In HIV infection (synonyms: Acquired immunodeficiency syndrome; AIDS/HIV; AIDS virus; ARV (AIDS-associated retrovirus); HIV infection; HIV virus; HTLV III (human T-cell lymphotropic virus III); HTV virus; human immunodeficiency virus; Human immunodeficiency virus disease; Human immunodeficiency virus; Immunodeficiency disease; LAV; LAV (lymphadenopathy-associated virus); Human immunodeficiency virus; Human immunodeficiency virus;err: HIV virus; ICD-10-GM B24: Unspecified HIV disease [human immunodeficiency virus disease]) is a currently incurable disease caused by the human immunodeficiency virus (HI virus). The HI virus belongs to the complex retroviruses. In Europe, an HIV infection usually presents as an HIV-1 infection. An HIV-2 infection is almost 1,000 times rarer compared to HIV-1.In Germany, infections with the human immunodeficiency virus-1 (HIV-1) are dominated by subtype B.Worldwide, however, HIV-1 subtype B is responsible for only 11% of HIV infections. The most common is HIV-1 subtype C, which is responsible for 48% of all HIV-1 infections globally. Focal points are India or South Africa, where more than 98% of HIV-1 infections are attributed to subtype C. The disease belongs to the sexually transmitted diseases (STD) or STI (sexually transmitted infections). Occurrence: The infection occurs worldwide. It is most common in sub-Saharan Africa. The largest group of people affected are homosexual men. However, for some time now, more and more heterosexual young people have also been infected. Transmission of the pathogen (route of infection) occurs through:
- Unprotected sexual intercourse (anal sex / anal sex, vaginal intercourse, rarely oro-genital contact).
- Introduction of blood or blood products containing pathogens into the bloodstream (use of injecting equipment by several persons – “needle exchange” in case of i. v. drug use; transfusion of contaminated blood or coagulation preparations)
- Pre-, peri-, or postnatal (through breastfeeding) from infected mother to her child; approximately 35-40% of mother-to-child HIV transmissions (transmissions) occur peripartum (around the birth period) and 15-45% of children become infected during breastfeeding if the mother is not receiving antiretroviral treatment.
Note: Women are more susceptible to HIV infection than men during heterosexual intercourse. The risk of infection from a needle stick injury (NSV, NSTV) with virus-positive blood is up to 0.3%. Note: HIV-infected persons without other sexually transmitted diseases (STD) are not sexually infectious under effective antiretroviral therapy. The prerequisite for this is strict adherence to antiretroviral therapy by the HIV-infected sexual partner, which must be monitored by the attending physician. Furthermore, the amount of virus in the blood must have been below the detection limit for at least six months and thus there must be suppression of viremia (presence of virus in the blood); likewise, there must be no detectable sexually transmitted diseases (STD). Other studies have confirmed this: the PARTNER (Partners of People on ART – A New Evaluation of the Risks) prospective observational study and the Opposites Attract cohort study of more than 350 HIV-serodiscordant gay male couples in Australia, Bangkok, and Rio de Janeiro. HIV infection is categorized as follows:
- Acute HIV disease – occurs a few days to weeks after infection in 50% of those affected; it manifests with fever, lymphadenopathy (enlargement of lymph nodes), and other flu-like symptoms; these symptoms resolve spontaneously after three to four weeks
- Symptom-free stage – this phase can last from a few months to many years (on average, about 10 years); usually the transition to the third phase is indicated by a gradual deterioration of the health condition
- Symptomatic stage – occurrence of AIDS-defining diseases (= full-blown Acquired Immunodefficiency Syndrome; acquired immunodeficiency syndrome, AIDS).
In 49.5% of HIV-infected people in Germany, the infection is diagnosed late (“HIV Late Presenters”), when the CD4 cell count is already below 350/µl or already AIDS-defining diseases (eg Pneumocystis jirovecii pneumonia, toxoplasmosis encephalitis, systemic candidiasis, Kaposi’s sarcoma).Frequency peak: The disease occurs predominantly between the ages of 25 and 40. In Europe, older people are becoming increasingly infected with HIV. According to a study, about one in six new diagnoses is among people over the age of 50. AIDS is the fourth leading cause of death worldwide. The incidence (frequency of new cases) is about 3.5 cases per 100,000 inhabitants per year. Course and prognosis: “HIV” stands for the pathogen. After a course of several years, the infection can turn into the disease “AIDS” (Acquired Immune Deficiency Syndrome). For the course, see above under “The HIV infection is divided as follows”. AIDS is chronic. Medical advances have significantly increased the life expectancy of those with the disease. The disease is now considered a chronic disease. Researchers predict a life expectancy of about 70 to 80 years. HIV-2 infected individuals, who are nearly 1,000 times less common in Europe compared with HIV-1, also have a high risk of developing AIDS and dying without antiretroviral therapy:
- Mean CD4 cell counts of HIV-2-infected individuals were higher on average than those of HIV-1-infected individuals and declined at a slower rate
- Mean time from infection to the development of AIDS was 6.2 (HIV-1) and 14.3 (HIV-2) years
- Median survival time after diagnosis of HIV infection was 8.2 (HIV-1) and 15.6 (HIV-2) years
HIV-infected individuals who start antiretroviral therapy immediately and are consistent with therapy can reliably prevent their sexual partners from becoming infected, if at the same time it is ensured that condoms are used. Notice:
- HIV infections have the third largest burden of disease of all infectious diseases after tuberculosis.
- In one in two Europeans, HIV infection is detected only at a late stage.
In Germany, the direct or indirect detection of the pathogen is reportable by name according to the Infection Protection Act (IfSG), as far as the evidence indicates an acute infection. Comorbidities (concomitant diseases): myocardial infarction (heart attack) and apoplexy (stroke; double risk in each case), virus-associated cancers (14 times more common), other forms of cancer (17 more common), chronic neurocognitive problems, chronic liver and kidney dysfunction, and osteoporosis-related fractures (broken bones).
