HIV/AIDS (Acquired Immunodeficiency Syndrome): Symptoms, Causes & Treatment

HIV/AIDS (Acquired Immunodeficiency Syndrome): Symptoms, Causes & Treatment

Acquired immunodeficiency syndrome (AIDS) is an ongoing, also called chronic, condition caused by the human immunodeficiency virus (HIV). HIV damages the immune system, making the body less able to fight infections and diseases. Whilst HIV was once considered a fatal diagnosis, modern antiretroviral therapy (ART) has transformed it into a manageable chronic condition. Thanks to advances in treatment, most people living with HIV do not develop AIDS.

Understanding HIV/AIDS is crucial for prevention, early detection, and effective management. This comprehensive guide covers the symptoms, causes, transmission methods, treatment options, and preventive measures for HIV/AIDS, with a focus on healthcare pathways.

What is HIV/AIDS?

HIV (human immunodeficiency virus) is a virus that attacks the body's immune system, specifically targeting CD4 T cells—white blood cells that play a crucial role in defending against infections. As HIV destroys more CD4 T cells, the immune system progressively weakens, leaving the body vulnerable to opportunistic infections and certain cancers.

AIDS (acquired immunodeficiency syndrome) is the most advanced stage of HIV infection. A person is diagnosed with AIDS when their CD4 T cell count drops below 200 cells per cubic millimetre of blood or when they develop specific AIDS-defining illnesses, such as certain opportunistic infections or cancers. Without treatment, HIV typically progresses to AIDS within 8 to 10 years, though this timeline varies considerably between individuals.

How HIV Spreads

HIV is transmitted through contact with certain body fluids from an infected person. The primary modes of transmission include:

• Unprotected sexual contact: HIV can be transmitted through vaginal, anal, or oral sex with an infected partner. The virus can enter the body through mucous membranes or small tears in the rectum or vagina during sexual activity. Anal sex carries a higher risk than vaginal sex.
• Blood contact: Sharing needles, syringes, or other drug-injecting equipment with someone who has HIV puts you at very high risk of infection. Healthcare workers may also be exposed through needle-stick injuries, though this is rare in properly managed clinical settings.
• Mother-to-child transmission: Pregnant individuals with untreated HIV can pass the virus to their babies during pregnancy, childbirth, or breastfeeding. However, with proper antiretroviral treatment during pregnancy, the risk can be reduced to less than 1%.

How HIV Does NOT Spread

It's crucial to understand that HIV is not transmitted through casual contact. You cannot contract HIV through:

• Hugging, kissing (on the cheek), or shaking hands
• Sharing food, drinks, or eating utensils
• Using public toilets, swimming pools, or gym equipment
• Insect bites or mosquito exposure
• Airborne transmission (coughing or sneezing)
• Donating blood (the equipment used is sterile and single-use)

HIV/AIDS Symptoms

HIV symptoms vary depending on the stage of infection and the individual. Many people experience no symptoms initially, which is why testing is so important if you believe you've been exposed to the virus.

Stage 1: Acute HIV Infection (Primary Infection)

Within 2 to 4 weeks after HIV enters the body, some people develop a flu-like illness known as acute HIV infection or seroconversion illness. This stage may last from several days to a few weeks. However, it's important to note that some individuals experience no symptoms at all during this phase.

Common symptoms of acute HIV infection include:

• Fever (often high)
• Severe headache
• Muscle aches and joint pain
• Skin rash (typically on the torso)
• Sore throat and painful mouth sores
• Swollen lymph nodes (glands), particularly in the neck
• Diarrhoea
• Unexplained weight loss
• Persistent cough
• Night sweats

These symptoms can be mild and easily mistaken for another viral illness, like the flu or a common cold. During this acute phase, the viral load in the bloodstream is extremely high, making HIV highly transmissible to others.

Stage 2: Clinical Latent Infection (Chronic HIV)

Following the acute phase, HIV enters a stage called clinical latency or chronic HIV infection. During this period, the virus remains active within the body and continues to reproduce at low levels, but many people experience few or no symptoms.

Without antiretroviral therapy (ART), this asymptomatic stage can last for many years—typically around 10 years, though some people progress more quickly, whilst others remain stable for longer periods. People receiving effective ART can remain in this stage indefinitely, with the virus suppressed to undetectable levels. When HIV is undetectable, it cannot be transmitted sexually (known as U=U: Undetectable = Untransmittable).

Stage 3: Symptomatic HIV Infection

As the virus progressively damages the immune system, individuals may begin experiencing more persistent symptoms, including:

• Recurring fever
• Chronic fatigue and weakness
• Persistently swollen lymph glands
• Chronic diarrhoea
• Significant weight loss
• Oral thrush (white patches in the mouth or on the tongue)
• Shingles (herpes zoster)
• Recurrent pneumonia

Stage 4: Progression to AIDS

Thanks to modern antiretroviral treatments, progression to AIDS has become increasingly rare. However, without treatment, HIV typically progresses to AIDS within 8 to 10 years. AIDS represents severe immune system damage, characterised by a CD4 count below 200 cells/mm³ or the development of specific opportunistic infections and cancers.

Symptoms of AIDS may include:

• Persistent night sweats
• Recurrent high fevers and chills
• Chronic diarrhoea lasting more than a week
• Severely swollen lymph nodes
• White spots or unusual lesions on the tongue, mouth, or throat
• Extreme and unexplained fatigue
• Profound weakness
• Rapid, unexplained weight loss
• Skin rashes, bumps, or lesions (including Kaposi's sarcoma)

Causes and Risk Factors

How HIV Destroys the Immune System

HIV specifically targets and destroys CD4 T cells (also called CD4+ T cells or helper T cells), which are crucial white blood cells that coordinate the immune system's response to infections. As HIV replicates, it uses these cells as factories to produce more virus particles, ultimately killing the cells in the process.

A healthy person typically has a CD4 count between 500 and 1,500 cells per cubic millimetre of blood. As HIV destroys more CD4 cells, the immune system becomes progressively weaker. When the CD4 count drops below 200, the person is diagnosed with AIDS and becomes highly vulnerable to opportunistic infections and certain cancers that a healthy immune system would normally prevent.

Who Is at Risk?

HIV can affect anyone regardless of age, race, sex, or sexual orientation. However, certain behaviours and circumstances significantly increase the risk of infection:

• Unprotected sexual contact: Having vaginal or anal sex without using a condom increases your risk, particularly if you have multiple sexual partners. Anal sex carries a higher risk than vaginal sex due to the delicate tissues in the rectum.
• Having another sexually transmitted infection (STI): Many STIs cause open sores or lesions on the genitals, providing entry points for HIV to enter the bloodstream. STIs like syphilis, herpes, chlamydia, gonorrhoea, and trichomoniasis all increase HIV transmission risk.
• Injecting drugs: Sharing needles, syringes, or other drug paraphernalia exposes you to infected blood, significantly raising your HIV risk. This also increases exposure to hepatitis and other blood-borne infections.
• Being an uncircumcised male: Research indicates that circumcision can reduce the risk of heterosexual HIV transmission, though it does not eliminate the risk. Condom use remains essential for protection.

Complications of HIV/AIDS

HIV progressively weakens the immune system, making the body vulnerable to a range of opportunistic infections, cancers, and other serious health conditions. Modern antiretroviral therapy has dramatically reduced the incidence of these complications, but they remain a concern for people with untreated or poorly controlled HIV.

Common Opportunistic Infections

• Pneumocystis pneumonia (PCP): This severe fungal infection affects the lungs and can cause life-threatening breathing difficulties. PCP remains one of the most common opportunistic infections in people with AIDS, though it's rare in those receiving treatment.
• Candidiasis (thrush): This fungal infection causes thick, white coatings on the mouth, tongue, oesophagus, or vagina. Oral thrush is often an early sign of immune system decline.
• Tuberculosis (TB): TB is a leading cause of death amongst people with AIDS worldwide. The risk is lower due to widespread HIV treatment, but TB screening remains an important part of HIV care.
• Cytomegalovirus (CMV): This common herpes virus is typically kept inactive by a healthy immune system. When HIV weakens immunity, CMV can reactivate and cause damage to the eyes, digestive system, lungs, or other organs.
• Cryptococcal meningitis: This fungal infection causes inflammation of the membranes surrounding the brain and spinal cord. It's caused by a fungus commonly found in soil and bird droppings.
• Toxoplasmosis: This parasitic infection, primarily spread through contact with infected cat faeces, can cause severe brain damage and seizures when it spreads to the central nervous system. It can also affect the heart and be fatal if untreated.

AIDS-Related Cancers

• Lymphoma: This cancer originates in the white blood cells. The most common early symptom is painless swelling of lymph nodes, typically in the neck, armpit, or groin.
• Kaposi's sarcoma: This cancer affects the blood vessel walls, appearing as pink, red, or purple lesions on the skin and inside the mouth. In people with darker skin tones, the lesions may appear dark brown or black. It can also affect internal organs.
• HPV-related cancers: Human papillomavirus (HPV) infection can lead to various cancers, including cervical, anal, and oral cancers. People with HIV are at increased risk of developing HPV-related cancers.

Other Serious Complications

• Wasting syndrome: Untreated HIV/AIDS can cause dramatic weight loss accompanied by diarrhoea, chronic weakness, and fever. This condition, though less common with modern treatment, can be debilitating.
• Neurological complications: HIV can cause a range of neurological symptoms, from mild cognitive impairment and forgetfulness to severe dementia, depression, anxiety, and difficulty walking. These conditions can significantly impact quality of life.
• HIV-associated nephropathy (HIVAN): This kidney disease involves inflammation of the tiny filters in the kidneys that remove waste from the blood. It most commonly affects people of Black or Hispanic heritage.
• Liver disease: Liver complications are particularly common in people who also have hepatitis B or hepatitis C co-infection, which frequently occurs alongside HIV due to shared transmission routes.

Treatment for HIV/AIDS

Whilst there is currently no cure for HIV, antiretroviral therapy (ART) can effectively control the virus, allowing people with HIV to live long, healthy lives.

Antiretroviral Therapy (ART)

Antiretroviral therapy involves taking a combination of HIV medicines (typically three or more drugs from different classes) every day. ART works by:

• Preventing HIV from replicating in the body
• Reducing the viral load (amount of virus in the blood) to undetectable levels
• Allowing the CD4 cell count to recover
• Protecting the immune system from further damage

When taken consistently as prescribed, ART can reduce the viral load to undetectable levels within 3 to 6 months. At this point, people with HIV cannot transmit the virus sexually (U=U: Undetectable = Untransmittable). This scientific breakthrough has transformed both treatment outcomes and prevention strategies.

Treatment as Prevention (TasP)

People living with HIV who maintain an undetectable viral load through consistent ART cannot transmit HIV to their sexual partners. This concept, known as Treatment as Prevention (TasP), has revolutionised HIV prevention. However, it's crucial to take medications exactly as prescribed and attend regular medical check-ups to ensure the viral load remains undetectable.

Prevention of HIV

Although there is no vaccine to prevent HIV, several highly effective prevention strategies are available. Combining multiple prevention methods offers the strongest protection.

Pre-Exposure Prophylaxis (PrEP)

PrEP is a preventive medication for people at very high risk of HIV infection. When taken as directed, PrEP can reduce the risk of sexually transmitted HIV by approximately 99% and the risk from injecting drugs by at least 74%, according to the US Centers for Disease Control and Prevention.

PrEP options include:

• Oral medications: Emtricitabine-tenofovir disoproxil fumarate (Truvada) and emtricitabine-tenofovir alafenamide fumarate (Descovy), taken daily
• Injectable medication: Cabotegravir (Apretude), given as an injection every two months (after two initial monthly doses)

PrEP is available in Thailand. To receive PrEP, you must test negative for HIV before starting and undergo regular HIV testing (every three months for oral PrEP or before each injection for cabotegravir). PrEP does not protect against other STIs, so condom use is still recommended.

Post-Exposure Prophylaxis (PEP)

PEP is an emergency medication that can prevent HIV infection after potential exposure. If you believe you've been exposed to HIV through sex, needle-sharing, or a workplace accident, seek medical help immediately. PEP must be started within 72 hours of exposure (ideally within 24 hours) and involves taking antiretroviral medicines daily for 28 days. Contact PULSE Clinic if you need help.

Safe Sex Practices

• Use condoms correctly and consistently: Use a new latex or polyurethane condom for every act of vaginal or anal sex. Both male and female (internal) condoms are effective when used properly.
• Use water-based lubricants: Oil-based lubricants can weaken condoms and cause them to break. Always use water-based or silicone-based lubricants.
• Protection during oral sex: Use a condom or dental dam (a piece of medical-grade latex) without lubricant to reduce transmission risk.
• Limit your number of sexual partners: Having multiple sexual partners increases your exposure risk.

Additional Prevention Measures

• Never share needles: If you inject drugs, always use sterile needles and syringes. Many areas offer needle-exchange programmes. Consider seeking support to address substance use.
• Inform sexual partners: If you're HIV positive, it's essential to tell all current and past sexual partners so they can get tested.
• Get tested regularly: Regular testing helps identify HIV early, when treatment is most effective.
• Seek prenatal care if pregnant: Pregnant individuals with HIV should receive immediate medical care. With proper treatment during pregnancy, the risk of transmitting HIV to the baby can be reduced to less than 1%.
• Consider circumcision: Studies show that male circumcision can reduce the risk of HIV acquisition in heterosexual men, though it doesn't eliminate the risk. Condom use remains essential.

When to See a Doctor

Seek medical attention immediately if you:

• Think you may have been exposed to HIV
• Have had unprotected sex with someone whose HIV status is unknown
• Share needles for drug use
• Experience symptoms that could indicate HIV infection
• Are at high risk and want to discuss PrEP or testing options

Early diagnosis and treatment dramatically improve long-term health outcomes.

Living Well with HIV

HIV is no longer a death sentence. With modern antiretroviral therapy, people living with HIV can expect a normal lifespan and excellent quality of life. Early diagnosis, consistent treatment, regular medical care, and healthy lifestyle choices are key to managing HIV successfully.

If you have concerns about HIV, speak to your GP or contact a sexual health clinic. Testing is quick, confidential, and could save your life. Remember: U=U (Undetectable = Untransmittable) means people with undetectable viral loads cannot transmit HIV sexually, transforming both treatment outcomes and prevention strategies.

Medical Disclaimer

This article is for informational purposes only and should not replace professional medical advice. If you suspect you have HIV or are at risk, please consult your GP or sexual health clinic immediately.