Causes

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HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding.

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Source: Mayo Clinic

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How does HIV become AIDS?

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HIV destroys CD4 T cells — white blood cells that play a large role in helping your body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes.

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You can have an HIV infection, with few or no symptoms, for years before it turns into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication, such as a serious infection or cancer.

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Source: Mayo Clinic

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How is HIV/AIDS transmitted?

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To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways:

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• Sexual contact.  HIV is spread most commonly by sexual contact with an infected partner. The virus enters the body through the lining of the vagina, vulva, penis, rectum, or mouth during sexual activity.

• Blood contamination.  HIV may also be spread through contact with infected blood. However, due to the screening of blood for evidence of HIV infection in the U.S., the risk of acquiring HIV from blood transfusions is extremely low.

• Needles.  HIV is often spread by sharing needles, syringes, or drug use equipment with someone who is infected with the virus. Transmission from patient to healthcare worker, or vice-versa through accidental sticks with contaminated needles or other medical instruments, is rare.

• Mother-infant.  HIV also can be spread to babies born to, or breastfed by, mothers infected with the virus.

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Source: John Hopkins Medicine

Source:  Mayo Clinic

How HIV doesn't spread

You can't become infected with HIV through ordinary contact. That means you can't catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection.

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HIV isn't spread through:

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• Saliva

• Sweat

• Tears

• Casual contact, such as sharing food utensils, towels, and bedding

• Swimming pools

• Telephones

• Toilet seats

• Biting insects (such as mosquitoes)

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Source: John Hopkins Medicine

Source:  Mayo Clinic

 

 

Symptoms

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The symptoms of HIV and AIDS vary, depending on the phase of infection.

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Source: Mayo Clinic

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1. Primary infection (Acute HIV)

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Some people infected by HIV develop a flu-like illness within two to four weeks after the virus enters the body. This illness, known as primary (acute) HIV infection, may last for a few weeks. Possible signs and symptoms include:

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• Fever

• Headache

• Muscle aches and joint pain

• Rash

• Sore throat and painful mouth sores

• Swollen lymph glands, mainly on the neck

• Diarrhea

• Weight loss

• Cough

• Night sweats

 

These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.

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Source: Mayo Clinic

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2. Clinical latent infection (Chronic HIV)

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In this stage of infection, HIV is still present in the body and in white blood cells. However, many people may not have any symptoms or infections during this time.

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This stage can last for many years if you're not receiving antiretroviral therapy (ART). Some people develop more severe disease much sooner.

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Source: Mayo Clinic

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3. Symptomatic HIV infection

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As the virus continues to multiply and destroy your immune cells — the cells in your body that help fight off germs — you may develop mild infections or chronic signs and symptoms such as:

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• Fever

• Fatigue

• Swollen lymph nodes — often one of the first signs of HIV infection

• Diarrhea

• Weight loss

• Oral yeast infection (thrush)

• Shingles (herpes zoster)

• Pneumonia

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Source: Mayo Clinic

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4. Progression to AIDS

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Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 8 to 10 years.

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When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually cause illness in a person with a healthy immune system.

 

The signs and symptoms of some of these infections may include:

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• Sweats

• Chills

• Recurring fever

• Chronic diarrhea

• Swollen lymph glands

• Persistent white spots or unusual lesions on your tongue or in your mouth

• Persistent, unexplained fatigue

• Weakness

• Weight loss

• Skin rashes or bumps

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Source: Mayo Clinic

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Risk factors

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Anyone of any age, race, sex or sexual orientation can be infected with HIV/AIDS. However, you're at greatest risk of HIV/AIDS if you:

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• Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners.

• Have an STI.  Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body.

• Use IV drugs.  People who use IV drugs often share needles and syringes. This exposes them to droplets of other people's blood.

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Source: Mayo Clinic

 

 

Complications

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HIV infection weakens your immune system, making you much more likely to develop many infections and certain types of cancers.

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Source: Mayo Clinic

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Infections Common to HIV/AIDS

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• Pneumocystis pneumonia (PCP). This fungal infection can cause severe illness. Although it's declined significantly with current treatments for HIV/AIDS, in the U.S. PCP is still the most common cause of pneumonia in people infected with HIV.

• Candidiasis (thrush).  Candidiasis is a common HIV-related infection. It causes inflammation and a thick, white coating on your mouth, tongue, esophagus or vagina.

• Tuberculosis (TB).   In resource-limited nations, TB is the most common opportunistic infection associated with HIV. It's a leading cause of death among people with AIDS.

• Cytomegalovirus.  This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other organs.

• Cryptococcal meningitis.  Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus found in soil.

• Toxoplasmosis.  This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, which may then spread to other animals and humans. Toxoplasmosis can cause heart disease, and seizures occur when it spreads to the brain.

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Source: Mayo Clinic

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Cancers Common to HIV/AIDS

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• Lymphoma. This cancer starts in the white blood cells. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.

• Kaposi's sarcoma.  A tumor of the blood vessel walls, Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs.

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Source: Mayo Clinic

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Other Complications

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• Wasting syndrome.  Untreated HIV/AIDS can cause significant weight loss, often accompanied by diarrhea, chronic weakness and fever.

• Neurological complications.  HIV can cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. HIV-associated neurocognitive disorders (HAND) can range from mild symptoms of behavioral changes and reduced mental functioning to severe dementia causing weakness and inability to function.

• Kidney disease.  HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. It most often affects black or Hispanic people.

• Liver disease.  Liver disease is also a major complication, especially in people who also have hepatitis B or hepatitis C.

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Source: Mayo Clinic

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Prevention

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There's no vaccine to prevent HIV infection and no cure for AIDS. But you can protect yourself and others from infection.

To help prevent the spread of HIV:

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• Use treatment as prevention (TasP).  If you're living with HIV, taking HIV medication can keep your partner from becoming infected with the virus. If you make sure your viral load stays undetectable — a blood test doesn't show any virus — you won't transmit the virus to anyone else. Using TasP means taking your medication exactly as prescribed and getting regular checkups.

• Use post-exposure prophylaxis (PEP) if you've been exposed to HIV.  If you think you've been exposed through sex, needles or in the workplace, contact your doctor or go to the emergency department. Taking PEP as soon as possible within the first 72 hours can greatly reduce your risk of becoming infected with HIV. You will need to take medication for 28 days.

• Use a new condom every time you have sex.  Use a new condom every time you have anal or vaginal sex. Women can use a female condom. If using a lubricant, make sure it's water-based. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a nonlubricated, cut-open condom or a dental dam — a piece of medical-grade latex.

• Consider preexposure prophylaxis (PrEP).  The combination drugs emtricitabine plus tenofovir (Truvada) and emtricitabine plus tenofovir alafenamide (Descovy) can reduce the risk of sexually transmitted HIV infection in people at very high risk. PrEP can reduce your risk of getting HIV from sex by more than 90% and from injection drug use by more than 70%, according to the Centers for Disease Control and Prevention. Descovy hasn't been studied in people who have receptive vaginal sex.

 

Your doctor will prescribe these drugs for HIV prevention only if you don't already have HIV infection. You will need an HIV test before you start taking PrEP and then every three months as long as you're taking it. Your doctor will also test your kidney function before prescribing Truvada and continue to test it every six months.

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• You need to take the drugs every day.  They don't prevent other STIs, so you'll still need to practice safe sex. If you have hepatitis B, you should be evaluated by an infectious disease or liver specialist before beginning therapy.

• Tell your sexual partners if you have HIV.  It's important to tell all your current and past sexual partners that you're HIV-positive. They'll need to be tested.

• Use a clean needle.  If you use a needle to inject drugs, make sure it's sterile and don't share it. Take advantage of needle-exchange programs in your community. Consider seeking help for your drug use.

• If you're pregnant, get medical care right away.  If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can significantly cut your baby's risk.

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Source: Mayo Clinic

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How is HIV/AIDS Diagnosed?

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Early HIV infection often causes no symptoms, and must be detected by testing a person's blood for the presence of antibodies—disease-fighting proteins—against HIV. These HIV antibodies generally do not reach levels high enough to detect by standard blood tests until 1 to 3 months following infection, and may take as long as 6 months. People exposed to HIV should be tested for HIV infection as soon as they think they may have been exposed to HIV.

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When a person is highly likely to be infected with HIV and yet antibody tests are negative, a test for the presence of HIV itself in the blood is used. Repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed, is often recommended.

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HIV can be diagnosed through blood or saliva testing.  Available tests include:

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• Antigen/antibody tests. These tests usually involve drawing blood from a vein. Antigens are substances on the HIV virus itself and are usually detectable — a positive test — in the blood within a few weeks after exposure to HIV.

  Antibodies are produced by your immune system when it's exposed to HIV. It can take weeks to months for antibodies to become detectable. The combination antigen/antibody tests can take two to six weeks after exposure to become positive.

• Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most rapid HIV tests, including self-tests done at home, are antibody tests. Antibody tests can take three to 12 weeks after you're exposed to become positive.

• Nucleic acid tests (NATs). These tests look for the actual virus in your blood (viral load). They also involve blood drawn from a vein. If you might have been exposed to HIV within the past few weeks, your doctor may recommend NAT. NAT will be the first test to become positive after exposure to HIV.

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Talk to your doctor about which HIV test is right for you. If any of these tests are negative, you may still need a follow-up test weeks to months later to confirm the results.

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Source: John Hopkins Medicine

Source: Mayo Clinic

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Treatment for HIV/AIDS

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As with many other conditions, early detection offers more choices for treatment. Today, there are medical treatments that not only can slow down the rate at which HIV weakens the immune system, but also may keep HIV in check so that the individual has a chance to live a normal life span.

 

Currently, there's no cure for HIV/AIDS. Once you have the infection, your body can't get rid of it. However, there are many medications that can control HIV and prevent complications. These medications are called antiretroviral therapy (ART). Everyone diagnosed with HIV should be started on ART, regardless of their stage of infection or complications.

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ART is usually a combination of three or more medications from several different drug classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that combine three HIV medications into one pill, taken once daily.

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Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from different classes to:

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• Account for individual drug resistance (viral genotype)

• Avoid creating new drug-resistant strains of HIV

• Maximize suppression of virus in the blood

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Two drugs from one class, plus a third drug from a second class, are typically used.

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The classes of anti-HIV drugs include:

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• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant) and doravirine (Pifeltro).

• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen), tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).

• Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).

• Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy), raltegravir (Isentress) and dolutegravir (Tivicay).

• Entry or fusion inhibitors block HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

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Source: John Hopkins Medicine

Source: Mayo Clinic

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Starting and Maintaining Treatment

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Everyone with HIV infection, regardless of the CD4 T cell count or symptoms, should be offered antiviral medication.

Remaining on effective ART with an undetectable HIV viral load in the blood is the best way for you to stay healthy.

For ART to be effective, it's important that you take the medications as prescribed, without missing or skipping any doses.

 

Staying on ART with an undetectable viral load helps:

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• Keep your immune system strong

• Reduce your chances of getting an infection

• Reduce your chances of developing treatment-resistant HIV

• Reduce your chances of transmitting HIV to other people

 

Staying on HIV therapy can be challenging. It's important to talk to your doctor about possible side effects, difficulty taking medications, and any mental health or substance use issues that may make it difficult for you to maintain ART.

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Having regular follow-up appointments with your doctor to monitor your health and response to treatment is also important. Let your doctor know right away if you're having problems with HIV therapy so that you can work together to find ways to address those challenges.

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Source: Mayo Clinic

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Treatment Side Effects

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Treatment side effects can include:

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• Nausea, vomiting or diarrhea

• Heart disease

• Kidney and liver damage

• Weakened bones or bone loss

• Abnormal cholesterol levels

• Higher blood sugar

• Cognitive and emotional problems, as well as sleep problems

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Source: Mayo Clinic

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Treatment for Age-Related Diseases

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Some health issues that are a natural part of aging may be more difficult to manage if you have HIV.

 

Some medications that are common for age-related heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It's important to talk to your doctor about your other health conditions and the medications you're taking.

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If you are started on medications by another doctor, it's important to let him or her know about your HIV therapy. This will allow the doctor to make sure there are no interactions between the medications.

Treatment response

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Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. These will be initially checked at two and four weeks, and then every three to six months.

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Treatment should lower your viral load so that it's undetectable in the blood. That doesn't mean your HIV is gone. Even if it can't be found in the blood, HIV is still present in other places in your body, such as in lymph nodes and internal organs.

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Source: Mayo Clinic

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Lifestyle and home Remedies

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Along with receiving medical treatment, it's essential to take an active role in your own care. The following suggestions may help you stay healthy longer:

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• Eat healthy foods.  Make sure you get enough nourishment. Fresh fruits and vegetables, whole grains, and lean protein help keep you strong, give you more energy and support your immune system.

• Avoid raw meat, eggs and more.  Food borne illnesses can be especially severe in people who are infected with HIV. Cook meat until it's well done. Avoid unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi.

• Get the right vaccinations.  These may prevent typical infections such as pneumonia and influenza. Your doctor may also recommend other vaccinations, including for HPV, hepatitis A and hepatitis B. Inactivated vaccines are generally safe, but most vaccines with live viruses are not, due to your weakened immune system.

• Take care with companion animals.  Some animals may carry parasites that can cause infections in people who are HIV-positive. Cat feces can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry cryptococcus or histoplasmosis. Wash hands thoroughly after handling pets or emptying the litter box.

 

Source: Mayo Clinic

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Alternative Medicine

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People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or counteract side effects of anti-HIV drugs.

 

However, there is no scientific evidence that any nutritional supplement improves immunity, and many may interfere with other medications you're taking.

 

Always check with your doctor before taking any supplements or alternative therapies to ensure there are no medication interactions.

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Source: Mayo Clinic

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Supplements that may be Helpful

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• Acetyl-L-carnitine.  Researchers have used acetyl-L-carnitine to treat nerve pain, numbness or weakness (neuropathy) in people with diabetes. It may also ease neuropathy linked to HIV if you're lacking in the substance.

• Whey protein and certain amino acids.  Early evidence suggests that whey protein, a cheese byproduct, can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase CD4 T cell counts. The amino acids L-glutamine, L-arginine and hydroxymethylbutyrate (HMB) may also help with weight gain.

• Probiotics.  There is some evidence that the probiotic Saccharomyces boulardii may help with HIV-related diarrhea, but use only as directed by your doctor. Bovine colostrum is also being studied for treating diarrhea.

• Vitamins and minerals.  Vitamins A, D, E, C and B — as well as the minerals zinc, iron and selenium — may be helpful if you have low levels of them.

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Source: Mayo Clinic

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Supplements that may be Dangerous

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• St. John's wort. A common depression remedy, St. John's wort can reduce the effectiveness of several types of anti-HIV drugs by more than half.

• Garlic supplements. Although garlic itself may help strengthen the immune system, garlic supplements may interact with some anti-HIV drugs and reduce their ability to work. Occasionally eating garlic in food appears to be safe.

• Red yeast rice extract. Some people use this to lower cholesterol, but avoid it if you take a protease inhibitor or a statin.

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Source: Mayo Clinic

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Mind-body Practices

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Practices such as yoga, meditation and tai chi have been shown to reduce stress, as well as improve blood pressure and quality of life. While they need more study, these practices may be helpful if you're living with HIV/AIDS.

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Source: Mayo Clinic

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Coping and Support

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Receiving a diagnosis of any life-threatening illness is devastating. The emotional, social and financial consequences of HIV/AIDS can make coping with this illness especially difficult — not only for you but also for those closest to you.

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But today, there are many services and resources available to people with HIV. Most HIV/AIDS clinics have social workers, counselors or nurses who can help you directly or put you in touch with people who can.

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Services they may provide:

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• Arrange transportation to and from doctor appointments

• Help with housing and child care

• Assist with employment and legal issues

• Provide support during financial emergencies

 

It's important to have a support system. Many people with HIV/AIDS find that talking to someone who understands their disease provides comfort.

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Source: Mayo Clinic

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AIDS/HIV and a Gluten Free Diet

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A gluten-free diet is recommended for people with celiac disease, gluten-sensitivity or the skin disorder Dermatitis Herpetiformis. A gluten-free diet may be helpful for some people with irritable bowel syndrome, the neurological disorder gluten ataxia, type 1 diabetes and HIV-associated enteropathy.

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Beyond this, there's little evidence that a gluten-free diet offers any particular health benefits. However, a gluten-free diet can still be a healthy way to eat depending on which gluten-free foods you choose, how often you eat them and whether your other food choices are healthy ones.

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Good gluten-free choices include naturally gluten-free foods, such as lean meats, low-fat dairy, vegetables, fruit, whole gluten-free grains and healthy fats.

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It's important not to replace gluten-containing foods with more red meat, full-fat dairy, starchy vegetables, sweets and fats, which can lead to a higher intake of cholesterol, saturated fat, sodium and unwanted calories.

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It's also prudent to limit commercially prepared gluten-free snacks and bakery products, which are typically high in refined carbohydrate, fat, sugar and salt — just like their gluten-containing counterparts.

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Studies suggest that the nutritional quality of commercially prepared gluten-free products varies from similar gluten-containing products. In several countries, for example, commercially prepared gluten-free foods are lower in protein than their conventional counterparts.

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In the U.S., gluten-free foods tend to be lower in folate, thiamin, riboflavin and niacin. This may be because in this country most wheat products are enriched with folic acid, thiamin, riboflavin, niacin and iron, while gluten-free flours, cereals and bread products typically are not.

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However, gluten-free whole grains, such as amaranth, quinoa, buckwheat, teff, millet, corn and rice, are good natural sources of folate, thiamin, riboflavin, niacin and iron — as well as protein and fiber.

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Source: Jennifer K. Nelson, R.D,.  L.D., Mayo Clinic

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