About Acquired Immunodeficiency Syndrome (AIDS)

Overview

Acquired immunodeficiency syndrome (AIDS) is a serious long-term condition that happens as a result of infection with the human immunodeficiency virus (HIV). It is the final stage of HIV infection, when the immune system becomes very weak and can no longer fight off infections and diseases. AIDS is marked by opportunistic infections—illnesses that take advantage of the weakened immune system—and other complications that can be life-threatening.

HIV is a global health issue and is mainly spread through unprotected sex, sharing needles for drug use, and receiving infected blood transfusions.

Although antiretroviral therapy (ART) has greatly improved the outlook for people living with HIV/AIDS, it is still a serious medical challenge. Despite ongoing research, no vaccine for HIV has been approved yet.

Causes and Risk Factors

Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV), a virus that progressively weakens the immune system by destroying CD4+ T cells (important cells that help the immune system fight infections). As the immune system becomes more damaged, the body becomes more vulnerable to serious infections and certain types of cancer.

The root causes of AIDS include:

HIV infection: The virus attacks and depletes CD4+ T cells, weakening the immune system.
Opportunistic infections: The compromised (weakened) immune system makes individuals susceptible to various infections that would not typically cause severe illness in healthy individuals.
Cancer: HIV infection increases the risk of certain cancers, including Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer.

Because AIDS develops from untreated or advanced HIV infection, the risk factors for HIV are also risk factors for AIDS. These include:

Unsafe sexual practices: Having unprotected sex with multiple partners or with someone who is at high risk for HIV can increase the chance of infection.
Intravenous (IV) drug use: Sharing needles or other drug equipment can spread HIV.
Lack of access to healthcare and education: Limited access to healthcare and HIV prevention education can increase the risk of infection.

Risk factors for HIV progressing to AIDS include:

Older age at diagnosis of HIV infection
Delayed diagnosis of HIV
Sexual transmission of HIV compared to infection through contaminated blood
Low CD4 count and detectable viral load despite antiretroviral therapy

It's important to note that practicing safe sex, using clean needles, and getting tested regularly can help reduce the risk of acquiring HIV.

Symptoms

As HIV progresses to AIDS, the immune system becomes severely weakened, and more serious symptoms may appear. These can include:

Blotches under the skin or inside the mouth and nose
Chronic diarrhea
Continuous swelling of the lymph glands
Extreme fatigue
Recurring fevers
Memory problems or other neurological issues
Pneumonia
Rapid weight loss
Sores in the mouth, anus, or genitals
Frequent methicillin-resistant staphylococcus aureus (MRSA) skin infections

As HIV progresses to its later stages and develops into AIDs, additional and more serious symptoms may occur, including:

Opportunistic infections: These are infections that are usually rare or harmless in people with healthy immune systems but become more common and dangerous in people with AIDS. Examples include tuberculosis, pneumocystis fungal infection, and other severe fungal infections.
Chronic illness: AIDS may cause ongoing flu-like symptoms such as fever, chills, night sweats, and diarrhea.
Physical changes: Severe weight loss can occur as the body becomes weaker.
Pneumonia: A person with AIDS may develop serious lung infections, including pneumonia, even after a minor illness. In some cases, pneumonia can happen suddenly and without warning.
Changes in mental health: AIDS can affect the brain and nervous system, leading to memory problems, confusion, or depression.

It's important to note that a formal diagnosis of HIV infection and AIDS cannot be made based on symptoms alone. Tests are needed to confirm the diagnosis. If you experience any concerning symptoms, it's best to consult with a healthcare professional for an accurate evaluation.

Diagnosis

To diagnose HIV infection and progression to AIDS, the following examinations, tests, and procedures are commonly performed:

HIV antibody test: This blood test checks for antibodies to HIV, the virus that causes AIDS. A positive result shows that the person has been infected with HIV.
Viral load test: This test measures the amount of HIV in the blood. A high viral load means the virus is actively multiplying and the infection is not well controlled.
CD4 cell count: This test measures the number of CD4 T-cells, a type of white blood cell that helps the body fight infections. A low CD4 count means the immune system is weak. When the CD4 count drops to below 200 cells per cubic millimeter (mm³) it meets one of the criteria for an AIDS diagnosis.
Opportunistic infection screening: Doctors may perform tests to look for infections or cancers that are common in people with AIDS. These include tuberculosis, pneumonia, and certain fungal or viral infections. Some illnesses are considered “AIDS defining conditions,” meaning their presence can confirm a diagnosis of AIDS. Examples include:
- Candidiasis (yeast infection) in the esophagus, lungs, ora airways
- Coccidiodomycosis and Cryptococcosis infections outside of the lungs
- Cytomegalovirus (CMV) disease
- Kaposi’s sarcoma
- Certain types of lymphoma

To determine the stage or severity of AIDS, additional examinations, tests, and procedures may include:

Clinical assessment: A healthcare provider will evaluate your symptoms and medical history to understand how far the diseases has progressed and how severe it is.
Opportunistic infection monitoring: Regular monitoring for opportunistic infections is important to gauge the impact of AIDS on the immune system.
Laboratory tests: Additional blood tests may be performed to assess organ function, monitor CD4 cell count and viral load, and screen for other complications associated with advanced AIDS.

It's important to note that these examinations, tests, and procedures should be conducted by healthcare professionals experienced in managing HIV/AIDS.

Treatment Options

The goals of treatment for HIV infection and AIDS are to:

Achieve viral suppression: The first goal is to reduce the amount of the human immunodeficiency virus (HIV) in the body to undetectable levels. This is done through antiretroviral therapy (ART), which involves taking a combination of medications that target different stages of the HIV life cycle. ART helps to slow down the progression of the disease, improve immune function, and reduce the risk of transmission.
Improve immune function: AIDS weakens the immune system, making individuals more susceptible to infections and certain types of cancers. ART helps to restore and strengthen the immune system by suppressing HIV replication and allowing the immune cells to recover.
Prevent opportunistic infections: People with AIDS are at a higher risk of developing opportunistic infections, which are caused by organisms that usually do not cause illness in individuals with a healthy immune system. To prevent these infections, individuals with AIDS may receive prophylactic medications such as antibiotics, antifungals, or antivirals.
Manage symptoms and complications: AIDS can cause various symptoms and complications such as weight loss, fatigue, diarrhea, and neurological problems. Symptomatic treatment may include medications to alleviate specific symptoms or manage complications.
Promote overall health and well-being: In addition to medication-based treatments, it is important for individuals with AIDS to make health behavior changes such as practicing safe sex, maintaining a healthy diet, exercising regularly, getting vaccinations as recommended, and avoiding substances that can further weaken the immune system.
For people who are at high risk of exposure to HIV are not currently HIV-infected (for example, partners of people who have AIDS), pre-exposure prophylaxis (PrEP) may be considered in addtion to safe sex practices. PrEP is an antiretroviral medication that is taken daily. It can stop HIV from reproducing in the body to help prevent HIV infection.

It's important to note that treatment plans for AIDS should be individualized based on factors such as viral load, CD4 cell count, comorbidities, and patient preferences.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.