HIV infection and AIDS

AIDS: short overview

• Description: AIDS is the final stage of HIV infection. HI viruses infect cells of the immune system and weaken the body’s defenses. Consequence: extreme susceptibility to infections
• symptoms: early symptoms flu-like, later severe weight loss, night sweats, diarrhea, immunodeficiency episodes such as pneumonia, yeast infection, tuberculosis, Kaposi’s sarcoma
• Treatment: Medicines that prevent the proliferation of the virus, relieve symptoms, strengthen immune strength
• Infection: unprotected sex, infected cutlery, stab injuries, especially with medical devices
• Diagnosis: Blood test for HIV antibodies, HIV antigens, reliable diagnosis possible only three months after infection
• Forecast: early discovered good treatable, but not curable

AIDS and HIV: description

AIDS is an acquired immunodeficiency disorder. The trigger is the HI virus, which attacks certain cells of the immune system.

The clinical picture of AIDS, however, occurs only in the final stages of HIV infection. While many HIV-infected people have not developed any symptoms or can avert them by medication, sufferers in the AIDS stage due to their pronounced immunodeficiency in various typical, often life-threatening sequelae and tumors.

Most patients become infected during unprotected sexual intercourse with HIV. The highest risk of infection, however, drug users have when they use syringes that have already been used by infected people.

Today, in countries with good health care, modern medicines allow AIDS to not even break out and patients to lead a more or less normal life. However, the infected must take life-long medications, otherwise the viruses quickly become dominant again.

HIV and AIDS in Germany

According to the RKI, around 100,000 HIV-positive people were living in Germany at the end of 2016. About 3,400 people have been infected in 2016 again. This number has remained roughly the same as in previous years.

What is HIV?

HIV stands for “human immunodeficiency virus”, translated: human immunodeficiency virus. It multiplies in special immune cells, so-called T helper cells type C4. For this purpose, it sends its genetic blueprints into the cell and uses their duplication structures. The T cells are destroyed by it.

T helper cells, however, play a central role in the immune defense: In the defense against pathogens they coordinate other cells of the immune system.

For a while, the body manages to fend off the HI viruses. Among other things, he trains special antibodies that detect the HIV virus. This so-called latency phase can last for years. The patient is then infected and can infect others, but he does not feel disease symptoms.

At some point, however, there are not enough T-helper cells left. Then other viruses as well as bacteria and fungi easily play.

In the course of the disease, certain infectious diseases and tumors often appear, which are otherwise rare, but are life-threatening in immune deficiency. Then the stage AIDS is reached.

What is AIDS?

In the final stages of HIV infection, patients develop AIDS syndrome. The abbreviation AIDS stands for “acquired immune deficiency syndrome”. This means “acquired immunodeficiency syndrome”.

At this stage, the immune defense is greatly weakened. The patient then suffers from infections that are otherwise rare, but can be dangerous to him. In addition, the patients develop a so-called Wasting syndrome with fever, diarrhea and severe weight loss.

Often the viruses now also attack the brain, resulting in so-called HIV-associated encephalopathy. This brain disease is associated with motor disorders and cognitive decline. It can lead to dementia. Special malignant changes such as Kaposi’s sarcoma are also typical of AIDS.

HIV and AIDS: symptoms

The stages of HIV infection are divided into three classes A, B and C, depending on the symptoms.

Incubation period of HIV and AIDS

The first symptoms of HIV occur in the first few weeks after infection. However, the time between HIV transmission and the outbreak of AIDS is several years. Ten years after the HIV infection, about half of all infected people are ill.

HIV stage A

Stage A is divided into two phases: The first early symptoms are followed by a symptom-free period.

Early symptoms

The first symptoms of HIV infection appear within six days to six weeks, but most often two weeks after infection. They are similar to a flu infection or a mild-running Pfeiffer’s glandular fever. Therefore, early stage HIV infection often goes undetected. First signs are:

• a headache
• Sore throat
• swollen lymph nodes
• fever

HIV rash

Another early HIV sign is a typical rash. HIV causes mild skin changes to the trunk in some patients. Physicians then speak of a discrete HIV exanthem on the body trunk. One also speaks of HIV rash and HIV spots.

Take early symptoms seriously!

If you have reason to believe that you have been infected with HIV through unprotected sex or a torn condom, you should be serious about such symptoms. Even as the symptoms subside, the virus can damage your body and your immune system. An early therapy protects against it. In addition, you could infect other people. Let yourself be tested!

Symptom-free latency phase

After the first symptoms of HIV subsided, the virus infection sometimes remains symptom-free for years. However, the virus is still active and damages the immune system. This silent phase of the infection (called the latency phase) ends with swelling of the lymph nodes all over the body. This condition can last for several months.

HIV stage B: AIDS related complex (ARC)

In stage B, the immune system is weakened to the extent that various diseases occur. Doctors call this “AIDS related complex”. Typical in this phase are:

• long-lasting diarrhea (over four weeks)
• unwanted heavy weight loss
• long-lasting fever
• night sweats
• caused by bacteria lung or meningitis
• bacterial toxemia (sepsis)

• phthisis
• Shingles (herpes zoster)
• oral hairy leukoplakia (whitish changes on the lateral tongue margin)
• pharyngitis caused by fungi
• Vaginal inflammation by fungi, malignant changes in the cervix

Stage C: AIDS

At an advanced stage, HIV infection leads to AIDS. In AIDS patients, the severely weakened immune system can no longer withstand many pathogens.

Opportunistic infections

The patients then contract so-called opportunistic infections. This means the pathogens use the immunodeficiency to multiply. While such infections are rare in humans with a healthy immune system and are well-managed by the immune system, they can be life-threatening in AIDS patients. Doctors refer to them as AIDS-defining diseases:

• Pneumonia caused by the pathogen Pneumocystis jirovecii
• Candida fungal infections of the esophagus and the deep respiratory tract
• Brain inflammation by toxoplasmosis pathogens
• Cytomegalovirus infections in the eye, lung, brain, intestine
• Kaposi’s sarcoma due to herpes 8 viruses (malignant neoplasm of blood vessels that are visible as brown-red patches, colloquially referred to as AIDS patches)
• active tuberculosis
• progressive multifocal leukoencephalopathy due to infection of the nervous system with the JC virus
• Retinal inflammation (retinitis) by the cytomegalovirus

Wasting Syndrome

The AIDS-defining diseases include the so-called Wasting syndrome. It is characterized by:

• a heavy weight loss of about ten percent of body weight in six months
• persistent diarrhea
• fever

HIV-related lymphoma cancer

Other AIDS-defining diseases are malignant lymphomas. This is a cancer of B lymphocytes.

AIDS: treatment

HIV infections are still not curable. However, modern medicines enable many patients to live a largely normal life with average life expectancy. However, this only applies if the disease is detected and treated early. Additional diseases such as hepatitis can complicate the treatment.

HIV & AIDS: medicines

HIV therapy is tailored to each patient individually. In the laboratory, the exact type of HI virus is determined to select the appropriate drugs. The treatment is only successful if the patient takes it for life and regularly.

The medical HIV therapy aims to

• to alleviate the symptoms
• to prevent the transition to a higher stage of disease,
• build a stable immune system again,
• to prevent a damaging, permanent activation of the immune system and
• to reduce the infectiousness, ie the risk of infecting others.

Highly active antiretroviral therapy (HAART)

HIV patients receive a highly active antiretroviral therapy, in short: HAART. It consists of a customized combination of different medications. There are currently more than 20 medicines used for HIV treatment. It is important to combine at least three medicines to prevent resistance to HIV. The following medications are available:

• Reverse transcriptase inhibitors (RTI): They prevent the HI virus from multiplying by inhibiting the necessary enzyme “reverse transcriptase”. Active substance examples: lamivudine, tenofovir, emtricitabine, efavirenz.
• Protease Inhibitors (PI): They prevent virus multiplication by inhibiting the recomposition of virus particles. One of these agents is atazanavir.
• Integrase Inhibitors (INI): They prevent the virus from inserting its genetic information into the human genome of the host cell. Then no new viruses can arise. A representative of INI is Raltegravir.
• Fusion inhibitors (FI): They prevent the virus from infiltrating a human cell. These include, for example, enfuvirtide.

Why HIV is not yet curable

Researchers are constantly updating available medicines to further improve the treatment of HIV. However, the disease is not curable with any of the current active ingredients, as none of them can kill all viruses.

Reasons include the fact that the virus is entrenched in the cells of the patient and that some organs such as the central nervous system for drugs are not easily accessible.

AIDS treatment: criteria for therapy

When and to what extent a HAART is initiated must be decided on a case by case basis for each patient. The decisive factors are, for example, the current symptoms and the possible side effects of HIV treatment.

But there are rough guidelines when a HAART is advisable. This is the case when the HIV patient suffers from category B or C symptoms.

Laboratory criteria are also taken into account in the therapy decision, for example the number of remaining helper T cells (CD4 cells): If their value is below 350 cells per microliter (μl) of blood, often a drug therapy is initiated.

AIDS treatment: checkups

To determine if the HAART is successful, the patient is bled every two to four months. It is examined for the number of HI viruses (viral load) and T helper cells.

At the latest six months after the start of therapy, the viral load should be less than 50 per microliter of blood. If it is higher, it may be necessary to try another combination of drugs.

HIV and AIDS – what you can do yourself

The drug treatment is the basis of AIDS therapy. In addition, as a patient you can do even more for your health:

• Find a doctor who is an AIDS specialist and whom you find sympathetic. You will be treated by him for a long time.
• Follow the instructions of your doctor. Take your medication according to the schedule. If you can not tolerate the preparations, do not just stop them, ask your doctor for advice.
• Be vaccinated against diseases that additionally weaken you or that are more severe because of HIV infection, such as influenza (influenza vaccine) or pneumonia (pneumococcal vaccine).
• Do not smoke and do not take drugs. That would further weaken your body.
• Eat lots of fruits and vegetables as well as whole grains. This will strengthen your immune system. If you have problems with the gastrointestinal tract, talk to a nutritionist.
• Avoid foods that may contain pathogens. These include unpasteurised dairy products, raw eggs, oysters, raw fish and raw meat. Wash raw fruits and vegetables thoroughly before eating!
• Move regularly. Not only does this make your body fitter, it also helps prevent some of the depression that is common in HIV-infected individuals.
• Sleep well enough – this strengthens your immune system.
• Be careful with pets. Always wash your hands after petting animals and wear gloves when cleaning the litter box or rodent shed (to protect against toxoplasmosis).
• Relax regularly. Any type of relaxation like Progressive Muscle Relaxation or Autogenic Training is good for your immune system.
• Wash your hands regularly. This is especially important when preparing or eating meals.
• Find an AIDS counseling center to learn more about living with HIV, help and self-help.

AIDS: examinations and diagnosis

If you are worried that you have been infected with the HI virus, consult your family doctor. He can then refer you to an AIDS specialist, such as an internist with experience in infectious diseases.

anamnese

First, your doctor will ask you in detail about your medical history (anamnesis). He will ask you the following questions:

• Did you have unprotected sex?
• Do you inject drugs?
• Do you have a medical profession?
• Were you in Southeast Asia or sub-Saharan and had physical contact with locals there?
• Have you had flu-like symptoms in the last few weeks?

Subsequently, your doctor will examine you. He pays attention to a possible rash and scans your lymph nodes after enlargement. To confirm an infection with the HI virus, or exclude, you will be taken blood for an HIV test.

HIV test

The HIV test, colloquially also called AIDS test, is a blood test. To be on the safe side, we basically test twice:

Test for antibodies

The first test looks for antibodies against HIV. Antibodies are components of the immune system that have formed in response to the pathogen. They precisely fit protein structures on the surface of the viruses and can thus find them.

This test starts at the earliest three weeks and at the latest three months after the infection. The result is then available within a few days. That is why the procedure is also referred to as an HIV rapid test.

Test for antigens

The second test detects just these antigens of the virus in the patient’s blood. It only works around six weeks after the infection.

How safe is the test?

Only when both tests provide evidence, the test result is therefore “positive”, the diagnosis of HIV infection is made.

A guarantee that you have not infected yourself, but also does not offer a negative test result. Since it can take up to three months to detect antibodies to HIV in the blood, the test provides only safe results for the period of three months.

When can you get tested?

If you fear that you have been infected at a certain time, a test is useful only three weeks after this event. Because at the earliest then antibodies have formed.

HIV test for the home

Since October 2018, you can also perform an HIV test on your own at home. It is just as meaningful as an HIV test at the doctor. If the test result is positive, however, you lack a competent contact person who can advise you in the difficult situation. Then contact your doctor or counseling center as soon as possible.

Further information on this topic can be found in the article HIV test

AIDS: infection and risk factors

The cause of HIV infection and AIDS is the HIV virus. The HI virus belongs to the family of retroviruses. The HI virus consists essentially of genetic information packaged in a protein capsule encased in a membrane. It is about 80 to 100 nanometers in size. Like all viruses, it relies on the cells of organisms to multiply. HI virus host cells are D4 helper cells. It injects hereditary information in the form of a single RNA strand. Before it can be reproduced, it must first be converted to DNA. An enzyme necessary for this, the reverse transcriptase, delivers the virus as well.

HIV – how to get involved?

Only those who know about the transmission pathways of HIV transmission can effectively protect themselves from the AIDS pathogen.

HIV transmission: sex without a condom

In unprotected intercourse, both partners can be infected. In heterosexual relationships the woman is more vulnerable than the man.

In unprotected anal intercourse the risk of HIV / AIDS infection is particularly high for the receiving partner. On the one hand, small injuries can occur in the anal area that allow blood contact. On the other hand, the liquid film on the intestinal mucosa facilitates the uptake of HI viruses. The delivery of HIV from the intestinal mucosa is easy, so that, conversely, the invading partner can also be infected.

Transmission of HIV in oral sex

HI viruses occur mainly in the ejaculate and in the blood. Therefore, if sperm or menstrual blood enters the mouth during oral intercourse, HIV can be transmitted. In the vaginal secretions or pleasure drops of the man one finds the virus only in small quantities.

Accordingly, the risk of transmission of HIV through oral sex is less high if only the pleasure or vaginal secretions enter the mouth. However, experts also recommend safe sex for oral sex: AIDS (or HIV) is not the only sexually transmitted disease that can be transmitted.

HIV infection: Will you stay infectious forever?

Thanks to modern medication, it is possible in many cases to drastically reduce the so-called viral load. If it is below the detectability limit, you can most likely no longer infect others. However, it is necessary to have this checked regularly, because the viral load can change again in the short term. Requirements are

• a treatment that has been successful for more than six months
• medical checks every three months
• no infection with other sexually transmitted infections

AIDS – who is at risk?

Some groups of people are at particular risk of becoming infected with HIV. You should take special care to protect yourself.

• People who have sex with many different people naturally have an increased risk of becoming infected with HIV and AIDS. Particularly at risk are men who are sexually active with men.
• If someone is already suffering from a venereal disease such as chlamydia or syphilis, the risk of becoming infected with HIV is also increased. The reason for this is that immune cells that ingest HIV are more likely to be present in the genital tract for such infections.
• The highest HIV infection risk for people who inject drugs. Using the same drug set as an infected person, the HI virus can be easily transmitted.
• Medical staff: Another risk group is medical staff. Needle injuries or puncture injuries during surgical procedures mean physicians are at increased risk of infection. HIV is transmitted in about one out of 330 medical stab wounds.

blood transfusion

In principle, HIV transmission can also take place via blood transfusions and organ transplants. Since 1985, however, blood products and donor organs in Germany have been tested for HIV. HIV transmission in this way is therefore very unlikely these days. The risk is below 1 to 3 million. Persons who received blood transfusions before 1985, but belong to the HIV risk group.

HIV transmission in pregnancy

If an HIV-positive or AIDS-ill woman becomes pregnant, the child is at risk of HIV transmission. This danger is especially high at birth, as maternal and childish blood can come into direct contact through birth injuries.

The risk, however, is less than one percent if:

• the mother is consistently treated with anti-HIV medicines during pregnancy
• the child is delivered by caesarean section
• the child receives a chemotherapeutic prophylaxis (HIV-PEP) after birth

Without these measures, the infection probability for the child is between 15 and 20 percent.

HIV transmission during breastfeeding

HIV transmission during breastfeeding is possible. HIV-positive mothers in Germany are therefore advised not to breastfeed their children, but to use a vial. In third world countries with poor food supplies, children should still be breastfed. The risk of malnutrition and related diseases and death is rated higher.

Protection against HIV transmission

To protect yourself from HIV transmission, you should minimize these risk factors:

• Use condoms: Always use a condom during intercourse. Safer sex is especially important with a new or unknown partner. So you protect yourself not only against HIV transmission, but also against other venereal diseases such as syphilis.
• Inform the partner: If you are HIV positive, you should inform your partner about it and be sure to use a condom during sex! This reduces the risk of infecting your partner.
• Use prophylaxis: However, a transmission of HIV despite the condom is possible, such as when it tears or slips off. In such cases you should consult a doctor and discuss the need for chemotherapeutic prophylaxis.
• Pre-exposure prophylaxis (PrEP): Certain HIV medications are now also prescribed for prevention. They catch the virus in the blood before they can implant themselves. They are considered about as safe as the use of condoms.
• Protect during oral sex: In order to prevent HIV transmission in oral sex, condoms or dental dams should be used.
• Use your own drug kit: If you consume drugs, you should always use your own, sterile drug kit! Not only does this reduce the risk of AIDS transmission, but it also reduces the risk of hepatitis C. So do not borrow drug kits from acquaintances.
• Wear gloves in the medical industry: If you work in the medical field, you should always wear gloves when handling infectious material. Goggles, face shields and disinfectants also reduce HIV infection risk.

When should one not be afraid of HIV infection?

Overall, in everyday, normal – not sexual – dealing with relatives, friends or colleagues who are HIV-positive or ill with AIDS, an HIV transmission is almost impossible.

• It is not possible to transmit HIV by kissing.
• Even when shaking hands and hugging is not HIV–Transmission.
• Nor can HIV / AIDS be shared by sharing swimming pools, toilets, towels or bedding.
• Even contact with sweat or tears of an infected person does not lead to HIV / AIDS transmission.
• Even insect bites can not be infected, even if the insect in question has previously sucked on an infected blood.

Prevent HIV

Post-exposure prophylaxis (PEP)

If you are worried that you have been infected with the HI virus, seek medical advice immediately and discuss the possibility or need for PEP and its potential side effects. Even medical personnel who have been stinging or having contact with blood in the care of HIV-infected and AIDS patients can take PEP.

You will then receive HIV medication for four weeks to reduce the likelihood of infection. Often, a triple combination of the drugs raltegravir, tenofovir and emtricitabine is prescribed. However, other combinations can also be used.

Narrow time window:The PEP should be started within 24 hours of the possible infection, preferably within two hours. You will be tested for HIV at the time you first take the medication and after six weeks, three months and six months.

Pre-exposure prophylaxis (PrEP)

HIV-negative persons who are at high risk of becoming infected can prevent so-called pre-exposure prophylaxis. Patients are taking a drug that is also used to treat HIV and contains the active substances emtricitabine and tenofovir disoproxil fumarate.

The efficacy is proven in homosexual men with risky sex life and similar to the use of condoms. However, the drug does not protect against other sexually transmitted diseases.

The prophylaxis is usually well tolerated, but can damage the kidneys. Users need to have their kidney function checked regularly and have an HIV test done every three months to prevent infection.

The drugs are available since October 2017 on private prescription for around 50 euros per 28 tablets in participating pharmacies.

AIDS: disease course and prognosis

The course of HIV is divided into different stages:

• Acute infection: From the sixth day after the infection up to six weeks as a feverish infection
• Inconspicuous persistence: For years, the infection can remain asymptomatic.
• Lymphadenopathy: Swollen lymph nodes lasting several months.
• AIDS related complex (ARC): Patients suffer from diseases that are due to a weakened immune system.
• AIDS: AIDS-defining diseases such as pneumonia or tuberculosis occur (sometimes only decades after infection with HIV).

The individual stages of HIV can be very diverse individually. In all patients, however, it comes to the weakening and destruction of the cellular immune system.

AIDS prognosis

With the current treatment options, the life expectancy of HIV-positive people in Germany is about the same as that of healthy people. However, this only applies to younger people who are otherwise healthy and begin therapy around the age of 25.

Life expectancy in HIV and AIDS

Patients with other conditions such as hepatitis B or C, the elderly or drug addicts have a limited life expectancy. In other countries with poorer health care, the survival of people with AIDS is significantly reduced.

HIV vaccine

Although intensive research is being carried out, there is no HIV vaccine yet. The most important safeguard against HIV and AIDS is therefore to avoid infection.

Additional information

guidelines:

• Guideline “antiretroviral therapy of HIV infection” of the German AIDS Society (2014)
• Guideline “HIV therapy in pregnancy and in HIV-exposed newborns” of the German AIDS Society (017)
• Guideline “Post-exposure prophylaxis of HIV infection” of the German AIDS Society (2013)

Support Groups:

• German AIDS help