HIV/AIDS

HIV is caused by the transmission of the human immunodeficiency virus through specific bodily fluids: blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. The virus must come into contact with a mucous membrane (found in the rectum, vagina, penis, or mouth), damaged tissue, or be directly injected into the bloodstream for infection to occur. Research published in The Lancet (2023) emphasizes that HIV cannot be transmitted through casual contact such as hugging, shaking hands, or sharing toilets.

Non-Modifiable Risk Factors

• Biological Sex: Some physiological factors may increase the susceptibility of mucous membranes to viral entry.
• Genetics: Certain genetic markers, such as the CCR5-delta 32 mutation, can influence how the virus enters cells, though this is rare.
• Age: Younger populations (adolescents) and older adults may have different risk profiles based on biological and social factors.

Modifiable Risk Factors

• Unprotected Sexual Activity: Engaging in vaginal or anal intercourse without consistent use of barrier methods (condoms).
• Sharing Needles: Using contaminated syringes or drug injection equipment.
• Presence of Other STIs: Infections like syphilis or herpes cause sores that provide an entry point for HIV.
• Substance Use: Alcohol and drug use can impair judgment, leading to higher-risk sexual behaviors.

According to the CDC (2024), certain populations are disproportionately affected due to systemic inequities. This includes men who have sex with men (MSM), transgender individuals, and Black/African American and Hispanic/Latino communities. These disparities are often linked to lack of access to healthcare, poverty, and social stigma rather than biological predisposition.

Prevention is highly effective through evidence-based strategies:

• PrEP (Pre-Exposure Prophylaxis): A daily medication or long-acting injection for people at high risk to prevent infection.
• PEP (Post-Exposure Prophylaxis): Emergency medication taken within 72 hours of a potential exposure.
• Treatment as Prevention (TasP): Maintaining an undetectable viral load to prevent transmission to partners.
• Harm Reduction: Using sterile needles and participating in syringe service programs.
• Regular Screening: The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care.

The diagnostic journey typically begins with a screening test following a potential exposure or as part of routine medical care. Because the virus has a 'window period' (the time between exposure and when a test can detect the virus), a single negative test shortly after exposure may need to be repeated.

A healthcare provider will perform a thorough physical exam, looking for swollen lymph nodes, skin lesions (like Kaposi's sarcoma), or signs of oral thrush (white patches in the mouth). They will also review the patient's medical history and potential risk factors.

• Antigen/Antibody Tests: These are the most common tests, usually performed on blood from a vein. They look for both HIV antibodies (produced by the immune system) and p24 antigens (part of the virus itself).
• Antibody Tests: Rapid tests often use oral fluid or finger-prick blood. These only look for antibodies and may take longer to show a positive result after exposure.
• Nucleic Acid Tests (NAT): These look for the actual virus in the blood. They are expensive and usually reserved for high-risk exposures or when early symptoms are present, as they can detect HIV sooner than other tests.
• CD4 Count: Once diagnosed, this test measures the number of CD4 cells to determine the health of the immune system.
• Viral Load (HIV RNA): Measures the amount of HIV in the blood to monitor the effectiveness of treatment.

According to the CDC surveillance case definition, a diagnosis of HIV requires laboratory evidence of HIV infection. A diagnosis of AIDS (Stage 3) is confirmed if an HIV-positive individual has a CD4 count of less than 200 cells/mm3 or is diagnosed with one of the 27 AIDS-defining opportunistic infections, such as Pneumocystis jirovecii pneumonia or esophageal candidiasis.

Symptoms of acute HIV can mimic several other conditions, which doctors must rule out:

• Infectious Mononucleosis (EBV): Presents with similar fever and lymphadenopathy.
• Influenza: Shares the systemic aches and respiratory symptoms.
• Secondary Syphilis: Can cause a similar skin rash and malaise.
• Viral Hepatitis: May cause similar fatigue and systemic symptoms.

The primary goal of HIV treatment is to reduce the viral load to an 'undetectable' level (typically fewer than 50 copies of HIV RNA per milliliter of blood). Achieving this preserves immune function, prevents progression to AIDS, and eliminates the risk of sexual transmission to others. Talk to your healthcare provider about which approach is right for you.

According to the Department of Health and Human Services (HHS, 2024) guidelines, the standard of care is Antiretroviral Therapy (ART). ART involves taking a combination of HIV medicines daily. Most people starting ART today take a single-pill regimen that combines three different medications from at least two different drug classes.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

• Mechanism: These act as faulty building blocks that the virus tries to use to replicate its DNA, effectively stopping the process.
• Side Effects: Nausea, headache, or long-term changes in bone density.

Integrase Strand Transfer Inhibitors (INSTIs)

• Mechanism: These block integrase, an enzyme HIV uses to insert its viral DNA into the DNA of the host CD4 cell.
• When Preferred: Often the preferred first-line choice due to high efficacy and few side effects.

Protease Inhibitors (PIs)

• Mechanism: These block protease, an enzyme HIV needs to break up large polyproteins into smaller pieces to create new mature virus particles.
• Side Effects: Metabolic changes, such as increased cholesterol or blood sugar.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Mechanism: These bind directly to the reverse transcriptase enzyme to prevent it from converting HIV RNA into DNA.

If a patient develops drug resistance or experiences severe side effects, healthcare providers may switch to second-line regimens. These may include 'boosted' regimens using agents that increase the concentration of other HIV medications in the blood, or newer classes like Entry Inhibitors or Capsid Inhibitors for multi-drug resistant HIV.

While medication is the only way to control the virus, supportive care is vital. This includes mental health counseling, nutritional support, and treatment for co-occurring conditions like Hepatitis C or tuberculosis. Surgery may be required for specific complications, such as the removal of certain tumors or abscesses.

ART is a lifelong commitment. Monitoring involves regular blood tests (every 3–6 months) to check viral load and CD4 counts. Adherence—taking medication exactly as prescribed—is the most critical factor in preventing drug resistance and treatment failure.

In pregnancy, ART is essential to prevent mother-to-child transmission; with proper treatment, the risk can be reduced to less than 1%. For the elderly, clinicians must carefully manage drug-drug interactions with medications for age-related conditions like hypertension or diabetes.

Maintaining a healthy weight and supporting the immune system through nutrition is vital. A 2023 study in the Journal of Nutrition suggests that a Mediterranean-style diet—rich in fruits, vegetables, lean proteins, and healthy fats—can help manage the chronic inflammation associated with HIV. Patients should focus on food safety (avoiding raw meats or unpasteurized dairy) to prevent foodborne illnesses, as their immune systems may be more sensitive.

Regular physical activity helps combat ART side effects like weight gain and bone density loss. The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity per week. Resistance training (weight lifting) is particularly beneficial for preventing muscle wasting and improving metabolic health.

Chronic HIV infection can interfere with sleep patterns. Practicing good sleep hygiene—maintaining a consistent schedule, limiting caffeine, and creating a dark, cool environment—is essential for immune recovery and mental clarity.

Living with a chronic illness requires robust coping mechanisms. Evidence-based techniques such as Mindfulness-Based Stress Reduction (MBSR), cognitive-behavioral therapy (CBT), and support groups have been shown to reduce cortisol levels and improve medication adherence.

While no supplement can replace ART, some patients find relief through complementary therapies:

• Yoga and Acupuncture: May help manage chronic pain or neuropathy (nerve damage).
• Supplements: Vitamin D and Calcium are often recommended for bone health, but patients must consult their doctor first, as some supplements (like St. John’s Wort) can dangerously interact with HIV medications.

Caregivers should focus on encouraging medication adherence without being 'policing.' Providing emotional support, assisting with transportation to medical appointments, and educating oneself about U=U can significantly reduce the patient's stress and the stigma they may feel.

The prognosis for HIV has been transformed by modern medicine. According to the NIH (2024), an individual diagnosed with HIV today who starts treatment early and adheres to ART can expect to live a near-normal lifespan, similar to someone without HIV. Early diagnosis is the single most important factor in a positive long-term outlook.

If HIV is not managed, it can lead to several complications:

• Opportunistic Infections: Such as Tuberculosis, Cryptococcal meningitis, or Toxoplasmosis.
• Cancers: Including Kaposi’s sarcoma and Non-Hodgkin lymphoma.
• Neurological Complications: HIV-associated neurocognitive disorders (HAND) or peripheral neuropathy.
• Cardiovascular Disease: Chronic inflammation can increase the risk of heart attacks and strokes.

Long-term management focuses on 'aging well' with HIV. This includes screening for comorbidities that may appear earlier in HIV-positive individuals, such as kidney disease, liver disease, and osteoporosis. Annual screenings for mental health and substance use are also standard components of comprehensive care.

Living well involves more than just a low viral load. It includes maintaining social connections, staying informed about new treatment options (like long-acting injectables), and advocating for one's health needs. Many patients find empowerment through advocacy and peer support networks.

Contact your healthcare provider if you experience:

• New or worsening side effects from ART.
• Symptoms of a new infection (fever, cough, skin changes).
• Difficulty taking your medication every day.
• Significant changes in mood, such as persistent sadness or hopelessness.