HIV, or human immunodeficiency virus, is a type of virus that can cause a disease called AIDS (acquired immune deficiency syndrome). HIV infection affects the immune system, which is the body’s natural defense against disease. If left untreated, serious illnesses can develop. Normally harmless infections, such as the flu or bronchitis, can get worse, become very difficult to treat, or even lead to death. In addition, the risk of cancer is also increased.

What sets HIV apart from other viruses is that it attacks the immune system by taking control of CD4 T cells. The latter’s role is to coordinate the immune response when a virus is detected. When HIV uses CD4 cells to spread, it damages and destroys them. In doing so, HIV undermines the immune system from within, which works to fight it.

Transmission of HIV

HIV is transmitted through body fluids: blood, semen, vaginal fluids, and breast milk. These bodily fluids do not transmit HIV unless they come into contact with an area that allows it to enter the body, a mucous membrane. Healthy skin is impermeable to HIV.

Most often, the virus is acquired through unprotected sexual activity or through needle exchange among people who inject drugs. The risk of transmission through kissing with the exchange of saliva is zero.

In most industrialized countries, anal sex between men is the most important factor of HIV transmission. However, heterosexual transmission has increased sharply since the start of the epidemic.

HIV cannot be transmitted by a handshake, sweat, or tears. It is not carried by insects. It is not contracted from toilet seats, swimming in public pools, sharing food, or using linens, towels, or the phone of an infected person.

The HIV epidemic

  • In North America, the first signs of the epidemic appeared in the late 1970s. Men who have sex with men (MSM) were the first to be affected;
  • The HIV virus was isolated in 1983;
  • The first antiretroviral treatment, AZT, was discovered in 1987. Triple therapy, combining several drugs that is much more effective, became available in the mid-1990s. A young adult with HIV who starts treatment early can live to be 80 years of age or older. These treatments often lead to an undetectable viral load, even though the virus is still not eradicated from the body.
  • About 35 million people around the world are living with HIV today. Two-thirds of them reside in sub-Saharan Africa.
  • In North America, 1.3 million people are living with HIV, in Western and Central Europe, 840,000, and in Sub-Saharan Africa 22.9 million.
  • The number of people living with HIV is increasing worldwide, with 2.5 million new infections per year and 1.5 million deaths. This is due to the dramatic improvement in the effectiveness of treatments.
  • In the United States, about 1.2 million people are living with HIV. 1 in 7 infected people don’t know that they carry the virus according to the U.S. Department of Health & Human Services.
Source: CDC, Estimated HIV Incidence and Prevalence in the United States 2014–2018, 2020

HIV-AIDS an increasingly well-treated disease

A well-cared-for HIV-positive person has an extremely low risk of transmitting HIV during sex, under certain conditions:

  • The treatment is taken regularly,
  • An undetectable viral load (or viral load below the threshold of 50 copies/ml in plasma for more than 6 months and at the most recent test),
  • The viral load is measured regularly, at least every 3 or 4 months
  • Both partners do not have a sexually transmitted infection.

There is currently no cure for AIDS or for removing HIV from the body. Even when it becomes undetectable by tests, the virus is not eradicated from the body. However, with the right treatment, a person with HIV can now live a long life. However, people with HIV are still susceptible to transmitting HIV throughout their lives, especially if they are not treated well.

Left untreated, HIV infection leads to AIDS and ultimately results in death. With HIV infection getting better and better, some at-risk populations are slowing down on their prevention efforts.

Evolution of HIV infection to AIDS

  • 1st phase – primary infection. In the weeks following infection, about a third of those affected show symptoms similar to those of the flu or mononucleosis: fever, headache, sore throat, rash on the skin, fatigue, muscle pain, etc.. These symptoms go away on their own, even without treatment.
  • 2nd phase – asymptomatic infection. The virus can live in the body for many years without causing symptoms. As a result, the person may not feel that they are sick, but they are likely to transmit HIV. Seroconversion – when a person who is HIV negative (no antibodies in the blood) becomes HIV positive (the presence of antibodies in the blood) – occurs during this phase, 1 to 3 months after infection.
  • 3rd phase Phase – AIDS (acquired immunodeficiency syndrome) or symptomatic infection. If still untreated, the person has one or more symptoms of HIV infection (fatigue, diarrhea, swelling of the glands, weight loss, night sweats, fever, etc.).
  • Stage 4 – If the number of immune cells (CD4 T lymphocytes) becomes very low and the body can no longer fight off other infections or diseases, the diagnosis of AIDS is made. The symptoms of the infection become more noticeable and constant. In addition, opportunistic infections can cause serious health problems. Opportunistic infections are infections that are usually not serious, but become serious in people with very weak immune systems. Examples of opportunistic diseases include candidiasis, pneumonia, tuberculosis, herpes infections, and also cancers (including lymphomas and Kaposi’s sarcoma).

Note. Research has shown that cardiovascular disease is more common in people with HIV because their bodies are subject to a higher degree of inflammation. Inflammation is known to build plaques in the lining of the arteries, which can interfere with the flow of blood. In addition, cases of cognitive degeneration (eg, Alzheimer’s disease) related to HIV infection have also been reported.

The fact that HIV takes direct control of the immune system makes it particularly dangerous.

Symptoms of HIV/AIDS

1st phase or primary infection — Symptoms are similar to those of the flu or mononucleosis and are present in about one in two cases. The primary infection can therefore go unnoticed. When they first appear, a person who has just contracted HIV is at a particularly high risk of transmitting the virus because the number of viruses in the body (viral load) is particularly high. These symptoms persist for 1 week to 1 month, then disappear. These symptoms include:

  • Fever;
  • Headache;
  • Sore throat;
  • Redness on the skin;
  • Tiredness ;
  • Muscle and joint pain.

2nd phase or asymptomatic phase — The HIV-positive person does not show symptoms, even if the virus suppresses the immune system (no symptoms).

3rd phase, or the AIDS phase — Symptoms appear because the immune system is overwhelmed by the virus. Some symptoms become more frequent, persistent, and sometimes chronic, for example:

  • Fever;
  • Night sweats ;
  • Significant weight loss;
  • Swelling of the glands;
  • Persistent diarrhea;
  • Skin infections;
  • Persistent dry cough;
  • Shortness of breath.

At this stage, opportunistic diseases appear. Due to the weakened immune system, various diseases can occur, especially infectious diseases or cancers. This phase occurs on average 10 years after the primary infection.

People at risk of HIV/AIDS

  • People living in or originating from a country where HIV infection is widespread (eg, sub-Saharan Africa and the Caribbean);
  • Children born to untreated HIV positive mothers. The virus can be transmitted during pregnancy or childbirth, but also during breastfeeding;
  • People who have a job that is exposed to blood or other body fluids (health professionals, police, firefighters, etc.);
  • People who received a transfusion of blood or blood products or an organ transplant from 1979 to November 1985 (when the test for HIV was developed).
  • People who have unprotected sex with multiple partners.
  • Men who have sex with men. This is a population where the number of cases of HIV transmission is increasing while it is decreasing in the rest of the population. The risk of contracting HIV is 200 times higher for these men than for men who have only heterosexual sex.

Risk factors for HIV/AIDS

  • Having unprotected sex with someone who has HIV. This includes vaginal or anal sex without a condom and oral sex without a condom (condom). People who have mouth ulcers (cold sores) or sexually transmitted infections like gonorrhea, syphilis, genital herpes, etc., are more likely to get or transmit HIV.
  • Having sex with more than one partner, with a partner who has or had more than one partner, or with a partner who uses or has consumed intravenous drugs and has had needle-swapping.
  • Sharing of syringes among drug users.
  • Getting a tattoo or “piercing” with material that is not disposable or non-sterile.

HIV screening

HIV testing can only be done with the consent of the person being tested. She must therefore be aware.

The HIV test is to look for seropositivity, that is, the presence of anti-HIV antibodies in a blood sample. The reference method used is the combined ELISA test, carried out from a blood test. This test is reliable as early as 6 weeks after taking a risk for HIV transmission. Because of the risk of false positives (positive result in the absence of HIV in 0.5% of cases), in the event of a positive result, this test must be supplemented with another screening test, the Western Blot.

There is also a rapid screening test or TROD (Rapid Diagnostic Orientation Test for HIV), carried out in certain anonymous and free testing centers or in associative places, clinics, and hospitals. The result of this test is reliable three months after taking a risk for HIV transmission. The result is achieved in 20 to 30 minutes. If this test is positive, it must be confirmed by a standard test carried out in an analysis laboratory.

Who should be tested?

  • People who have lived in a situation putting them at risk of contracting the virus;
  • People whose symptoms may be due to an HIV infection (talk to your doctor);
  • All women before becoming pregnant or at the start of pregnancy in order to set up treatment to prevent transmission to the unborn child.
  • People who donate tissue, sperm, milk and organs are systematically screened for HIV.
  • People in a faithful couple relationship wanting to stop using condoms, first making sure that they are not HIV positive.
  • And anyone can get tested because 30 to 50% of people with HIV don’t know it. So don’t hesitate to ask for a screening if you have never had it before.

When to take the test

The best time to have a reliable HIV test is 3 months after you believe you are at risk of exposure to HIV.

Basic preventive measures

For HIV negative people who do not have HIV

  • Use condoms for all sexual intercourse regardless of type (vaginal, anal, oral). Petroleum-based lubricants can damage the rubber of condoms: use only water-based lubricants;
  • Do not exchange sexual accessories;
  • Do not share your toothbrush, razor, file or any other personal item that may be in contact with blood;
  • For people who inject drugs, do not share needles or injection equipment.

For people with HIV

  • Use condoms (condoms) for every sexual encounter (oral, vaginal and anal). This will not only prevent HIV from spreading to a partner, but it will also prevent you from overexposing yourself to the virus. Getting HIV again can worsen an existing infection and speed up the progression to AIDS. Plus, protecting yourself helps reduce your risk of contracting another sexually transmitted infection (STI). People with HIV are at increased risk of getting other STIs and they can be more difficult to treat.
  • Do not share needles or devices associated with drugs;
  • Do not share your toothbrush, razor, file or any other personal item that may have traces of blood;
  • Cover any wounds with a bandage;
  • Clean any surface contaminated with your blood with bleach.
  • Do not donate blood, organs or semen for artificial insemination;
  • If you are pregnant, you should receive treatment immediately to prevent the baby from getting the HIV.
  • If your partner has been exposed to HIV, see a doctor as soon as possible, within 72 hours at most. Preventive treatment may be given (“post-exposure prophylaxis”).

Note. Researchers are working to develop a vaccine that would prevent people from contracting HIV. However, there are many obstacles and no one expects such a vaccine to be available before 2023. It is very difficult to find molecules that completely neutralize the virus at its site of entry. In addition, HIV often mutates, which means that its genes change and therefore the duration of the vaccine can be very short.

That said, some researchers believe that research for the vaccine should not obscure progress: knowing that with an effective treatment leading to an undetectable viral load, HIV-positive people are hardly at risk of transmission anymore. If all of them were to be treated, the epidemic could end in about 40 years. This means that rich countries must help the countries most affected in order to eradicate this virus together.

Additional measures

  • To support the body and the immune system, it is recommended to have a healthy lifestyle: eat well, exercise, get enough rest, do not smoke, have moderate alcohol consumption, etc. Using emotional and spiritual support also helps you cope better with stress. As life expectancy with HIV has increased dramatically over the past 30 years, doctors are emphasizing the importance of taking care of your health even more.
  • Several vaccinations may be given, depending on the case (against pneumococci, influenza, tetanus, diphtheria, hepatitis A and B, etc.) Despite the immune depression and less efficiency, it is possible to vaccinate an HIV-positive person with a vaccine that does not contain a live infectious agent, that is to say no bacteria or virus. Vaccines containing a virus or a living bacterium with attenuated virulence are most often contraindicated (eg chickenpox, tuberculosis, yellow fever, measles, mumps, etc.) It is up to each person’s doctor to determine the useful and beneficial vaccines.
  • In order to avoid foodborne infections and poisoning, people living with HIV/AIDS should be particularly careful and avoid certain raw foods (eggs, poultry, rare meats and tartars, fish and seafood) as well as unpasteurized dairy products.
  • Great caution is also required with pets and the like, which can lead to serious opportunistic infections. Wash hands thoroughly after handling animals.

Treatment of HIV/AIDS

None of these treatments cure the disease, but with them, the majority of people with HIV can live a very long time. In addition, the side effects of medications are less bothersome than in the past.

Treatment against HIV/AIDS has two main components: immediate treatment with antiretroviral therapy (ART) and that of opportunistic diseases.

HIV is usually treated with highly active antiretroviral therapy (HIV is a retrovirus), a potent combination of at least 3 drugs. These antiretroviral drugs slow the progression of HIV by attacking the virus to reduce the viral load, which is the number of viruses (HIV) in the blood, as much as possible.

The price of this ART has dropped significantly over the years. This allows poorer countries to better treat their HIV-positive inhabitants. However, this price is that of treatments called first-line treatments. In the event of resistance to treatment, there are second-line treatments that are much more expensive and often not easily accessible to everyone, especially in countries without public or private health insurance.

There are several classes of antiretroviral drugs, and several slightly different molecules in each.

  • Nucleoside reverse transcriptase inhibitors (NRTIs) (AZT or zidovudine, belongs to this class of drugs, as well as abacavir, d4T or stavudine, ddI or didanosine, 3TC or lamivudine
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs); for example nevirapine, delavirdine and efavirenz, rilpivirine, etravirine.
  • Protease inhibitors (PIs); such as saquinavir, atazanavir, arunavir, lopinavir-ritonavir, nelfinavir, ritonavir, tipranavir.
  • Entry and fusion inhibitors. Used later in the disease, when the patient has already taken several other drugs; example, enfuvirtide or T20.
  • Integrase inhibitors. Used later in the disease, when the patient has already taken several other drugs.
  • CCR5 receptor inhibitors, such as maraviroc.
  • Treatment is tailored to each person and is a combination of several medicines. The goal of treatment is to achieve an undetectable viral load within 6 months.

Most people are treated with a combination of three drugs, and there are several possible choices depending on the effectiveness, immediate or long-term tolerance, individual living conditions.

To be effective, the treatment must be followed to the letter, that is, you must take the tablets every day at the times prescribed by the doctor, and therefore be ready to adapt your lifestyle. Many of these drugs are now available in just 1 daily dose. Compliance with treatment is extremely important, as it also prevents the development of drug resistance (if the dosage of a drug drops in the body, this increases the risk that the virus will transform or mutate to “survive”).

In addition, the best possible balance must be found between effective treatment and maintaining a good quality of life. The side effects of drugs can be significant: fatigue, headaches, loss of appetite, rashes, diarrhea, etc.

Unique tablets have emerged (for example, Atripla®, Eviplera®, or Stribild® combining 4 molecules). Instead of taking 3 or 4 antiretroviral drugs, for example, these are combined into 1 single tablet, taken once a day.

Prevention and treatment of opportunistic diseases linked to AIDS

When one is HIV positive, it is necessary to undergo regular examinations to detect certain diseases at their early stage. You also need to receive certain vaccines and take medications to prevent infections common in people with HIV/AIDS. If an opportunistic infection develops, your doctor may recommend that you continue treatment even after recovery to prevent a recurrence.

In cancer, chemotherapy or radiation therapy is used.

Vitamin and mineral deficiencies are more common in people with HIV. Some medications can suppress your appetite, and fighting the virus requires more energy and nutrients. Scientific studies suggest that these deficiencies may accelerate the progression of HIV to AIDS. This effect was especially noticed in underprivileged areas. Many healthcare professionals believe that taking a daily multivitamin and mineral supplement may be beneficial for people with HIV, especially if their diet is poor.

All people with HIV infection should have their sex hormone levels monitored. In the event of a deficiency, hormone replacement therapy may be undertaken. In men, for example, hormone therapy can help maintain muscle mass or restore libido.

Some people take marijuana (Cannabis sativa) to stimulate their appetite. In fact, in Canada and the United States, dronabinol (synthetic prescription THC) capsules are approved to stimulate appetite in people with AIDS. This medication can be obtained with a prescription.

Arthur Marquis

Marquis was born in Paris, France and emigrated to United States at the early age of 5. He gained a medical degree from the University of Michigan and has worked as a dermatologist for over 10 years. He covers a wide-range of health related subjects for the Scientific Origin.