Acquired Immunodeficiency Syndrome (AIDS): Symptom and Treatment

Acquired Immunodeficiency Syndrome (AIDS) is a life-threatening condition caused by the Human Immunodeficiency Virus (HIV).

HIV attacks the immune system, specifically targeting CD4 cells (T-helper cells), which play a key role in defending the body against infections.

Over time, the destruction of these cells weakens the immune system, leaving the body vulnerable to opportunistic infections and certain cancers. Globally, AIDS remains a significant public health issue, with millions affected despite advances in prevention and treatment.

What is AIDS?

AIDS is the final and most severe stage of HIV infection. By the time a person develops AIDS, their immune system is critically weakened, unable to fend off illnesses that a healthy immune system could easily manage.

While HIV is the virus that causes the disease, AIDS is not inevitable if the infection is treated effectively.

Epidemiology of AIDS

According to the World Health Organization (WHO), approximately 38 million people globally were living with HIV by the end of 2022. Sub-Saharan Africa bears the highest burden, accounting for more than two-thirds of all cases. Despite improvements in awareness and treatment access, many individuals still lack the resources needed to manage the disease effectively.

How does AIDS occur?

AIDS develops as a result of prolonged, untreated HIV infection. Here’s a simplified analogy: imagine the immune system as a security system for a house.

HIV is like a thief that disables the security system, allowing burglars (infections and cancers) to enter freely.

1. HIV Entry: HIV enters the bloodstream through direct contact with infected bodily fluids. It binds to CD4 cells, using them as factories to replicate itself.
2. Replication: As the virus multiplies, it kills off CD4 cells, progressively weakening the immune response.
3. Progression to AIDS: Without treatment, the body loses its ability to fight off infections, leading to the clinical syndrome known as AIDS.

What are the causes of AIDS?

AIDS is caused exclusively by HIV infection. The virus spreads through:

1. Unprotected Sexual Contact: Accounts for approximately 70% of HIV transmissions worldwide.
2. Sharing Needles: Responsible for about 10% of cases, particularly among people who inject drugs.
3. Mother-to-Child Transmission: Occurs during pregnancy, childbirth, or breastfeeding in about 15% of cases without intervention.
4. Blood Transfusions: Rare due to rigorous blood screening in most countries, but still possible where safety protocols are lacking.

Risk Factors for AIDS

HIV infection, which leads to AIDS, is associated with various risk factors:

• Engaging in Unprotected Sex: Particularly with multiple partners or in high-prevalence areas.
• Injection Drug Use: Sharing needles greatly increases the risk of HIV transmission.
• Sexually Transmitted Infections (STIs): Infections like syphilis or gonorrhea can compromise the integrity of mucosal barriers, facilitating HIV entry.
• Lack of Awareness or Testing: Many individuals are unaware they are infected, delaying diagnosis and treatment.
• Poverty and Lack of Access to Healthcare: Inadequate resources contribute to higher infection rates and poorer outcomes.

Symptoms of AIDS

HIV infection progresses through three stages, with AIDS being the last and most severe. Symptoms during the AIDS stage often include:

1. Frequent Infections: Recurrent bacterial, viral, or fungal infections such as pneumonia or tuberculosis.
2. Unexplained Weight Loss: Sometimes referred to as “wasting syndrome.”
3. Persistent Fever and Night Sweats: Due to opportunistic infections.
4. Chronic Diarrhea: Often linked to gastrointestinal infections.
5. Skin Conditions: Including rashes, lesions, or cancers like Kaposi sarcoma.
6. Neurological Symptoms: Memory loss, confusion, or difficulty concentrating due to HIV-associated dementia.

Differential Diagnosis

Diagnosing AIDS can be challenging because its symptoms overlap with those of other diseases. Conditions that may mimic AIDS include:

• Tuberculosis (TB): Particularly in endemic areas.
• Severe Malnutrition: Leads to immune suppression and infections.
• Certain Cancers: Like lymphoma, which can present with similar systemic symptoms.
• Autoimmune Diseases: Lupus or other immune system disorders may share overlapping features.

Healthcare providers must consider these possibilities while conducting investigations.

How to Diagnose AIDS?

The diagnosis of AIDS relies on a combination of clinical criteria, laboratory findings, and history.

Gold Standard Investigations

1. HIV Testing:
   • ELISA (Enzyme-Linked Immunosorbent Assay): A sensitive initial screening test.
   • Western Blot or PCR (Polymerase Chain Reaction): Confirms HIV infection.
2. CD4 Cell Count:
   • AIDS is diagnosed when the CD4 count drops below 200 cells/mm³.
3. Viral Load Testing:
   • Measures the amount of HIV RNA in the blood, indicating disease progression.
4. Opportunistic Infection Tests:
5. Blood cultures, imaging studies, or biopsies are used to detect associated infections or malignancies.

Treatment of AIDS

Although there is no cure for AIDS, antiretroviral therapy (ART) has revolutionized its management. ART can suppress the virus, prevent disease progression, and allow individuals to lead near-normal lives.

Gold Standard Treatment

1. Antiretroviral Therapy (ART):

• A combination of medications from different drug classes (e.g., NRTIs, NNRTIs, and protease inhibitors) is used to block HIV replication.
• ART can reduce the viral load to undetectable levels, preventing the progression to AIDS.

Other Treatments

2. Prophylaxis for Opportunistic Infections:
   • Preventive medications (e.g., cotrimoxazole for pneumocystis pneumonia) are given when CD4 counts are very low.
3. Symptomatic Management:
   • Antifungals, antivirals, or antibiotics to treat infections.
   • Nutritional support and counseling for mental health issues.
4. Advanced Therapies (Research):
   • Gene editing (e.g., CRISPR) and vaccines are promising areas under study.

When ART Fails?

In cases where ART resistance develops, salvage therapy involving new drug combinations or experimental treatments may be employed.

Prevention of AIDS

While treatment has advanced, prevention remains key to reducing new cases. Methods include:

• Safe Sex Practices: Consistent condom use and reducing the number of sexual partners.
• Needle Exchange Programs: To prevent transmission among drug users.
• Pre-Exposure Prophylaxis (PrEP): Daily medication for high-risk individuals to prevent infection.
• Education and Testing Campaigns: To raise awareness and encourage early diagnosis.

Conclusion

AIDS, once a devastating diagnosis, has become a manageable condition with advances in modern medicine.

Early detection through testing, consistent treatment with ART, and widespread preventive measures have significantly improved outcomes for those living with HIV.

However, challenges such as stigma, limited access to healthcare, and socio-economic disparities continue to hinder global progress. By addressing these barriers and continuing research, the goal of an AIDS-free generation remains achievable.

References

1. World Health Organization (WHO). “HIV/AIDS Factsheet.” www.who.int
2. Centers for Disease Control and Prevention (CDC). “HIV Basics.” www.cdc.gov
3. UNAIDS. “Global HIV & AIDS Statistics.” www.unaids.org
4. Mayo Clinic. “HIV/AIDS Overview.” www.mayoclinic.org
5. NIH. “HIV Treatment Guidelines.” www.nih.gov