HIV/AIDS

What is HIV/AIDS?

HIV (Human Immunodeficiency Virus) is a virus that attacks the body’s immune system, specifically targeting CD4+ T cells, which are crucial for fighting infections. If left untreated, HIV can progress to AIDS (Acquired Immunodeficiency Syndrome), the most advanced stage of HIV infection characterized by severe immune system damage. HIV affects people of all ages, races, and sexual orientations worldwide, though certain populations face disproportionately higher risks. According to UNAIDS, approximately 39 million people globally were living with HIV in 2022, making it one of the world’s most significant public health challenges.

Key statistics

Symptoms

HIV symptoms vary significantly depending on the stage of infection: acute infection symptoms include fever, fatigue, swollen lymph nodes, sore throat, rash, muscle aches, and headache; chronic HIV symptoms may include persistent fatigue, weight loss, recurring infections, and night sweats; AIDS-defining symptoms involve severe opportunistic infections, certain cancers, and profound immune system failure.

During acute HIV infection (2-4 weeks after exposure), many people experience flu-like symptoms including high fever, severe fatigue, swollen lymph nodes, sore throat, skin rash, muscle and joint aches, and headache. This stage, called acute retroviral syndrome, occurs as the virus rapidly multiplies in the body. Following acute infection, HIV enters a chronic phase that can last years without treatment. During this stage, the virus continues to multiply but at lower levels, and symptoms may be mild or absent. However, the virus progressively damages the immune system. Without treatment, HIV typically progresses to AIDS within 8-10 years, characterized by a CD4+ T cell count below 200 cells/mm³ or the presence of AIDS-defining opportunistic infections such as pneumocystis pneumonia, cryptococcal meningitis, or certain cancers like Kaposi’s sarcoma.

Causes and risk factors

HIV is caused by infection with the human immunodeficiency virus, which is transmitted through specific body fluids including blood, semen, vaginal fluids, rectal fluids, and breast milk. The virus cannot survive long outside the human body and is not transmitted through casual contact, saliva, tears, or sweat.

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Key risk factors include unprotected sexual contact with an infected person, sharing needles or injection equipment, receiving contaminated blood transfusions (rare in countries with proper screening), and mother-to-child transmission during pregnancy, childbirth, or breastfeeding. Certain behaviors and conditions increase transmission risk, including having multiple sexual partners, presence of other sexually transmitted infections (which can create breaks in skin or mucous membranes), engaging in anal sex (which has higher transmission rates than vaginal sex), and using alcohol or drugs that impair judgment regarding safe practices. Healthcare workers face occupational exposure risks through needlestick injuries or contact with infected blood, though proper precautions significantly reduce this risk.

Prevention

HIV prevention strategies have proven highly effective when implemented consistently. Pre-exposure prophylaxis (PrEP) using medications like tenofovir combined with emtricitabine can reduce HIV acquisition risk by over 90% when taken daily. Post-exposure prophylaxis (PEP) involves taking antiretroviral medications within 72 hours of potential exposure and continuing for 28 days.

Consistent condom use during sexual activity provides significant protection against HIV transmission. Regular HIV testing allows for early detection and immediate treatment, which reduces viral load to undetectable levels, making transmission impossible (undetectable = untransmittable or U=U). For people who inject drugs, using sterile needles and participating in needle exchange programs eliminates transmission risk through contaminated equipment. Prevention of mother-to-child transmission involves antiretroviral treatment during pregnancy and avoiding breastfeeding in resource-rich settings, reducing transmission rates to less than 2%. Healthcare settings implement universal precautions including proper handling of blood and body fluids, safe injection practices, and immediate medical evaluation following potential exposure.

Complications

Without treatment, HIV progressively destroys the immune system, leading to AIDS and life-threatening complications. Opportunistic infections become increasingly common as CD4+ T cell counts decline, including pneumocystis pneumonia, tuberculosis, cryptococcal meningitis, cytomegalovirus infections, and severe bacterial infections.

AIDS-defining cancers may develop, particularly Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cervical cancer in women. HIV can also affect the nervous system, causing HIV-associated neurocognitive disorders ranging from mild cognitive impairment to severe dementia. Cardiovascular complications increase due to chronic inflammation, including higher risks of heart disease and stroke. Kidney disease, liver disease (especially in people co-infected with hepatitis B or C), and bone disorders including osteoporosis may develop. Wasting syndrome, characterized by severe weight loss and muscle atrophy, can occur in advanced disease stages.

Diagnosis

HIV diagnosis involves several types of tests with varying detection windows. Initial screening typically uses enzyme immunoassays (EIA) or rapid tests that detect HIV antibodies, with results available within minutes to hours. Fourth-generation tests detect both HIV antibodies and p24 antigen, reducing the window period to 2-4 weeks after infection.

Confirmation requires additional testing, often using Western blot or immunofluorescence assays, though newer algorithms may use differentiation immunoassays to distinguish HIV-1 from HIV-2. For acute infection diagnosis, HIV RNA (viral load) testing can detect the virus within 7-10 days of infection, before antibodies develop. CD4+ T cell count measurement determines immune system status and disease progression, with normal counts ranging from 500-1,200 cells/mm³. Additional tests include HIV resistance testing to guide treatment selection, particularly important in areas with high rates of transmitted drug resistance.

Treatment

Modern HIV treatment involves antiretroviral therapy (ART) using combinations of medications from different drug classes to suppress viral replication. Current first-line regimens typically include two nucleoside reverse transcriptase inhibitors plus an integrase strand transfer inhibitor. Common medications include tenofovir, emtricitabine, efavirenz, dolutegravir, and rilpivirine.

Single-tablet regimens combining multiple medications improve adherence and include formulations like tenofovir/emtricitabine/dolutegravir or tenofovir/emtricitabine/rilpivirine. For treatment-experienced patients or those with drug resistance, newer agents include bictegravir, cabotegravir, and maraviroc. Long-acting injectable formulations using cabotegravir plus rilpivirine administered monthly or every two months represent significant advances for patients preferring alternatives to daily pills. Treatment goals include achieving undetectable viral loads (typically Prognosis

With consistent antiretroviral treatment, people with HIV can expect near-normal life expectancy and quality of life. Studies show that individuals diagnosed with HIV in their twenties who maintain viral suppression through treatment can live into their seventies, approaching the life expectancy of HIV-negative individuals.

The key to excellent outcomes is early diagnosis and immediate treatment initiation, regardless of CD4+ count, combined with excellent medication adherence (>95% of doses taken as prescribed). People who achieve undetectable viral loads cannot sexually transmit HIV to others, dramatically improving quality of life and reducing transmission at the population level. However, outcomes remain poor without treatment, with progression to AIDS typically occurring within 8-10 years and death within 1-2 years after AIDS diagnosis. Prognosis also depends on access to healthcare, social support, mental health, and management of comorbid conditions.

Quality of life

Living well with HIV involves comprehensive self-care extending beyond medication adherence. Regular exercise helps maintain bone density, muscle mass, and cardiovascular health while reducing depression and anxiety commonly associated with chronic illness. A balanced diet rich in fruits, vegetables, lean proteins, and whole grains supports immune function and helps manage medication side effects.

Mental health support is crucial, as HIV diagnosis can trigger depression, anxiety, and adjustment disorders. Counseling, support groups, and psychiatric care when needed significantly improve outcomes. Many people benefit from connecting with HIV-positive peer networks for emotional support and practical advice. Workplace accommodations are rarely necessary for people with well-controlled HIV, and discrimination based on HIV status is illegal in many jurisdictions. Regular medical monitoring every 3-6 months helps optimize treatment and prevent complications. Healthy sleep habits, stress management, and avoiding smoking and excessive alcohol consumption enhance overall wellbeing and treatment effectiveness.

Pregnancy and fertility

HIV does not significantly impact fertility in either men or women, and people with HIV can safely conceive and have healthy children with proper medical care. For HIV-positive women, antiretroviral treatment during pregnancy reduces mother-to-child transmission risk to less than 2% in resource-rich settings.

Pregnancy management involves optimizing maternal viral suppression, typically using regimens containing zidovudine due to extensive safety data. Cesarean delivery may be recommended if viral loads remain detectable near delivery. Newborns receive antiretroviral prophylaxis for 4-6 weeks, and HIV testing continues for 12-18 months to determine infection status. In resource-rich settings, formula feeding is recommended to eliminate transmission risk through breastfeeding. For serodiscordant couples (one partner HIV-positive), pre-exposure prophylaxis for the negative partner, combined with viral suppression in the positive partner, allows safe conception without transmission risk.

Children

Pediatric HIV requires specialized care due to developing immune systems and different treatment considerations. Children may present with failure to thrive, recurrent infections, developmental delays, or opportunistic infections. Early diagnosis is challenging because maternal antibodies persist for up to 18 months, requiring HIV DNA or RNA testing rather than antibody tests.

Treatment regimens must account for developmental changes affecting drug metabolism and availability of pediatric formulations. Many antiretroviral medications are available as liquid formulations or can be crushed for younger children. School accommodations are typically unnecessary for children with well-controlled HIV, and confidentiality protections prevent discrimination. Transition to adult care requires careful planning, typically beginning in mid-adolescence, with focus on developing independence in medication management and healthcare navigation. Psychosocial support helps children understand their condition and develop coping strategies.

When to see a doctor

Immediate medical attention is required for symptoms suggesting opportunistic infections, including persistent fever, severe headache with neck stiffness, difficulty breathing, persistent cough with weight loss, or unusual skin lesions. New onset of confusion, severe diarrhea, or vision changes also warrant urgent evaluation.

Routine care involves regular monitoring every 3-6 months for people with well-controlled HIV, including viral load testing, CD4+ counts, and screening for complications. Anyone at risk for HIV exposure should seek testing, particularly after unprotected sexual contact, needlestick injuries, or sharing injection equipment. Post-exposure prophylaxis must be initiated within 72 hours of potential exposure for maximum effectiveness. People experiencing medication side effects or having difficulty with adherence should contact their healthcare providers promptly rather than stopping treatment independently.

Regional context

The Caucasus region shows varying HIV epidemiology, with Georgia reporting approximately 7,000 people living with HIV, while Armenia and Azerbaijan have lower documented prevalence. Injection drug use remains a significant transmission route in the region, though sexual transmission is increasing. Healthcare systems have expanded HIV testing and treatment access through international partnerships, though stigma remains a barrier to care engagement. GMJ welcomes contributions from regional researchers to build the evidence base for HIV/AIDS prevention and treatment strategies specific to the Caucasus populations.

Research and clinical trials

HIV research continues advancing toward better treatments and potential cures. Long-acting injectable medications are expanding beyond monthly options to quarterly and potentially annual formulations. Gene therapy approaches, including CCR5 gene editing and “shock and kill” strategies to eliminate viral reservoirs, show promise in early trials.

Broadly neutralizing antibodies represent potential alternatives to traditional antiretroviral therapy, with trials of ibalizumab and experimental antibodies showing encouraging results. Vaccine development continues despite decades of challenges, with new approaches targeting broadly neutralizing antibody induction. Prevention research includes vaginal rings containing antiretroviral medications and implantable devices for long-term drug delivery. Current trials can be found through ClinicalTrials.gov, including studies of cure strategies, new treatment regimens, and prevention methods.

Frequently asked questions

Can HIV be cured?

Currently, HIV cannot be cured in most cases, but highly effective treatment can suppress the virus to undetectable levels, preventing disease progression and transmission. A few individuals have achieved HIV cure through experimental procedures, but these approaches are not widely applicable.

How quickly should treatment start after HIV diagnosis?

Treatment should begin immediately after HIV diagnosis, regardless of viral load or CD4+ count. Early treatment initiation improves long-term outcomes and prevents transmission to others.

What does “undetectable = untransmittable” mean?

When HIV treatment suppresses viral load to undetectable levels (Are there side effects from HIV medications?

Modern HIV medications generally have minimal side effects. Some people experience nausea, headache, or fatigue initially, but serious side effects are uncommon. Most side effects resolve within weeks of starting treatment.

How often do I need medical monitoring with HIV?

People with well-controlled HIV typically need monitoring every 3-6 months, including viral load testing, CD4+ counts, and routine health screening. More frequent monitoring may be necessary when starting new treatments or if complications arise.

Support and resources

International support organizations provide comprehensive resources for people affected by HIV/AIDS. UNAIDS (unaids.org) offers global policy guidance and epidemiological data. The International Association of Providers of AIDS Care (iapac.org) provides clinical resources and education. Regional organizations include the European AIDS Clinical Society (eacsociety.org) and AIDS Healthcare Foundation (aidshealth.org).

Local support groups and community-based organizations provide peer support, advocacy, and practical assistance. Many countries have national AIDS organizations offering helplines, educational materials, and patient advocacy services. Online communities and telemedicine options have expanded access to support and specialized care, particularly important in regions with limited HIV expertise.

Related conditions

Hepatitis B commonly co-occurs with HIV due to shared transmission routes and can complicate treatment decisions. Hepatitis C co-infection is frequent among people who inject drugs and requires careful treatment coordination. Tuberculosis represents the leading cause of death among people with HIV globally and requires specialized management approaches. Pneumocystis pneumonia is a common AIDS-defining opportunistic infection. Kaposi’s sarcoma is an AIDS-associated cancer caused by human herpesvirus 8 co-infection.

Sources: Orphanet (orpha.net), OMIM, GeneReviews (NCBI), WHO ICD-11, UpToDate, relevant EULAR/ACR/WHO guidelines. This article is for informational purposes only and does not constitute medical advice.

Licensed under CC BY 4.0. Free to share with attribution to GMJ News.

Sources: Orphanet (orpha.net), OMIM, GeneReviews (NCBI), WHO ICD-11, EULAR/ACR guidelines. Schema.org MedicalCondition structured data included.