Understanding HIV and AIDS

Acquired Immunodeficiency Syndrome (AIDS) is a disease of the human immune system caused by the Human Immunodeficiency Virus (HIV). During early infection, a person may experience brief flu-like symptoms, followed by a long symptom-free phase. As the disease progresses, the immune system becomes severely weakened, making the person vulnerable to opportunistic infections and cancers. AIDS is a major global health problem, affecting millions, including children.

HIV attacks CD4 T cells, which are vital for immune defense. Common bacteria, fungi, parasites, and viruses that do not cause serious disease in healthy individuals can become life-threatening in people with AIDS. HIV is present in saliva, tears, blood, semen, vaginal fluids, spinal fluid, and breast milk. However, infection is transmitted only through blood, semen, vaginal secretions and breast milk.

Modes of Transmission

HIV spreads through:

Unprotected sexual contact (oral, vaginal, anal)

Blood exposure (needle sharing in IV drug abusers, unscreened transfusions—now rare)

Mother to child during pregnancy, delivery, or breastfeeding

Rare methods include accidental needle injuries, infected semen during artificial insemination, and infected organ transplantation.

HIV is NOT spread by hugging, mosquitoes, sports participation, or touching objects used by infected individuals.

Blood and Organ Donation

HIV is not transmitted to donors during donation. However, recipients may be infected if the donated blood or organ is contaminated. To prevent this, strict screening is mandatory.

High-Risk Groups

People at highest risk include:

Injection drug users sharing needles

Sexually active individuals practicing unprotected sex

Infants born to untreated HIV-positive mothers

Individuals who received blood transfusions before 1985

Sexual partners of high-risk individuals

Signs and Symptoms

Common warning signs include:

Unexplained weight loss

Chronic diarrhea (over one month)

Persistent fever

Mouth ulcers

Genital burning

Loss of appetite

Weakness and night sweats

Swollen lymph nodes

Tuberculosis not responding to treatment

Social Factors Contributing to Spread: Migration, Industrialization, Poverty, Social and economic instability

Pathogenesis

After entering the body, HIV multiplies rapidly, causing a sharp decline in CD4 T cells. The immune system initially responds by activating CD8 T cells and producing antibodies. However, the virus is not eliminated. Over time, continuous HIV replication causes chronic immune activation and gradual CD4 T cell depletion, leading to AIDS. Mucosal immune cells, especially in the gut, are affected early due to the CCR5 receptor used by HIV for cell entry.

Prevention

Avoid illicit drug use and needle sharing

Use sterile needles and participate in needle-exchange programs

Practice safe sex with consistent condom use

Avoid contact with infected blood

HIV-positive individuals must not donate blood or organs

HIV-positive pregnant women should take preventive medications to protect the baby

Breastfeeding should be avoided by HIV-infected mothers where safe alternatives exist

Abstinence is the only 100% effective prevention method

Treatment

There is no cure for AIDS, but treatment significantly improves survival and quality of life. Highly Active Antiretroviral Therapy (HAART) suppresses viral replication, increases CD4 counts, and lowers viral load. Strict adherence is essential because irregular intake leads to drug resistance. Genetic resistance testing helps guide therapy.

Side effects of HAART may include fat redistribution, diarrhea, nausea, weakness, headache, and increased cardiac risk due to raised cholesterol and sugar. Regular monitoring of CD4 count and viral load every three months is required.

Medications are also used to prevent opportunistic infections when immunity is low. Growth factors such as erythropoietin and filgrastim help manage anemia and low white blood cell counts.

HIV/AIDS is diagnosed using: Total Leukocyte Count (TLC), Tri-Dot test, Card tests, ELISA, Western Blot, PCR, Detection of viral proteins (p24, gp120, p20)

Aejaz Iqbal is a Microbiologist from Nadihal Bandipora