The virus, which is transmitted from person to person through certain bodily fluids, is a life-long condition that typically progresses over time. Certain treatments help to slow or stop HIV progression.
If left untreated, HIV continues to damage the immune system cells and increases the likelihood of developing AIDS (acquired immune deficiency syndrome).
Untreated HIV also increases the risk of developing certain types of infections known as opportunistic infections. According to the Centers for Disease Control and Prevention (CDC), opportunistic infections are "infections that occur more frequently and more severely in those with weakened immune systems, including people with HIV."
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Stages of HIV
There are three stages to HIV infection.
Stage 1: Acute HIV infection
People in the acute stage of HIV infection may have flu-like symptoms within the first month of contracting the virus.
Those in stage 1 of HIV have a large amount of the virus in their bloodstream. During this stage, there is a high risk of transmitting the virus to others.
Within 2 to 4 weeks of becoming infected with the HIV, flu-like symptoms develop in many people, but not all. These symptoms represent the body's natural response to an infection as it attempts to kill off the virus. However, the human body is unable to completely remove HIV once it is contracted.
The virus replicates itself using the body's own CD4 cells and spreads throughout the body. In the process, it destroys the CD4 cells.
Eventually, this process stabilizes. The immune system brings the level of viral cells down while the CD4 cell count increases. However, CD4 cells may not return to their original level.
Symptoms at acute stage
- muscle and joint aches and pains
- raised temperature
- ulcers in the mouth
- night sweats
- body rash
- sore throat
- swollen glands
Stage 2: Clinical latency
During the second stage, the virus is active but reproduces at very low levels. People in this stage of HIV generally experience no symptoms, or very mild ones. This is why stage 2 is also known as the "asymptomatic stage."
For people who are not taking any medication, the clinical latency stage lasts approximately 10 years. Those who are on a treatment program may remain in this stage for many decades, as drug treatment reduces viral activity.
HIV can be transmitted to others during the clinical latency stage, although those undergoing treatment are less likely to transmit it. However, transmission is still possible at all stages so appropriate precautions must be always be taken.
Stage 3: AIDS
AIDS is the final stage of HIV infection. Those who are not taking medication for HIV are likely to progress to this stage once their viral load increases and their CD4 cell count drops. People who are undergoing drug therapy for HIV may never progress to AIDS.
An AIDS diagnosis is made when the CD4 cell count of someone with HIV drops to under 200 cells per cubic millimeter (cells/mm3) of blood. Healthy individuals have a CD4 count of between 500 and 1,600 cells/mm3.
Alternatively, the development of one or more opportunistic infections can also indicate the virus has progressed to AIDS.
Symptoms at AIDS stage
Symptoms at this stage vary greatly as they are typically symptoms associated with various opportunistic infections. Some of the more common symptoms include:
- blotches under the skin or in the mouth and nose
- blurred vision
- diarrhea lasting longer than 1 week
- swollen lymph glands
- constant tiredness
- fever that keeps coming back
- memory loss
- weight loss
- mouth, anus, or genital sores
Slowing or preventing HIV progression
The most effective way of slowing or stopping the progression of HIV is through early diagnosis and appropriate drug therapy.
A post-exposure prophylaxis or PEP drug may be taken within 72 hours of exposure to HIV and has a high success rate in reducing new infections.
The earlier a person is diagnosed with HIV and a drug treatment program is started, the greater the chance they will enjoy a near-normal lifespan. Early diagnosis also lowers the risk of transmission of the virus to others.
The two types of medications used to inhibit the progression of the virus are:
Antiretroviral therapy (ART)
The medication used to treat HIV is known as antiretroviral therapy. This treatment is beneficial for people at all stages of the virus. ART suppresses viral activity, increasing the lifespan of people with HIV.
Doctors can adapt the combination of drugs used to each patient. The prescribed schedule of medication should be strictly adhered to in order to ensure its effectiveness and prevent the virus becoming resistant to the drugs.
Post-exposure prophylaxis (PEP)
This is an emergency treatment that can be given to someone who believes they have been exposed to HIV within the previous 72 hours. It aims to stop HIV from becoming a lifelong condition.
The World Health Organization estimate that when taken correctly, the 28-day course of PEP reduces the risk of HIV infection by over 80 percent.
Certain lifestyle factors play a role in the progression of HIV, particularly those that boost the immune system and help the body fight infection. They include:
- Reducing stress: Stress weakens the immune system and increases the risk of developing other illnesses and opportunistic infections.
- Avoiding infections: People with HIV should take steps to protect against infection and illness, and get regular vaccinations if advised to by a doctor.
- Using condoms during intercourse: Condoms reduce the risk of transmitting HIV to others. They also safeguard those with HIV against other sexually transmitted infections that will further weaken immunity.
- Quitting smoking: Smokers with HIV are more likely to get infections such as candidiasis and pneumonia, or other illnesses such as certain cancers, heart disease, and chronic obstructive pulmonary disease (COPD).
- Exercising regularly: A regular exercise plan brings many benefits to those with HIV including reduced risk of heart disease, increased energy, improved circulation and lung capacity, better sleep, and less stress.
- Eating a healthful diet: Maintaining a balanced diet with low or no alcohol intake will help to boost the immune system and ward off infections.
Other factors affecting progression
Quitting smoking is recommended for people with HIV.
Although many of the factors that affect disease progression can be controlled by people with HIV, other factors also have an influence. These include:
- general health before infection
- HIV subtype
- the presence of other infections
Outlook if treatment is not received
People who are HIV-positive and do not seek treatment will generally progress to the AIDS stage within 2 to 15 years after infection.
After a diagnosis of AIDS, people who do not have treatment typically survive for 3 years. If a person who is not receiving treatment for AIDS also develops an opportunistic illness, their life expectancy drops to 12 months.
However, if treatment is sought before the virus advances, and the treatment regimen is adhered to, people with HIV can generally expect to live almost as long as those who do not have HIV.
According to 2013 research, a 20-year-old person who has HIV and who is receiving ART in the United States or Canada can expect to live into their early 70s. This life expectancy is not far off that of the general population.