AIDS and HIV

The pathogen that causes HIV and AIDS has been known since 1981. In the meantime, researchers assume that the HI virus has been up to its mischief since the beginning of the 20th century, originating from a type of virus transmitted from monkeys to humans. While around three thousand new infections were reported in Germany in 2015, more than 36 million people worldwide are infected with HIV. Although HIV is now treatable, a cure is not yet in sight. After infection with the HIV virus, many affected people live for several years without any major symptoms until they develop AIDS.

HIV weakens the immune system

In the early 1980s, reports of patients with similar symptoms began to accumulate: they suffered from many different diseases that are normally warded off by the immune systems of healthy people. Thus, severe pneumonia or unusual forms of cancer such as Kaposi’s sarcoma appeared. In 1982, the disease got its name: AIDS, short for Acquired Immune Deficiency Syndrome. At that time, it had already been diagnosed in 14 countries. Three years later, it was possible to find the virus that caused the disease, and a year later it was christened “human immunodeficiency virus” (HIV). Thousands of people worldwide were already known to be infected and many of them had already died. With the discovery of the virus, hopes were high that a treatment would soon be found. But it was not until the mid-1990s that a combination therapy was developed – which helped but did not cure. Since then, research has made great strides; however, no cure has been found to date. But at least the quality and expectation of life for HIV sufferers is many times better than it was in the early days.

Transmission of HIV

The HI virus, researchers suspect, is a relative of the “simian immunodeficiency” virus (SIV) that affects chimpanzees and monkeys. Presumably, the virus was transmitted to humans through the consumption of monkey meat, where it transformed into HIV. The retrovirus is transmitted from person to person via the mucous membranes through the exchange of body fluids (blood, semen, vaginal fluid, breast milk), especially during unprotected sexual contact, through the shared use of syringes or (especially in the early days) through contaminated blood supplies. Theoretically, there is also a risk of infection during oral sex or tongue kissing, but the risk is now considered by scientists to be virtually zero. Shaking hands, hugging, sharing dishes, bathrooms or toilets, on the other hand, are not dangerous. The virus survives outside the human body only for a short time.

HIV – often no symptoms or discomfort for a long time

The HI virus docks onto a protein (CD4 protein) of certain body cells, infiltrates the cell and hides there in the DNA, the “memory” for the human genetic material – this process is also called “reverse transcription”. It can remain undetected in the host DNA for a long time. This is also the reason why many infected people do not know about their disease for months or even years. HIV uses the host cell to copy its own genetic information over and over again, producing new proteins and splicing them together to create a new virus. This can cut itself off from the host cell and break open to new cells, infecting them as well and thus potentiating the cycle described. Since certain of the body’s own immune cells in particular possess the protein CD4, to which the virus docks, it is primarily these helper lymphocytes that are affected by viral invasion. This in turn leads to the typical signs at the outbreak of AIDS, the full-blown HIV infection: symptoms due to diseases caused by the immune system not working properly. Namely, the affected defense cells are destroyed or can no longer perform their tasks because their power plants are misused by the viruses to reproduce them.

Course of HIV infection

The course of HIV infection is divided into three stages with different symptoms:

  1. Primary phase
  2. Latent phase
  3. AIDS stage

Primary phase with flu-like symptoms.

After an initial infection, symptoms do not appear until a few days to weeks after transmission of the virus and last up to 2 weeks. They are often mistaken for influenza because of general fatigue, fever, night sweats, loss of appetite, and lymph node swelling and rash.At this stage, the viruses in the blood multiply extremely quickly, which means that the infected person is very contagious.

Latent phase – number of viruses decreases.

During the latency phase, the defense system first tries to cope with the viral invasion. The number of viruses (“viral load”) in the blood drops massively. Those affected sometimes live for years without feeling any symptoms. However, the HIV is not inactive, but multiplies continuously. Therefore, the number of CD4 helper cells gradually decreases, so that the efficiency of the immune system steadily decreases. If the infection is not detected and the virus is not contained with medication, the HIV infection progresses to the AIDS stage.

AIDS stage: opportunistic infections

The AIDS stage is characterized by “opportunistic infections,” infections caused by bacteria, fungi, or viruses that rarely cause disease in healthy individuals. Typical examples include pneumonia caused by Pneumocystis carinii (PCP) or toxoplasmosis of the brain. In the blood, this stage of immunodeficiency is shown by the decrease in CD4 cells and the increase in the number of viruses.

Treatment of HIV

Although HIV infection still cannot be cured, early initiation of therapy can prevent the onset of the AIDS stage or at least delay it for years. For this reason, an HIV test is advisable at the slightest suspicion of a possible infection – even if there are no symptoms. The therapy is carried out with antiretroviral drugs (antiretroviral therapy / ART), a vaccination is still not in sight. Drug therapy can intervene at various points in the viral cycle. For optimal effect, different active ingredients (usually at least three) are combined. Thus, the virus is prevented from entering the cell, its incorporation into the host DNA by reverse transcriptase is impeded in various ways, and protein production for copying and assembly of the viral genome is inhibited. Other targets are being tested. The goal is to minimize viral replication, i.e., to keep the virus in check to the extent that it does not interfere with the function of immune cells. It is currently not possible to completely remove the HI virus from the body. Therefore, according to the current state of knowledge, the therapy must be maintained for life. It is important to take the tablets regularly and exactly as prescribed, otherwise the HIV can become resistant and the medication ineffective. The start of therapy is based on the number of viruses and CD4 helper cells in the blood.

Side effects of HIV therapy

Side effects of combination therapy are varied and depend on the active ingredient and the individual’s response. Often only temporary and easily treatable are diarrhea and headaches. Especially in the first two weeks of therapy, acute side effects are not uncommon. Painful nerve inflammations (neuropathies) in the arms and legs as well as disturbances in fat metabolism and fat distribution occur as typical long-term consequences of HIV treatment. Subcutaneous fat tissue is reduced in the face, arms and legs, while it is increasingly stored in the abdomen and neck. In addition, organ damage, for example to the liver, can also occur. Other side effects of HIV therapy include:

  • Nausea and constipation
  • Metabolic disorders such as diabetes mellitus
  • Vertigo
  • Insomnia
  • Increased blood lipid levels
  • Renal dysfunction
  • Osteoporosis
  • Polyneuropathy

In order not to jeopardize the effectiveness of HIV therapy by discontinuing it due to the various side effects, the doctor often has to change the combination of drugs.

Nutrition in HIV and AIDS

Proper nutrition can also play a role in the treatment of HIV and AIDS and have a positive effect on the immune system, while malnutrition can promote the development of AIDS symptoms. Especially in the advanced stage of the disease, the so-called wasting syndrome is typical, which is accompanied by significant weight loss, diarrhea and/or fever. Complaints such as loss of appetite, vomiting, dysphagia, general weakness or infections in the oral cavity can lead to reduced food intake. The result is significant weight loss. Artificial feeding with a tube is sometimes necessary to stabilize the weight.For prevention, it is advisable to ensure adequate food (especially the energy and protein supply) and a balanced, healthy diet at every stage of the disease:

  • Several small portions a day are advisable, especially if there is a loss of appetite.
  • In case of diarrhea and vomiting, the compensation of water, vitamin and mineral losses is strongly recommended.
  • For chewing and swallowing difficulties, the food can be pureed.
  • Peppermint tea can help with a dry mouth.
  • In consultation with the doctor, dietary supplements can be taken to meet the increased need for vitamins and minerals (especially vitamins A, C and E, and zinc and selenium).
  • On unwashed fruits and vegetables, as well as foods with raw egg, fish or meat, those affected by HIV or AIDS should better avoid to prevent infection with salmonella or toxoplasma.