HUMAN IMMUNODEFICIENCY VIRUS

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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.

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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.

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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.

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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.