AIDS and HIV: Symptoms and Treatment

Brief overview

  • Symptoms: Early symptoms resemble flu, later severe weight loss, night sweats, diarrhea, secondary diseases such as lung inflammation, fungal infections, tuberculosis, Kaposi’s sarcoma
  • Treatment: drugs that prevent the virus from multiplying, alleviate symptoms, strengthen immunity
  • Diagnosis: Blood test first for HIV antibodies, then for HIV antigens; confirmed diagnosis only possible three months after infection
  • Causes and risk factors: unprotected sex, infected drug paraphernalia, puncture wounds with, for example, infected needle
  • Course and prognosis: Can be treated very well if detected early, but cannot be cured.
  • Prevention: Condoms, clean drug paraphernalia, if necessary certain medications if there is a reasonable suspicion of infection

What is HIV and AIDS?

AIDS is an acquired immune deficiency syndrome. It is caused by the HI virus, which attacks certain cells of the immune system. The difference between HIV and AIDS is that HIV refers to the pathogen that causes the immune deficiency, while AIDS refers to the final stage of an HIV infection.

Many people who have been infected with HIV do not yet show any symptoms or they can still be averted by medication. Patients in the AIDS stage, on the other hand, suffer from various typical, often life-threatening secondary infections and tumors due to the pronounced immune deficiency.

In countries with good health care systems, modern medicines often prevent the onset of AIDS. In most cases, the viral load in the blood can be reduced to such an extent that the pathogen is no longer detectable. A largely normal life with a normal life expectancy is then possible. However, it is important that treatment begins early.

What does HIV stand for?

HIV stands for “human immunodeficiency virus”, which means human immunodeficiency virus. It multiplies in special immune cells, so-called T-helper cells. To do this, it introduces its genetic blueprints into the cell, uses its replication structures and thus destroys the T cells. However, T-helper cells play a central role in the immune defense system: In the defense against pathogens, they coordinate other cells of the immune system.

For a while, the body manages to fight off the HI viruses. To do this, it forms special antibodies that detect the HI virus. This so-called latency phase sometimes lasts for years. The patient is then infected and infectious for others, but does not feel any symptoms of the disease.

At some point, however, there are no longer enough T-helper cells. Then other viruses as well as bacteria and fungi have an easy time in the body of the infected person.

What does AIDS stand for?

In the final stage of an HIV infection, patients develop AIDS. The abbreviation AIDS stands for “acquired immune deficiency syndrome”. This means “acquired immune deficiency syndrome”.

In this stage, the immune defense is severely weakened. The patient then falls ill with infections that are otherwise rare but quickly become dangerous. In addition, patients develop a so-called wasting syndrome with fever, diarrhea and severe weight loss.

Frequently, the viruses now also attack the brain, resulting in a so-called HIV-associated encephalopathy. This disease of the brain is accompanied by disturbances in physical but also mental performance. In some cases, it leads to dementia. Specific malignant changes such as Kaposi’s sarcoma are also typical of AIDS.

What are the symptoms of HIV and AIDS?

The symptoms of HIV infection up to AIDS stage differ according to the phase of the disease.

Acute HIV infection

In about 30 percent, the first symptoms of HIV infection appear within six days to six weeks after infection. In this acute phase, the symptoms resemble a flu-like infection or a mild case of glandular fever. Therefore, HIV infection often goes undetected in the early stages. First signs are:

  • Headache and/or sore throat
  • Fever and/or night sweats
  • Diarrhea
  • Skin rash especially on chest and back

This first acute phase of HIV infection usually lasts only one to two weeks. In many cases this is also mild in its course, which is why many affected people do not see a doctor here. Here there is a strong virus multiplication, which is why the risk of infection via body fluids such as semen, blood or via the mucous membranes is high.

If you are worried that you have contracted HIV, for example through unprotected sexual intercourse, it is important to consult a doctor. Be sure to take symptoms seriously, even if they subside again. Only an early therapy will help you. A test brings security for you and also protects others from an infection.

Symptom-free latency phase

After the first HIV symptoms have subsided, the virus infection sometimes remains symptom-free or symptom-poor for years. On average, this is ten years, but may be shorter in infants or young children or in immunocompromised individuals.

However, the virus remains active during this time and causes long-term damage to the immune system. This silent phase of the infection (also called the latency phase) ends in about 40 percent of HIV sufferers with swelling of the lymph nodes all over the body. This condition usually lasts longer than three months.

Phase with symptoms of HIV infection

  • Prolonged diarrhea (over four weeks)
  • Fever above 38.5 °C
  • Peripheral neuropathy (nerve disorders apart from brain and spinal cord, e.g. in arms or legs)
  • Fungal diseases in the throat or genital area
  • Shingles (herpes zoster)
  • Oral hair leukoplakia (whitish changes on the lateral edge of the tongue)

Symptoms in the AIDS stage of HIV infection

In the advanced stage, HIV infection leads to AIDS. Especially in untreated or late diagnosed HIV patients, AIDS then occurs. In this phase, the severely weakened immune system is no longer able to withstand the many pathogens. If left untreated, about half of all infected persons develop AIDS ten years after HIV infection.

AIDS-defining diseases include:

  • Wasting syndrome
  • Brain function disorders (HIV-associated encephalopathy).
  • Opportunistic infections (such as certain fungal infections, cerebral toxoplasmosis, or common bacterial lung infections)
  • Certain cancers such as Kaposi’s sarcoma, non-Hodgkin’s lymphoma, cervical carcinoma

Wasting syndrome

Symptoms of the so-called wasting syndrome are:

  • Unintentional weight loss of more than ten percent of body weight
  • Persistent diarrhea (for more than 30 days)
  • Fever and exhaustion

HIV-associated encephalopathy

  • Concentration and memory disorders
  • Gait disturbances as well as fine motor performance deficits
  • Depression

Opportunistic infections

In so-called opportunistic infections, pathogens take advantage of immune deficiencies to multiply. While such infections are rare in people with a healthy immune system and can be easily fought, they can be life-threatening in AIDS patients.

These include the following diseases:

  • Lung inflammations caused by the pathogen Pneumocystis jirovecii
  • Candida fungus infections of the esophagus and deep respiratory tract
  • Brain inflammations caused by the toxoplasmosis pathogen
  • Cytomegalovirus infections in the eye, lung, brain or intestine
  • Tuberculosis

Certain cancers

In 20 percent of cases, AIDS is diagnosed only in conjunction with these diseases. These AIDS-defining cancer diseases include:

  • Kaposi’s sarcoma: malignant neoplasm of blood vessels visible on the skin as brown-red spots, colloquially known as AIDS spots; but occur throughout the body (stomach, intestines, lymph nodes, lungs)
  • Non-Hodgkin’s lymphoma: mostly in men
  • Carcinoma of the uterus (cervical carcinoma).

There are also other cancers, such as Hodgkin’s lymphoma or lung carcinoma, that also occur in people with HIV, but are not definitive of AIDS.

How can HIV/AIDS be cured?

The HIV drugs succeed in reducing the viral load in the blood to below the detection limit. This makes it possible to rebuild a stable immune system, prevent the transition to a higher stage of the disease and eliminate the risk of infecting others (infectivity).

Carefree sex and parenthood are then possible without any problems. The earlier the disease can be treated, the better the chances of an unencumbered life. Additional diseases such as hepatitis, on the other hand, make treatment more difficult.

Highly active anti-retroviral therapy (HAART)

HIV patients receive highly active anti-retroviral therapy, or HAART for short. It consists of an individually adapted combination of different drugs. A combination of different drugs is important to prevent the development of resistance of the HI virus. The following drugs are available:

  • Reverse transcriptase inhibitors (RTI): these prevent the HI virus from replicating by inhibiting the “reverse transcriptase” enzyme required for this purpose. Active ingredient examples: Lamivudine, tenofovir, emtricitabine, efavirenz.
  • Protease inhibitors (PI): These prevent viral replication by inhibiting the reassembly of viral particles. One of these agents is atazanavir.
  • Fusion inhibitors (FI): These prevent the virus from entering a human cell. They include enfuvirtide, for example.

In addition, since 2020/2021 there have been other newly approved substances (monoclonal antibodies and attachment inhibitors) that are used for the drug treatment of HIV.

When and to what extent physicians initiate HAART depends on each individual patient. Decisive for the decision are, for example, the current symptoms as well as the possible side effects of the HIV treatment. Laboratory criteria also play a role in the treatment decision, for example the number of remaining T-helper cells.

In addition to the lifelong, regular intake of medication, regular control appointments are part of the treatment. Doctors determine the number of HI viruses (viral load) and T helper cells in the blood and thus check the success of the therapy. The doctor also keeps an eye on possible long-term side effects such as cardiovascular diseases, kidney problems or osteoporosis.

HIV and AIDS – What those affected can do themselves

Drug treatment is the basis of AIDS therapy. In addition, there are the following recommendations within the framework of treatment:

  • Look for a doctor who is an AIDS specialist and whom you find sympathetic. Since you will be in his medical care for a long time, this is important.
  • Follow your doctor’s instructions. Take your medications according to the schedule given. If you cannot tolerate the medications, it is important that you do not just stop taking them, but talk to your doctor first.
  • Immunizations (influenza, SARS-CoV-19, and pneumococcal) are especially important for those who are immunocompromised. Because of HIV infection, there is a possibility that certain diseases may be more severe for you or weaken you.

A healthy lifestyle is also important, especially for those affected by HIV. Aspects that you as an affected person can influence yourself are:

  • It is advisable not to smoke or take drugs, as this further weakens your body.
  • Strengthen your immune system by eating plenty of fruits and vegetables and whole grain products. If you have problems with the gastrointestinal tract, nutritionists will help.
  • Move regularly. This will help keep your body and mind in balance. Relaxation and sufficient sleep also strengthen your immune system.
  • Be careful with pets. Always wash your hands after petting animals, and wear gloves when cleaning the litter box or a rodent pen to protect yourself from toxoplasmosis.

Counseling & Self-Help: If you have HIV, it is often helpful to go to an AIDS counseling center. Here you will receive comprehensive information about living with HIV, support options and help for self-help. Also the exchange with other affected people often opens new perspectives. You will find a link to a self-help group at the end of this article.

How are HIV and AIDS diagnosed?

If you fear that you have contracted HIV, your first port of call is usually your family doctor. He or she will then refer you to an AIDS specialist, such as an internist with experience in infectious diseases. First, your doctor will ask you in detail about your medical history. Among other things, he will ask you the following questions:

  • Have you had unprotected sexual intercourse?
  • Do you inject drugs?
  • Do you work in a medical profession?
  • Have you had flu-like symptoms in the last few weeks?

The next step is the HIV test, i.e. a blood test to detect HIV, also known colloquially as the AIDS test. There are different ways to perform this test, as a laboratory test with blood from the crook of the arm or as a rapid test with blood from the fingertip.

As a rule, the doctor takes blood from the crook of the arm and sends the test to the laboratory. There they look for antibodies. If these are present, a further test is performed for confirmation. Sometimes the test result is inconclusive, in which case doctors arrange for further specific tests. These include, for example, the detection of a special component of HIV (HIV RNA).

The infection can only be ruled out by the HIV test in the laboratory six weeks after the suspected infection. However, the result is already available after a few days. With the rapid test, the period for the definite exclusion of an infection is even longer and is twelve weeks, but the result is available after only a few minutes.

The body needs about two to ten weeks until antibodies are detectable in the blood. A negative HIV test three months after a possible infection therefore usually rules out infection with a high degree of certainty.

Further information on this topic can be found in the article HIV test.

  • Viral load: amount of virus in the blood; the aim of therapy is to reduce this as much as possible
  • T-helper lymphocytes: provide information about the stage of the disease and the extent of immunodeficiency
  • HIV resistance determination: Before starting therapy and if the drugs do not work

What are causes and risk factors of HIV and AIDS?

The causative agent of HIV infections and AIDS is the HI virus. The HI virus belongs to the family of retroviruses. The HI virus consists essentially of hereditary information (RNA), which is packaged in a protein capsule and enveloped by a membrane. It is about 80 to 100 nanometers in size. There are two types of HIV, with type 1 being the most common worldwide.

Like all viruses, it depends on the cells of organisms (host cells) to replicate. Host cells of the HI virus are T helper cells of type D4. It introduces genetic information into them in the form of a single RNA strand. First, this RNA strand is converted into DNA by the enzyme reverse transcriptase, followed by replication.

HIV – how do you get infected?