HUMAN IMMUNODEFICIENCY VIRUS


What is HIV?

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This section contains information on what HIV is and what it does once it enters your body. Since it is important to understand HIV in order to control it, we suggest you review the following information which we hope you will find useful.

Remember, if you have any doubts regarding HIV, make sure to contact your attending physician and staff at the comprehensive care clinic.

 

What is HIV?

HIV stands for Human Immunodeficiency Virus, and it is the virus responsible for AIDS (Acquired Immunodeficiency Syndrome). The HIV virus attacks the body’s defenses, leaving it unprotected and exposed to bacterial, fungal and other viral infections.

 

Although HIV and AIDS are different, they are closely related. When a person acquires HIV, the infection goes through a series of stages as the virus spreads and affects your body. The most advanced stage of the infection is known as AIDS, which is when symptoms first appear due to the weakening of the body’s defenses to the point at which they can no longer protect us.

Although there is no cure for HIV and it cannot be completely eliminated once it has entered the body, there are treatments to keep it under control and prevent damage.

With the development of Antiretroviral Therapy (ART), HIV has become a treatable disease, allowing HIV-positive people, with proper care and adherence to treatment, to enjoy a similar life expectancy to the rest of the population.

 

Do you know how the virus enters the body?

The HIV virus can be found in blood, semen and pre-seminal fluid, vaginal fluids, and in HIV-positive women’s breast milk.

The HIV virus, after entering the body through anal, vaginal or oral sexual contact, or by contact with infected fluids, begins to multiply in the body using the CD4 defense cells.

The virus enters a CD4 cell and infects it. Within the infected CD4 cell, the virus begins to create new copies of itself which, when mature, break out and infect other CD4 cells.

Each one of these new viruses will repeat the cycle to the point that your body’s defenses will begin to weaken as the quantity of the virus increases. Without treatment, the virus can multiply very quickly and weaken your defenses to the point at which they are no longer capable of protecting you.


What is CD4 and Viral Load?

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CD4 cells are our body’s defense cells. Their main function is to alert our immune system to the presence of viruses, bacteria or any other microorganism that pose a threat to our health.

CD4 cells are the main target of the virus since it uses them to reproduce within the body, leaving our body unprotected by attacking them.

Once HIV has damaged a CD4 cell, it is no longer able to perform its protective function. This is why it is essential to control the virus with treatment so that it does not damage the immune system, putting people’s health and lives at risk.

When visiting an HIV treatment clinic, a doctor will perform tests to measure the CD4 count in the blood, determining the number of healthy cells which have not been damaged by the virus. The test allows the doctor to assess an HIV-positive person’s health, their risk of becoming ill, and the best time to begin treatment.

Normal CD4 counts vary from person to person, but people are usually at a much higher risk of contracting an opportunistic disease once it falls below 200. By stopping the virus from multiplying through medication, a person’s CD4 count can be maintained at an appropriate level, reducing the risk of illness and making it possible to lead a normal life.

Viral Load 

This refers to the amount of HIV virus particles in the blood. By measuring the number of virus particles present in the blood, we know how it is behaving and we are able to calculate the speed at which it is spreading in the body, so it is important to have this test once your doctor considers it necessary.

Viral load is reported in HIV copies. The best result of a viral load test is less than 20 copies of the virus, which doctors call an “undetectable” viral load.

Having less than 20 copies of the virus does not mean that there is no virus in your body, just that the amount is so low that the laboratory tests can no longer count them.

A low viral load means the infection is controlled, that it cannot damage your immune system, and that you are at a lower risk of getting sick. An undetectable viral load is obtained through medication, so it is essential to visit your healthcare system for comprehensive care.


Sexually Transmitted Infections (STIs)

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These are infections transmitted through unprotected sex without using a condom and can be caused by fungi, viruses or bacteria. Currently, over 50 types of STIs have been identified.

It is important to seek specialized medical treatment once you detect any symptoms since, if treated early, some STIs can be controlled and will not reappear.

The use of latex condoms is essential in order to prevent STI transmission. Although HIV is considered to be a sexually transmitted infection, if you already have it, this does not mean you cannot get other STIs or have more than one at a given time, which makes condom use very important.

 

 

Some STIs combined with HIV can further complicate a person’s health.

Let us identify some common STIs and their symptoms.

STI Symptoms Treatment In patients with HIV
Chlamydia: This is a common infection caused by a bacterium. Often asymptomatic, but may appear as a burning sensation when urinating with abnormal discharge from the vagina or penis. Treated with antibiotics, doctors recommend routine chlamydia tests. HIV-positive women have a higher risk of developing pelvic inflammatory disease due to a weakened immune system. Presence of the Chlamydia bacteria in the uterus and ovaries may cause inflammation of the internal organs, which can lead to infertility.
Gonorrhea: common in young adults. Caused by the Neisseria gonorrhea bacteria When transmitted through sexual contact, it will usually result in pain when urinating and abnormal secretions from the penis and vagina. It can also be transmitted from mother to child during natural childbirth. It is treated with doctor-prescribed antibiotics. May lead to higher risk of pelvic inflammatory disease in women.
Human Papilloma Virus (HPV): caused by a virus. More than 100 papilloma subtypes exist, with 30 of them associated with cancer. Only certain types of HPV cause warts on the penis and vulva. In women, warts are more commonly found inside the vagina, making a Pap smear essential for detection. A doctor may try to remove the warts, but since HPV is incurable, it will remain present in the body. Maintaining healthy defenses helps keep the virus inactive. HIV-positive people should keep their viral load under control and their defenses high to ensure HPV remains inactive. Untreated HPV in HIV-positive persons leads to a higher risk of uterine cancer in women and of anal or penile cancer in men.

In recent years, HPV-related mouth and throat cancers have been detected, so latex barriers or condoms are essential when practicing oral sex.

 

Genital herpes: Caused by the herpes simplex virus. Presence of blisters at the places where the virus has entered the body. The blisters are usually painful and are accompanied by itching and burning sensations.

Sometimes people are unaware that they have herpes due to the absence of symptoms or because symptoms are very mild since blisters may disappear once the immune system becomes stronger and controls the outbreak.

Medication does not cure genital herpes, but it can help the body fight the virus. This can make the symptoms milder, decrease the number of outbreaks, and reduce the risk of transmitting the virus to another person.

Correct use of latex condoms can reduce, but not completely eliminate, the risk of contracting or transmitting herpes.

In HIV-positive patients, decreased immune function makes herpes outbreaks more common, and the infection is usually more aggressive.
Syphilis: caused by a bacterium. It infects the genital area, lips, mouth, or anus and affects both men and women. It can be transmitted from mother to child during pregnancy. At an early stage, the infection usually causes a single, small, painless sore. If left untreated, it will usually cause a skin rash that itches, frequently on the hands and feet. Many people do not notice the symptoms for many years, since they disappear and reappear.

In advanced stages, it can damage the nervous system, bones and internal organs.

At the initial stage, syphilis can be treated with doctor-prescribed penicillin. Syphilis becomes incurable once it progresses to advanced stages. HIV weakens the immune system, increasing the risk of syphilis.

Syphilis in an HIV-positive person will progress rapidly, since their immune system is not capable of controlling the infection.

Symptoms in HIV-positive people can be much more severe and they are more likely to develop nervous system damage (neurosyphilis).

Hepatitis A, B, C:

caused by a virus. Hepatitis A can be contracted through contact with food or water contaminated with fecal matter.

Hepatitis B and C are transmitted through sexual contact or contaminated blood. Hepatitis B and C cause permanent liver damage, cirrhosis, or liver cancer.

Common symptoms include: fatigue, lack of appetite, nausea, vomiting, yellowing of the skin, dark urine, and pain on the right side (where the liver is located).

 

 

Hepatitis A is cured when the immune system fights it.

Hepatitis B and C do not have any specific treatment, the person should undergo constant medical control. For HIV-positive people, antiretroviral treatment may help to control the hepatitis and the damage it can cause.

Having HIV and acquiring Hepatitis B or C complicates a person’s health situation. An HIV-positive person’s immune system cannot protect them from a quickly progressing hepatitis. Liver cancer and cirrhosis are common in HIV-positive patients with high viral loads and CD4 counts below 200, in addition to increased damage if they consume alcohol.

Opportunistic Infections (OIs)

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An opportunistic infection is caused by fungi, viruses or bacteria that would not normally attack a healthy body. A sick body is an “opportunity” for different microorganisms to attack the body.

Due to their suppressed immune system, people living with HIV are more vulnerable to these infections which take advantage of this by entering the body and making it sick.

The most common OIs include:

 

Tuberculosis (TB) 

An infection caused by a bacterium that mainly affects the lungs, but it can attack other organs in the body as well. It usually affects people with a CD4 count below 200.

TB bacteria may be air-borne or transmitted in the saliva, expelled from the body when we speak, kiss, sneeze and cough.

Symptoms include fatigue, night sweats, chills, coughing and fever.

Treatment usually lasts six months, during which tests are carried out in order to find out if the infection is being controlled. In some cases, treatment can extend for up to 9 months and require hospitalization.

After having tuberculosis, it is important to take good care and continue antiretroviral therapy (ART) in order to prevent your immune system from being attacked by the virus, which will help in defending you from this and other infections.  Additionally, if diagnosed with tuberculosis, anybody living with the patient should be tested for TB and undergo treatment if necessary.

 

Pneumonia

A type of respiratory infection that affects the lungs. The lungs consist of small sacs, called alveoli, that, in a healthy person, are filled with air when they breathe. The alveoli of a person with pneumonia are filled with pus and fluid, which makes breathing painful and limits the absorption of oxygen.

Pneumonia can spread in several ways: viruses and bacteria commonly present in the nose and throat can infect the lungs when inhaled.

By airborne transmission, in droplets produced by coughing and sneezing, or through blood.

Symptoms include rapid or difficult breathing, coughing, fever, night sweats, chills, chest pain, confusion and delirium, and loss of appetite.

Treatment usually consists of amoxicillin, but it is important to receive a medical diagnosis since some patients may have contracted an antibiotic-resistant strain.

 

Toxoplasmosis 

Toxoplasmosis is an infection caused by a parasite. Cats, birds and other animals are carriers of the parasite, but it can also be found in some meats (especially pork), and in contaminated water and unpasteurized milk.

The parasite can infect the lungs, the retina of the eye, the heart, pancreas, liver, colon and testes. Once infected, it invades the body and remains there, but a healthy person’s immune system prevents it from causing sickness.

In people with weakened immune systems, such as those with Acquired Immunodeficiency Syndrome (AIDS), the parasite may begin to multiply and cause serious diseases. The most commonly affected organ is the brain, causing severe inflammation.

Symptoms include severe headaches that fail to improve with pain medication, weakness on one side of the body, fever, seizures, vision problems, and difficulty in talking and walking. Other symptoms may include confusion, decreased attention span, and personality changes.

Toxoplasmosis is treated with antibiotics, but people with weakened immune systems due to HIV should receive a permanent, low-dose treatment for life in order to avoid relapses, avoid contact with bird and cat feces, drink purified water and pasteurized milk, and eat well-cooked meats.

 

Histoplasmosis

Histoplasmosis is a disease caused by a fungus called Histoplasma capsulatum, which is common in central and southern USA, South America, Central Africa, Southeast Asia and Australia.

This fungus grows in bird and bat feces, and its spores are breathed into the body, so it is not transmitted from person to person. In people with weakened immune systems, the fungus is able to grow in the bloodstream and spread to the lungs, skin, and occasionally to other parts of the body.

Over 90% of AIDS patients diagnosed with histoplasmosis have CD4 counts below 100, so keeping the virus in check through antiretroviral therapy (ART) is important in order to reduce the risk of infection.

Histoplasmosis may cause fever, weight loss, skin lesions, respiratory difficulties and inflammation of the liver and spleen. It frequently affects the bones and causes anemia.

It is treated with antifungal medications. Histoplasmosis can be prevented by reducing exposure to dust in chicken coops, caves with bats and other high-risk locations. You might be at risk if you work in agriculture, gardening or construction. Use a mask and other protective equipment if you enter or work in these environments.

 

Cytomegalovirus

Is an extremely common virus across the globe. Cytomegalovirus can be transmitted by saliva, blood, semen and other body fluids. It may cause a mild disease and many people never show any symptoms. Once infected, however, it cannot be eliminated from the body. It can cause eye and gastrointestinal infections in HIV-positive patients with low CD4 counts.

Symptoms include sore throat, swollen glands, fatigue, and fever.

In people with low CD4 counts it may cause blurred vision (if the cytomegalovirus infection is in the eye), pain when swallowing, diarrhea, and abdominal pain.

 

Cryptosporidiosis 

Cryptosporidiosis is a diarrheal disease caused by a protozoan called Cryptosporidium, and can develop into a chronic illness in people with CD4 counts ranging between 50 and 100.

Symptoms include abdominal cramps and severe chronic diarrhea. Infection with the parasite can occur by drinking water contaminated with fecal matter (such as that found in swimming pools, lakes or public water supplies), by eating infected raw food (such as oysters), or by transmission from person to person, including changing diapers or exposure to feces during sexual contact. Antiretroviral treatment and therapy are important for controlling the infection and protecting against it.

 

Cryptococcal disease or cryptococcosis

Cryptococcal disease is caused by a fungus that enters the body through the lungs and can spread to the brain causing cryptococcal meningitis. In some cases, it can also affect the skin, the skeletal system and the urinary tract. It can be fatal if not detected and treated appropriately with antifungal medication.

Although the infection is mainly found in the central nervous system, it may spread to other parts of the body, especially in people with CD4 counts below 50.

Signs and symptoms of cryptococcal meningitis may include fever, headaches, fatigue, stiffness of the neck.

Some patients may suffer memory loss or changes in awareness (altered consciousness) and in conduct.


FREQUENTLY ASKED QUESTIONS

What is HIV?

1. If I am HIV-positive, do I also have AIDS?

No, there are a number of criteria used to determine if a person has reached the AIDS phase of HIV infection. One of them is the amount of virus versus the number of immune cells, as well as the presence of infections or symptoms characteristic of this stage. A person may be HIV-positive but not have advanced to the AIDS phase of the infection.

2. How can I know how long I have had HIV?

After an HIV-positive diagnosis, it is important to seek medical care at a clinic. There, a doctor will perform tests to determine the amount of virus and immune cells in your body, in addition to carrying out a physical examination and other laboratory tests. This is known as Integral Diagnosis and it can help a doctor to advise you as to your current health status and identify which stage of the infection you are at.

What is CD4 and Viral Load?

1. How can I help raise my defenses?

Since medication controls the virus, it will stop it from damaging your defenses. However, in order to raise your defense level, you should practice a healthy lifestyle, combining medication with a good diet, stress and emotional management, as well as getting enough sleep and avoiding alcohol, tobacco and drugs.

2. How often should I have viral load and CD4 tests?

After your initial diagnosis, the clinic will carry out these tests to obtain information on the status of your health. Your doctor will repeat these tests approximately every six months in order to monitor the virus and to check that your medication is controlling the virus.

Sexually Transmitted Infections (STIs)

1. What should I do if I get an STI?

If you suspect that you have an STI or start showing symptoms, the most important thing is to immediately visit your doctor. You should never self-medicate, since only a doctor specialized in STIs can prescribe the correct treatment.

2. Why it is important to treat STIs?

If left untreated, some STIs can cause severe long-term damage. Even though some STIs are incurable, keeping them under control will allow you to monitor their progress and prevent further complications.

Opportunistic Infections (OIs)

1. How can I find out if I have an Opportunistic Infection (OI)?

It is important to be aware of any symptoms, taking into account that these may be mild in some cases, so it is important to tell your doctor how you feel, visit the clinic for your regular checkups, and consult your doctor immediately if any symptoms arise.

2. How do I know if I am at risk of an OI?

In general, people with low CD4 counts are more exposed, so it is important to have lab tests whenever your doctor requests them to adequately monitor your health and detect any complications at an early stage.