiretroviral Therapy or HAART.
HAART usually utilizes 3 different antiretroviral drugs from 2 different classes. This is the standard treatment for HIV because no drug can cure HIV, and taking a single drug by itself will not stop HIV from harming you. Taking 3 different medications does the best job of controlling the amount of virus in your body and protecting your immune system. It also helps prevent HIV drug resistance.

The 5 classes include:

  • Nucleoside/nucleotide Reverse Transcriptase Inhibitors (NRTIs)
  • Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
  • Protease Inhibitors (PIs)
  • Entry inhibitors/Fusion Inhibitors
  • Integrase Inhibitors

There are now medications available that combine multiple drugs into one pill that will reduce the number of pills you have to take every day.

It is important to take your medications exactly how they are prescribed and to not share them or miss doses. These practices can lead to drug resistance which will make it harder to find a regimen that will decrease your viral load and achieve disease suppression.

Individuals that have possibly been exposed to HIV or are at high risk of HIV infection may also receive prophylactic treatment with multiple medications for an extended period of time. These instances include things such as an accidental needle stick in a healthcare professional or a person whose partner is HIV positive.

On top of pharmacologic treatment individuals must practice lifestyle changes to keep themselves in others safe. It is important for infected individuals to continue practicing safe sex, with condom use. Even if both partners are HIV positive there can be re-infection with a different strain of HIV and this can lead to a HIV superinfection. Also it is important to not safe needles or other blood contaminated products.

Sources Accessed May 12, 2015.
National Institute of Allergy and Infectious Diseases– Accessed May 12, 2018.
Centers for Disease Control. Accessed May 12, 2018.

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