HIV 101: Causes, Symptoms, Prevention and Treatment

When Charlie Sheen recently broke the news of his HIV-positive status on American television in 2015, the world sat up and took note.

According to the Centers for Disease Control and Prevention (CDC), more than 1.1 million people are currently HIV infected in the USA, and as many as 15 percent (1 in 7 people) remain unaware of their infection.^[1]

HIV stands for human immunodeficiency virus. This virus infiltrates and destroys the CD4 cells, which are a type of T-helper cells or white blood cells that play an important role in the immune system.

These cells navigate the entire body through the bloodstream and are responsible for detecting any cellular anomalies as well as signs of an infection or disease. Thus, they essentially work as foot soldiers in the body’s natural defense system.

As the HIV virus breaks down more and more of CD4 cells over time, the immune system is rendered weak and incapacitated to fight off everyday infections and more serious ailments such as cancer.

Once contracted, the impact of these conditions is also far more amplified and dangerous. In fact, for an HIV victim, even the most minor sickness can end up being fatal if not attended to properly as the damage tends to progressively worsen.^[2]

Although HIV is a lifelong disease without a cure, early diagnosis and adequate medical care, including a treatment called antiretroviral therapy, can allow patients to live a more normal and long life. Moreover, getting tested also helps lower the chances of transmitting the virus to healthy individuals.

If not medically treated, HIV poses the threat of progressing to AIDS (acquired immunodeficiency syndrome), which is the final and most severe stage of this infection. AIDS goes beyond just the infection and is basically a potentially life-threatening set of symptoms that severely undermine the immune system to the point of failure, eventually leaving it completely unable to fight fatal infections and cancers.

Some research demonstrates that there is a disparity in gender incidence for HIV infection and shows that HIV-1 prevalence among girls and young women is double that among males of the same age.^[3]

HIV Transmission

HIV is most commonly transmitted through semen, preseminal discharge, anal discharge, vaginal discharge, breast milk, and blood. The most common ways the HIV virus may enter your body are through high-risk sexual behavior and exposure through injection or infusion.^[4]

HIV Exposure Through Sexual Behavior

Engaging in intercourse with an HIV-infected person – Anal intercourse is the first and vaginal intercourse is the second highest-risk sexual behaviors for HIV transmission.
Engaging in unprotected intercourse with multiple partners – This can lead to other sexually transmitted infections, making you more susceptible to contracting the HIV virus through intercourse.
Engaging in transactional intercourse (intercourse in exchange for money) – This typically involves multiple partners and high-risk sexual behavior.

HIV Exposure Through Injection or Infusion

Sharing drug-injecting equipment (syringes, needles, and rinsing water) with an HIV-infected person can infect you, too.
Sharing drug preparation equipment with an HIV-infected person can also infect you.
Healthcare workers are at high risk of accidentally being struck with an HIV-infected needle.
Using needles or syringes bought from street sellers can infect you with HIV, as these sellers often repackage used needles and syringes and sell them as new items.
HIV-contaminated blood transfusions or organ and tissue transplants also raise the risk of spreading HIV.

General Misconceptions About HIV Transmission

There are several myths regarding the spread of HIV that add to the sense of suspicion that shrouds this condition and contribute to the unjust and unwarranted alienation of its victims. People tend to make assumptions without educating themselves about the facts, and as a result, HIV patients are forced to become social pariahs.

Instead of operating out of the fear of a probable infection, one must get his/her facts straight. Unlike your run-of-the-mill viral infections, the HIV virus, contagious as it may be, does not spread through the following:

Skin-to-skin contact
Water or air
Sharing a toilet
Sharing your bedding or towels
Fecal excrement or urine of an HIV-positive individual
Saliva, perspiration, or tears of an infected person
Vomit of an infected person
Mosquito or bug bites
Coughing or sneezing
Holding hands, hugging, or kissing an HIV patient
Sharing eating utensils or drinking glasses with a patient

Types of HIV

There are two distinct variants of the HIV virus, namely, HIV-1 and HIV-2. The former is by far the earliest and most predominantly reported of the two, with almost 95 percent of HIV cases worldwide being attributed to the HIV-1 strain. HIV-2, on the other hand, is fairly less common and is largely concentrated in West Africa, with a few cases reported in other countries.

Moreover, this type of HIV infection is also less aggressive in terms of progression and symptoms, thereby accounting for fewer deaths than its counterpart.

HIV-1 and HIV-2 viruses are more or less 55 percent genetically different from each other. Thus, separate tests have been designed to detect each of these viruses that take into account their specific genetic makeup.

One must keep in mind that the individualistic test for either of these viruses will fail to reliably identify the other. However, for convenience sake, there are tests available on the market that are sensitive to both types of viruses.^[5]

Risk Factors

The odds for sexually contracting an HIV infection is higher among the following groups:

People who engage in unprotected sex (sex without condoms)
Gay and bisexual women as well as transgender women who indulge in same-sex activity
People with multiple sex partners or high-risk partner(s) (if your sexual counterpart has multiple sex partners, is a male who has sex with other men, or shares needles and injection equipment with other users)
People with an active or recent case of a sexually transmitted infection, such as syphilis or active herpes^[6]
People who inject drugs or steroids, especially if they share needles, syringes, cookers, or other equipment used to inject drugs
Babies who are born to HIV-positive mothers

Stages of HIV

1. Acute HIV Infection

This refers to the earliest phase of HIV infection, which tends to set in within 2 to 4 weeks after contracting the virus. This stage is perhaps when the infection is as its aggressive best as it spreads rapidly throughout the body, wreaking havoc on the infection-fighting CD4 cells of the immune system.

Acute HIV infection is characterized by flu-like symptoms, such as a headache, running a high temperature, and the development of a rash. Moreover, since the virus tends to multiply at increased momentum, the level of HIV in the blood increases significantly during this stage. Thus, even at this nascent stage of the infection, the risk of HIV transmission tends to be considerably high.

2. Chronic HIV Infection

Chronic HIV infection is the next stage of HIV progression, during which the virus continues to proliferate throughout the body but with substantially decreased speed. In the absence of proper treatment, the HIV virus can continue to replicate itself within the body causing slow but steady organ damage for the next 10 years before transforming into full-blown AIDS.

This lull also implies that there is a marked absence of standard HIV symptoms that were previously noticeable. It is precisely because of this reason that this stage is also referred to as asymptomatic HIV infection or clinical latency. During this stage of the disease, patients tend to feel and appear healthy but can still transmit the HIV virus to others.

3. AIDS

Stage three HIV or AIDS is the phase when the infection reaches its peak and becomes largely unmanageable. By the time the HIV infection progresses into AIDS, the immune system becomes so severely damaged and compromised that the body can’t fight off opportunistic infections.

Opportunistic infections refer to a group of infections and infection-related cancers that occur with greater frequency and severity among people with weakened immune systems than in people with healthy immune systems. The CD4 cell count for healthy individuals figures somewhere between 500 cells/mm³and 1,600 cells/mm³.

However, in a person with AIDS, the magnitude of CD4 cell damage is such that the count plummets to less than 200 cells/mm³. Another identifying factor to determine if an HIV infection has reached this climactic stage is the development of one or more opportunistic illnesses, regardless of your CD4 count.

In the absence of effective ART treatment, an AIDS patient can survive for about 3 years before succumbing to this deadly disease.

The Difference Between HIV and AIDS

It is incorrect to use HIV and AIDS interchangeably. While an HIV infection is a starting point, AIDS is its most advanced and final stage. Thus, a person with HIV need not progress to this late-stage condition called AIDS, but a person with AIDS has to have contracted HIV first.

HIV is a virus that targets and destroys a type of white blood cell called a CD4 cell, thereby diminishing the body’s natural immunity against infection and illness over time. AIDS, on the other hand, is the final outcome, which manifests itself in the form of a syndrome when an HIV patient fails to undergo the stipulated treatment.

Conversely, people who get tested and diagnosed early and subsequently adhere to the doctor-prescribed treatment regimen for HIV are unlikely ever to develop AIDS.

Symptoms of HIV

Early Symptoms

Once infected with HIV, it is not possible to have it go away.

However, with early identification of common symptoms, proper medical treatment, and a healthy lifestyle, it is possible for an HIV-positive person to lead a long and productive life.

Symptoms of an HIV infection may start presenting themselves 2 to 6 weeks after it is contracted.

The following are 10 early signs and symptoms of HIV that you must know:

1. Fever

The most common primary symptom of an HIV infection is a fever and flu-like symptoms.

A fever during the initial HIV stage is likely to be recurrent and persists for 2 to 4 weeks at a time. Night sweats often accompany infection-associated fevers.^[8]

Because fevers are the immune system’s response to viral infections, getting a fever in the early stages of HIV is a good sign. It proves your immune system has not weakened yet.

2. Night Sweats

If you are unable to sleep because you just cannot stop sweating and you have recently engaged in any of the previously described high-risk behaviors, it might be a cause for concern.^[9]

HIV-induced night sweats occur persistently and without exertion. They may drench your clothes and sheets and may be nearly impossible to sleep through.

Night sweats usually accompany a fever in HIV patients.

3. Sore Throat

A sore throat is another common symptom of early HIV. It is highly likely to accompany a fever in HIV-positive patients.^[10]

A sore throat may occur before the onset of fever as an indicative sign in many patients.

You may experience pain when swallowing food, water, and sometimes your own saliva.

Your sore throat may last up to 2 weeks and may be accompanied by mouth ulcers.

4. Swollen Lymph Nodes

Immune system cells are spread throughout the body. One of the primary locations for their distribution is the lymph nodes.

Lymph nodes are found in the neck, under the armpits, and in the groin area.

Because the main task of HIV cells is weakening the immune system, they identify the key immunity-boosting parts of the body and attack them. This includes the lymph nodes.

The swelling of the lymph nodes is your body’s way of telling you that your immune system is working hard to minimize the damage caused by the HIV infection.^[11]

Lymph nodes are painful and tender to the touch. They can frequently appear and disappear. It is a cause for concern if swelling persists longer than 2 to 4 weeks.

5. Rashes and Seborrheic Dermatitis

Seborrheic dermatitis on the scalp, face, and chest is one of the earliest symptoms of HIV.^[12]

Sebaceous glands are mainly located in the face, head, chest, upper back, and groin area. An early symptom of HIV is the appearance of red, inflamed, itchy, and flaky skin around these regions that may last for 2 to 3 weeks or more.^[13]

6. Muscle Pain (Myalgia) and Joint Pain (Arthralgias)

While these conditions are present throughout the trajectory of the disease, they are also key primary symptoms to identify if you fear that you may have contracted HIV.

Musculoskeletal disorders (those affecting the muscles and bones) are often the initial symptoms of HIV.^[14] The muscle and joint pain may manifest itself in the form of moderate to severe pain in two or more joints that lasts between 2 and 24 hours.

In a study published in the Indian Journal of Sexually Transmitted Diseases in 2013, the musculoskeletal symptoms of 300 patients of primary HIV were evaluated for a year. It found that 63.3 percent of patients reported musculoskeletal disorders. Out of these, 46.7 percent reported body aches, 26.7 percent reported joint pain, 8.3 percent reported lower back pain, and 6.7 percent reported osteoporosis.^[15]

These symptoms intensify as the disease progresses.

7. Fatigue/Tiredness

Fatigue from HIV can be described as a lack of energy and feeling of exhaustion that are not cured with a good night’s sleep. It may be constant and occur without any physical exertion. A study found that fatigue significantly affected the patients’ ability to perform chores, walk, exercise, work, and engage in other activities.^[16]

8. Headaches

Headaches are the most common and persistent form of pain experienced by HIV patients. They severely deteriorate the patients’ quality of life and hinder their day-to-day activities.^[17]

Primary headaches (migraines, tension-type headaches, and headaches occurring on one side and persisting for weeks) are recurrent headaches not associated with any underlying illness. They may signify that HIV is in its initial stage.

Secondary headaches (sinus headaches or headaches from meningitis) are associated with other illnesses that develop in the later stages of HIV when the immune system further weakens, allowing for opportunistic infections to thrive.

9. Nausea and Vomiting

Nausea and vomiting are two of the most common symptoms of HIV, according to a study published in the International Journal of STD & AIDS.^[18] Because the HIV infection compromises the immune system, the body may contract bacterial, fungal, and viral infections even in the initial stages. Nausea is your body’s way of letting you know your system is under attack by these infections.

Furthermore, if you have recently engaged in any of the high-risk behaviors mentioned earlier and have been feeling nauseated regularly, it might be indicative of HIV.

10. Diarrhea

Diarrhea is a disorder of the gastrointestinal tract caused by bacterial, fungal, or viral infections attacking the body when the immune system is weak and fighting an HIV infection.^[19] A common symptom of early HIV, diarrhea severely damages the quality of life of the patient and interferes with his or her routine activities.

11. Yeast Infection.

Yeast infections are more prevalent among women than men and stem from microscopic fungi that thrive naturally in our mouths and vaginas. Initial exposure to the HIV virus leads to the rapid proliferation of this fungi, often resulting in a full-blown yeast infection.^[20]

While HIV has often been associated with subsequent yeast growth, often the infection is rooted in some other underlying health condition such as diabetes or no health condition at all. In fact, women, in particular, are prone to developing this infection without any other culpable cause.

Thus, a symptom such as this cannot suffice to indicate an HIV infection. Instead, one should ideally get the condition checked by a medical practitioner to determine if HIV has a role and then pursue the recommended course of testing and treatment.

Late Symptoms (Progression to AIDS)

Symptoms that indicate that your HIV infection has progressed to its final stage, that is, AIDS, can include the following:

You tend to become visibly weaker due to rapid weight loss.
You tend to experience repeated episodes of fever or profuse night sweats.
You are plagued by a constant state of extreme and unexplained fatigue.
You might notice swelling in your lymph glands, including the groin, neck, and armpits, which will persist for an extended period of time.
You are likely to get loose stools that would last for more than a week.
Your mouth, anus, or genitals might become painful.
You may suffer through bouts of pneumonia.
You are likely to develop red, brown, pink, or purplish blotches on or under the skin as well as inside the nose, eyelids, or mouth.
You might grapple with neurological disorders such as memory loss and depression.

Because all of the above-mentioned symptoms are not exclusive to AIDS alone and can be indicative of some other unrelated illness, the only way to get a clear diagnosis is to get tested.

If the diagnosis turns out to be AIDS, most of these symptoms can be traced back to one or the other opportunistic infection or illness that may have found its way into your body because of the severely compromised immune system.

Medical Treatment

Once the HIV virus makes its way into your body, it will stay around in your system for the rest of your life. Thus, HIV treatment is more about managing this condition rather than curing the disease. Treatment entails taking medicines that arrest and set back the proliferation of the virus in your body.

Given that HIV figures among the retrovirus family, the drugs used to treat it are called antiretrovirals (ARV). These drugs are administered as part of a combination therapy in conjunction with other ARVs. This standard treatment is collectively called antiretroviral therapy (ART).

Although a cure for HIV does not yet exist, this is no reason to resign yourself to fate and disregard the current treatments available. The lack of medical care is the reason most cases of HIV deteriorate into a much more advanced form of this disease. While it’s best to start your ART from the initial stages of the infection, the therapy is equally imperative for people with AIDS.

In fact, ART is recommended for all HIV patients, regardless of their stage or symptoms, and is the only way to ensure a long and healthy life for them. So much so that if you are fortunate enough to get an early diagnosis, you can live just as long as a healthy individual given that you strictly follow your ART regime.

Moreover, this therapy can also reduce the viral load in your blood and body fluids and thereby can lower the risk of transmitting HIV to your partner(s).

Preventive Measures

Healthcare professionals recommend the following precautionary measures to prevent the risk of contracting or transmitting the HIV infection:

The first and foremost step towards HIV prevention is to get tested for it, in order to rule out an active infection, especially before you engage in sex with others. Similarly, it is equally important to know the HIV status of your partner before sexual intercourse.
Because having an STI of any kind increases your risk of contracting HIV, it’s best you get tested for them to pursue the appropriate treatment in case you test positive for any. Insist that your partner does the same.
Limit the number of your sexual partners, as multiple partners translate to greater chances of transmission.
The most common mode of HIV transmission is through unprotected sex. It is therefore paramount that you always use condoms or pre-exposure prophylaxis (PrEP) when engaging in sex with someone who has multiple partners and risk factors.^[21]
In developed countries, intravenous drug use with shared or contaminated needles is often responsible for the spread of this virus. If having to use a needle to take medications or drugs, make sure that the drug injection equipment is sterile and unused. Moreover, never share your own injection equipment or borrow it from others.
Because the infection is often contracted through exposure to contaminated blood, healthcare workers are naturally at an increased risk. Following universal precautions to minimize the chances of transmission is necessary. These precautions include wearing protective gear such as a mask, gowns, gloves, and eyewear when dealing with body fluids and following protocols after exposure.
Pregnant women who have tested positive for HIV can reduce the chances of passing it on to their fetus by following the prescribed regimen of medications. Also, such cases usually warrant the baby to be delivered via a C-section instead of vaginal birth.
If you happen to be at an increased risk of contracting HIV, consult your healthcare provider about pre-exposure prophylaxis (PrEP). PrEP is the daily administration of a combination of two pills that works as an HIV prevention option for people who don’t already have the disease.

What is PrEP?

Pre-exposure prophylaxis (or PrEP) is a recommended preventive measure against HIV transmission for people with an increased susceptibility of getting infected. It entails taking HIV medicines daily to stave off the virus from taking hold and spreading throughout your body. However, in order to be effective, one must adhere to the prescribed dosage religiously.^[21]

If you follow the prescribed daily administration of PrEP, your odds of getting HIV through sexual transmission go down by 90 percent. To further mitigate the risk of sexual transmission, its best to couple this therapy with other safeguards such as condoms.

Moreover, PrEP works to reduce the risk of getting infected via contaminated injections by as much as 70 percent.^[21] If not taken consistently, these preventive medicines fail to have the desired protective effect.

Is There Any Cure for HIV?

Unfortunately, HIV continues to be incurable despite ongoing scientific efforts to find a more permanent solution to this problem. This, however, does not mean that HIV patients cannot live long, healthy, and fulfilling lives.

Managing this condition with proper medical care, particularly with the assistance of ART, allows patients to go about their daily business just like anyone else. However, consistency is key when following ART for arresting the spread of the virus in the body.

With the prescribed administration of this therapy, the viral load (amount of HIV in the blood) reduces to such an extent that it becomes virtually undetectable. The best case scenario is that with adequate, timely, and consistent treatment, an HIV-positive person can expect to live almost as long as a healthy individual.^[22]

Any deficiency of proper medical care is bound to make the condition progressively worse and eventually advance to AIDS.

How Does the HIV Test Work?

The HIV test is done using your blood or saliva samples to detect the presence of HIV specific antibodies in the body. These antibodies are proteins produced by your body in response to an active HIV infection that help to fight the culpable virus.

The detection of such antibodies is taken to be a conclusive sign of an ongoing infection, except in cases where these antibodies might be passed on by infected mothers to their newborns who then carry them in their system for as long as 18 months.

Such diagnostic tests do not provide the complete picture, however. They simply indicate if you are infected or not, without highlighting the possibility of AIDS, nor the extent or the progression of the disease.

Who Should Get Tested and How Often?

The CDC recommends that people within the age gap of 13–64 years should make it a point to get tested at least once in their lifetime.^[23] Furthermore, people who are in high-risk populations should exercise greater precaution and get tested often, which is every 3–6 months.

To be more certain, you must speak with your healthcare provider to get a fair assessment of your risk factors and accordingly determine how often you should get tested for HIV.

Window Period: When Does HIV Become Detectable by Testing?

After being exposed to the HIV virus, the body’s natural defenses spring into action and start producing antibodies to fight the invading pathogens. The time it takes for the body to create enough HIV antibodies for the infection to be picked up by a standard HIV test is referred to as the window period.

Although the window period for HIV varies depending on the test used, the earliest possible diagnosis can be no sooner than 3 weeks. Most people generally develop identifiable antibodies within 3 to 12 weeks of infection, whereas some might even test negative during this tentative period despite having HIV.

Dos and Don’ts for HIV-Positive Pregnant Women

HIV-positive women who are expecting to give birth can avert the risk of transmitting the infection to their babies by following a doctor-prescribed treatment and certain precautionary measures.

The efficacy and success rate of the currently available treatment plan designed for this purpose is such that it reduces the risk of mother-to-fetus transmission to less than 1 percent, even in the case of normal delivery. Conversely, in the absence of this safeguard, the mother is 25 percent likely to pass on the virus to her baby.^[24]
Moreover, some women might have to opt for a cesarean delivery regardless, due to certain unrelated reasons. It is best to enlist the advice of the more informed practitioners at your HIV clinic.
Also, the mother’s milk is another medium through which the virus can be passed on to the baby; therefore, breastfeeding in most cases is not recommended in HIV-positive mothers.

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