HIV and AIDS

When one first becomes infected with HIV, it is known as primary infection. Some people develop symptoms at this time such as sore throat, fever, rash, lethargy and headache; these symptoms can last up to 3 weeks. Because these symptoms are non-specific and similar to other viral infections (including respiratory viral infections), the diagnosis of primary HIV infection is often missed. 

After primary infection settles, one can remain without any symptoms for several years (up to 10 years in some cases). Although these HIV infected individuals remain asymptomatic, HIV continues to multiply in their body and the number of CD4 cells falls progressively. During this period, infected individuals do not realise that they are infected, and can continue to pass on the virus to others through sexual transmission or when others come into contact with their blood.

In time, as the body immune system continue to weaken, problems start to develop. These can include but are not limited to the following symptoms such as repeated mouth ulcers, shingles, profound weight loss, fever, non resolving diarrhoea, prolonged cough, breathlessness and general feeling of being unwell. Such symptoms are often associated with opportunitic infections or AIDS defining malignancies. 

Patients with advanced HIV / AIDS can develop opportunistic infections. Some of the more common opportunistic infections include but are not limited to the following conditions such as Pneumocystis jiroveci pneumonia, Cryptococcosis, oesophageal candidiasis, viral infections (e.g. Cytomegalovirus, Herpes simplex virus (HSV), Varicella-zoster virus (VZV), JC virus),    Toxoplasma gondii encephalitis, tuberculous and non-tuberculous mycobacterial infections, invasive bacterial infections (e.g. Salmonellosis, recurrent Streptococcus pneumoniae pnuemonia) as well as parasitic infections (e.g. chronic microsporidiosis, cryptosporidiosis and isosporiasis). Apart from infections, certain cancers such as cervical cancer, lymphoma and Kaposi Sarcoma can also develop in patients with advanced HIV / AIDS.

Prevention is better than treatment. 

Safe and protected sexual practices (e.g. use of condoms, limit your number of sexual partners) is recommended. For persons with multiple sexual partners, we recommend getting tested and treated for other sexually transmitted disease to reduce the risk of HIV transmission as well. In individuals who are at high risk for acquiring HIV, pre-exposure prophylaxis with a medication, tenofovir disoproxil fumarate-emtricitabine, is sometimes offered, but this should be discussed with your healthcare provider and close follow-up is required. 

Injection drug use is not recommended. For persons who practice injection drug use, safe injection practice is advised, (e.g. do not share needles). 

HIV infected women should be on HIV medications to reduce the risk of passing HIV to their babies. 

Following exposure to someone with HIV (either through needlestick injury in the healthcare setting or through sexual contact), post exposure prophylaxis is offered in high risk cases within up to 72 hours of exposure. Again, you should be reviewed by your healthcare provider to discuss this. 

To become infected with HIV, some infected blood, semen, vaginal secretions, or other body fluids would have to get into your body. Some common modes of transmission include:

One cannot get HIV from ordinary contact with another person with HIV, such as hugging, shaking hands, sharing food and utensils.

The diagnosis of HIV is confirmed by blood test (which is a HIV antibody/antigen immunoassay). 

If diagnosed with HIV, another blood test (CD4 assay) to evaluate the immune function is also performed. 

Although there is still no cure for HIV, a combination of oral medications, also known as highly active anti-retroviral therapy (HAART), is available to control the infection. There has been an expansion of HIV medications over the last 20 years. Current available treatment is relatively tolerable, effective and allows individuals with HIV to live their lives as normally as possible. 

The use of HAART reduces and eventually suppresses HIV replication with some recovery of the immune system. When HAART is discontinued, HIV viral load rebounds and immune function is depressed. Lifelong ART is currently recommended for HIV suppression.

Selection of ART is often individualized and should be discussed with the infectious diseases specialist. Once started on ART, it is very important that one remains compliant and takes ALL of the prescribed medications in a timely manner. Stopping ART altogether results in HIV replication and depression of immune function as discussed above. Occasional missed doses of ART or taking half doses of ART promotes the development of treatment resistant HIV which is not ideal.