Understanding HIV and AIDS
Through this health file, understand the difference between HIV and AIDS, learn how to prevent this infection and adopt the right gestures to live better with it.
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1) HIV and AIDS: definitions and key figures
Definition: from HIV to AIDS
AIDS, also known as Acquired Immune Deficiency Syndrome, is a disease that results from infection with a virus called HIV (Human Immunodeficiency Virus). When a person is infected with HIV, he/she is HIV positive. Their immune defenses are weakened and then destroyed which prevents their body from fighting infections and cancers and therefore makes the individual vulnerable to the disease, possibly resulting in death in the most advanced cases. [1]
There are two types of HIV:
- HIV-1 which is very present in France where it represents 98% of infections.
- HIV-2, which is more common in West Africa [1].
AIDS is the most advanced stage of HIV infection and generally appears 10 years after the initial infection in the absence of treatment. Due to the destruction of the immune system, it is characterized by the development of certain cancers and opportunistic infections such as pulmonary pneumocystis, cerebral toxoplasmosis, esophageal candidiasis, tuberculosis, Kaposi’s disease, and non-Hodgkin’s lymphoma [1].
Key figures in 2021:
- 4 million people were living with HIV worldwide. [3]
- 5 million people became newly infected. [3]
- 650,000 people have died from AIDS-related illnesses [3].
- Since the beginning of the epidemic, AIDS has killed 40.1 million people worldwide. [3]
Ratio of acquisition of new HIV infections in 2021 [5]
2) Causes and routes of transmission
The HIV virus can be transmitted through close and unprotected contact with certain biological fluids of an infected person, such as blood, breast milk, semen, and vaginal secretions. There are therefore 3 main routes of HIV transmission:
Sexual transmission:
Through semen and vaginal secretions during unprotected vaginal, oral, or anal sex. [1] [6]
- Female sex workers are 30 times more likely to acquire HIV than adult women in the general population (ages 15-49). [5]
- Men who have sex with other men are 28 times more likely to become infected with HIV than adult men in the general population (ages 15-49). [5]
- Transgender women are 14 times more likely to acquire HIV than adult women in the general population (15-49yrs). [5]
Blood transmission:
- Through contact with contaminated blood (when sharing injection equipment or in the event of an exposure for caregivers) [7]
- Injection drug users are 35 times more likely to contract HIV than the non-injection drug using population. [5]
Mother to child:
- During breastfeeding.
- During childbirth.
- During the last trimester of pregnancy when HIV passes through the placental barrier [2].
3) Symptoms
The symptoms of HIV infection vary according to the different stages of the disease:
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First stage:
The person infected with HIV may be asymptomatic or develop symptoms of a phase called primary infection characterized by flu-like symptoms (fever, headache, muscle pain, diarrhea etc.) [2].
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Second stage:
After the primary infection, the asymptomatic phase begins, which can last for several years. During this phase, the patient has no symptoms but continues to be contagious. Throughout this period, HIV continues to weaken the immune system and therefore new symptoms may appear at the end of the phase such as weight loss, fever, skin infections, diarrhea, and cough [2].
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Final stage:
In case the HIV-infected person has not taken a treatment, the disease progresses to AIDS, the final stage of HIV infection. This stage is characterized by the appearance of certain cancers and so-called opportunistic infections because they appear due to the weakening of the immune system. In this case, patients develop several infections that may be bacterial, fungal, or parasitic in origin [2].
4) Treatment
Today, no treatment can completely eliminate HIV from the body. However, there are drugs that block the multiplication of this virus in order to ensure a functioning immune system. [2]
It is strongly recommended to start the treatment at the time of diagnosis regardless of the stage of infection in order to keep the immune system as intact as possible, to reduce the chronic inflammation that results from the infection and to limit the risk of HIV transmission. [1] [2]
Therapeutic classes:
Drugs used against HIV are called “antivirals” or “antiretrovirals” (HIV belongs to the retrovirus family). [10]
There are several therapeutic classes of drugs to control HIV and they are characterized by different modes of action. The main classes are nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, integrase inhibitors, and CCR5 receptor antagonists [10]
Typically, treatment consists of a combination of several drugs that belong to different classes. The most common combinations are as follows:
- two nucleoside/nucleotide reverse transcriptase inhibitors
- a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor boosted with ritonavir
In the less common case of HIV-2, triple therapy consists of two NRTIs and a protease inhibitor (lopinavir or darunavir) boosted with ritonavir. [10]
5) Prevention
There are many ways to prevent HIV and to protect against this infection. These include:
- Using a condom during sex. If unprotected sex is planned, it is essential that each partner takes a blood test before sex to find out if he or she has HIV and to avoid infecting other partners [13].
- Do not share or use previously used injection equipment (syringes, needles) [13].
- Use single-use equipment for drug users [1].
- Disinfect surgical tools and medical equipment [1].
- Get tested regularly
6) Living with HIV / AIDS
Thanks to medical advances and treatments, living with AIDS is now possible.
A recent study shows that the life expectancy of a 20-year-old person on antiretroviral treatment reaches 78 years after 2 to 3 years of treatment. However, these results have been observed in Europe and the United States and cannot necessarily be extended to all countries, especially to African countries, where millions of infected patients have only partial access to treatment [9].
If you are HIV-positive or know people in your life who are, here are some dietary and health tips to help you live with HIV:
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Treatment monitoring and follow-up visits
If you are HIV-positive, it is essential to take your treatment regularly to keep your immune system working. Talk to your doctor before taking any other medications, as many drugs can interact with antiretrovirals [13].
Also, be sure to see your doctor regularly for frequent monitoring and report any unusual symptoms or side effects from your treatment. [13]
If possible, get any vaccinations that are available and recommended, and have regular blood tests to monitor treatment effectiveness and organ function. [13]
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Regular physical activity
Moderate physical activity can boost the immune system and give the body the strength to fight HIV. It may even delay the onset of the final stage of the disease: AIDS [11].
Indeed, thanks to physical activity, the level of white blood cells and immunoglobulins tends to increase, which helps to fight infections. [12]
In addition, the practice of sports promotes social integration and the fight against stigmatization. [11]
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Improvement of lifestyle:
It is advisable to follow a rather healthy and balanced diet in order to fight against overweight on the one hand and against undernutrition on the other hand [13].
Sleeping well is also important for the quality of life. This allows you to have more energy throughout the day and to avoid anxiety and fatigue.
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Taking care of your mental health:
Discovering one’s HIV status is psychologically difficult because of the need to adjust to a diagnosis and to living with a chronic infectious disease [14]. As a result, people with HIV are at increased risk of developing mental health problems such as depression or anxiety.
Therefore, it is very important to take care of one’s morale and to surround oneself with positive people with whom it is possible to talk freely about one’s HIV status and who can provide the patient with strong and regular psychological support. [14]