Typical Case
The human immunodeficiency virus (HIV) attacks the human immune system and erodes resistance to a variety of illnesses and cancers that healthy immune systems are better able to combat. Infected individuals eventually lose their immunological capacity as the virus kills and damages immune cells. The disease progresses in three stages: acute HIV infection transitions into chronic and ultimately manifests as ADIS – acquired immune deficiency syndrome (World Health Organization, 2022). Depending on the individual, the most advanced stage of HIV infection might take many years to manifest.
The symptoms of HIV vary in every stage of infection. Although those who have HIV are typically most contagious in the first few months after becoming infected, many are still unaware of their condition until much later. The initial stage of HIV infection typically appears 2–4 weeks after contagion. Some people may suffer no symptoms; others, however, may have flu-like symptoms, such as fever, headache, rash, or sore throat (World Health Organization, 2022). There could be other signs, such as swollen lymph nodes, weight loss, fever, diarrhea, and cough, as the virus gradually weakens the immune system. HIV multiplies quickly during the acute stage of infection and spreads throughout the body. The infection-fighting CD4 cells (CD4 T lymphocytes) are attacked by the virus and destroyed. Eventually, their level becomes too low (>200 cells/mm3) for the organism to stop any other opportunistic infections (HIVinfo.nih.gov, 2021). In addition, there is a high risk of contracting life-threatening conditions like lymphomas, as well as severe bacterial infections, and tuberculosis.
Pathogen
Two strands of RNA, 15 different viral protein subtypes, a few proteins from the most recent infected host cell, and a lipid bilayer membrane make up HIV. These elements work together to enable the virus to infect immune system cells and compel them to make additional virus copies. From the initial stages of viral attachment through the last stage of budding, every molecule in the virus participates in this process (Eisinger et al., 2019). In CD4 T cells infected with HIV, glycolytic metabolism is increased. Both enhanced glucose utilization and glutamine metabolism are crucial for HIV infectivity and replication in CD4 T cells.
The family Retroviridae includes the genus Lentivirus, which includes HIV, and this is how HIV is classified. The morphologies and biological characteristics of lentiviruses are quite diverse. Lentiviruses, which typically cause long-lasting infections with a prolonged incubation time, are present in many animals. Positive-sense, single-stranded, enclosed RNA viruses are how lentiviruses spread. The virally encoded enzyme reverses transcriptase, which is delivered with the viral genome in the virus particle, reverse transcribes the viral RNA genome into double-stranded DNA upon entry into the target cell (Jiang et al., 2020). A virally encoded enzyme called integrase and host co-factors are then used to import the resultant viral DNA into the cell nucleus and integrate it into the cellular DNA. The virus may become dormant after integration, enabling the virus and its host cell to evade the immune system for an illogically long period of time.
After the first infection, HIV can stay dormant in the human body for up to ten years when no symptoms are present. As an alternative, the integrated viral DNA may be transcribed to create fresh RNA genomes and viral proteins using the resources of the host cell. These new virus particles are then packaged and expelled from the cell to start the replication cycle all over again.
Epidemiology
There are many behaviors and conditions that increase the risk of contracting HIV. World Health Organization (2022) mentions them as follows: having condomless sex (vaginal, anal), having other sexually transmitted diseases (syphilis, herpes), and engaging in sexual behavior subjected to harmful alcohol and drug use. It is due to semen and vaginal secretions of HIV-infected people being highly contagious. For transmission to occur, HIV must enter the HIV-negative organism through a mucous membrane found in the rectum, vagina, oral cavity, or tip of the penis (Becasen et al., 2017; Ssentongo et al., 2021). However, normal daily interactions like kissing, hugging, shaking hands, or sharing personal items, food, or water do not cause an infection in a person (Fauci et al., 2019). If people with HIV follow their HIV drugs as prescribed and attain and maintain an undetectable viral load, they can lead long, healthy lives and prevent the spread of the virus through sexual contact with their HIV-negative partners.
Another HIV transmitter is an HIV-positive person’s blood, which makes utilizing drugs through injection entail behaviors that contribute to the spread of HIV. Direct needle sharing is the main category of these behaviors and means using syringes and needles that have already been contaminated. As evidenced by instances of needlestick injuries among healthcare professionals, penetration of the needle into the skin (or contact with an open cut or sore) is sufficient for transmitting the HIV virus into the uninfected organism’s bloodstream. There are no specific disease vectors as it proceeds only through the body fluids.
Since its start in 1981, the human immunodeficiency virus infection and acquired immunodeficiency syndrome pandemic have been a major global public health concern. The World Health Organization (2022) estimates that as of 2021, HIV/AIDS has claimed the lives of over 40.1 million people worldwide and that there are currently about 38.4 million individuals living with the virus. The continent of Sub-Saharan Africa is where HIV is most prevalent. As of 2020, more than two-thirds of people with HIV resided in Africa, where an estimated 61% of new HIV infections occurred in 2018 (World Health Organization, 2022). In this context, the region receives different aids to prevent the spread of the virus.
However, HIV outbreaks can still occur in developed countries, as was the case with Kanawha County during the COVID-19 pandemic. In October 2019, the West Virginia Bureau for Public Health (WVBPH) registered an increasing incidence of HIV diagnosis among people injecting drugs. Compared to previous years, the annual number of HIV diagnoses had more than doubled (from five to eleven) (CDC, 2022). Subsequently, the HIV outbreak case was defined by confirmed HIV diagnoses on and after January 1, 2019, which included a total of 85 persons (CDC, 2022). In order to respond to the outbreak, WVBPH prepared a Health Advisory and, in conjunction with Kanawha-Charleston Health Department and CDC’s remote assistance, established an HIV task force (CDC, 2022). Overall, WVBPH focused on expanding HIV outreach and testing, using investigation and surveillance data to address the future spread of infection.
Treatment
Reducing a body’s level of the virus (called the viral load) is one of the key objectives of HIV treatment. Therefore, HIV medications and antiretroviral (ARV) medication combinations aim to stop HIV from replicating (creating copies of itself), lowering the total viral load, and controlling the HIV illness (Eisinger et al., 2019). The immune system then can heal and create more CD4 cells when there is less HIV in the body. Although the body still contains some HIV, the immune system is powerful enough to fend off infections and several malignancies associated with HIV. In addition, the danger of HIV transmission to partners who are HIV-negative is practically nonexistent in the case of an undetectable viral load (Eisinger et al., 2019). Thus, ART is advised for all HIV-positive individuals as it helps patients with HIV live longer, healthier lives and stops transmission, despite being unable to cure the illness completely.
References
Becasen, J. S., Denard, C. L., Mullins, M. M., Higa, D. H., & Sipe, T. A. (2019). Estimating the prevalence of HIV and sexual behaviors among the US transgender population: A systematic review and meta-analysis, 2006–2017. American Journal of Public Health, 109(1), 1-8.
CDC. (2022). Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs — Kanawha County, West Virginia, 2019–2021. Centers for Disease Control and Prevention.
Eisinger, R. W., Dieffenbach, C. W., & Fauci, A. S. (2019). HIV viral load and transmissibility of HIV infection: Undetectable equals untransmittable. Jama, 321(5), 451-452. doi:10.1001/jama.2018.21167
Fauci, A. S., Redfield, R. R., Sigounas, G., Weahkee, M. D., & Giroir, B. P. (2019). Ending the HIV epidemic: A plan for the United States. Jama, 321(9), 844-845. doi:10.1001/jama.2019.1343
HIVinfo.nih.gov. (2021). HIV Overview. HIVinfo.NIH.gov. Web.
Jiang, H., Zhou, Y., & Tang, W. (2020). Maintaining HIV care during the COVID-19 pandemic. The Lancet HIV, 7(5), e308-e309.
Ssentongo, P., Heilbrunn, E. S., Ssentongo, A. E., Advani, S., Chinchilli, V. M., Nunez, J. J., & Du, P. (2021). Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis. Scientific Reports, 11(1), 1-12.
World Health Organization. (2022). HIV. Who.Org.