HIV (Human Immunodeficiency Virus) is a virus which leads to ‘HIV infection,’ that targets the body’s immune system, specifically the white blood cells called CD4 cells. HIV infection if not treated, leads to progressive fall in the CD4 counts, significant decrease in the immunity, and hence, risk of multiple opportunistic infections and malignancies. At very low CD4 counts, generally 200/cu.mm, the body’s immune system is the weakest. This stage, when HIV infection is in its most advanced form, is called AIDS i.e. acquired immunodeficiency syndrome.
HIV can be transmitted through anal or vaginal sex, blood transfusion; sharing needles, syringes, or drug injection equipment; and can also be passed on during pregnancy, childbirth, and breastfeeding.
The tests used for diagnosis of HIV infection are either antibody tests, antigen/antibody tests, or nucleic acid tests (NAT). Antibody tests detect antibodies to HIV in blood or oral fluid, while antigen/antibody tests detect both antibodies and antigens. Most of the laboratories use a combination of antigen/antibody-based tests, done by 2-3 different methods and kits, to have the maximum specificity (i.e. to avoid false positive results). These tests can usually detect HIV infection by 3 weeks after the exposure.
On the other hand, PCR-based or NAT tests detect the actual HIV virus in the blood, detecting HIV earlier than other tests, especially for those with early symptoms.
People with HIV progress through three stages. Acute HIV infection is the earliest stage and generally develops within 2-4 weeks after exposure. The level of HIV in the blood is very high at this time, and the patient is very contagious. If treatment (ART) is started at this time, the patient derives the maximum benefit from the treatment.
Chronic HIV Infection is the stage when HIV continues to multiply but the patients have zero or minimal symptoms. This stage may persist for years before the patients start developing symptoms.
AIDS is the most severe stage in which the patients present with either opportunistic infections or AIDS-related cancers, like tuberculosis, cryptococcal meningitis, bacterial and fungal infections, lymphomas, and Kaposi’s sarcoma.
As per the current guidelines, treatment for HIV infection (ART i.e. anti-retroviral treatment) should be started the same day as diagnosis, provided there is no opportunistic infection present, which may delay the initiation of ART. Taking prescribed HIV treatment keeps the viral load under control or undetectable, prevents the progression of the disease, and prevents transmission of HIV from an infected person to others. HIV without ART causes CD4 count to decrease, weakening the immune system and increasing illness risk. ART helps increase CD4 count gradually (normal CD4 count: 500-1,500 cells/mm3).
Recent advancements in HIV treatment, and the availability of safe and highly effective ART, have improved life expectancy significantly. However, despite these advances, HIV still presents a huge challenge. 88.4 million people have been infected with HIV since the epidemic began, with 42.3 million deaths. By the end of 2023, about 39.9 million people were living with HIV globally, including close to 1.5 million children.
Even today, effective HIV management faces challenges like social non-acceptance, limited healthcare infrastructure and poor access to HIV treatment, high treatment costs in the private
sector, poor compliance to the daily pills, and lack of adequate counseling and motivation for adherence to ART. A lot of work still needs to be done in these areas!
We at Tathaagat Infectious Disease Clinic are committed to providing the care you need and understand the challenges of living with HIV. If you or someone you care about is seeking HIV treatment in Ahmedabad, India, please don’t hesitate to reach out to us at +91 96646 30466
