When a person first contracts HIV, the virus will affect their body in several stages. If left untreated, HIV is likely to lead to AIDS.
Due to medical advances over the last 30 years, the development of HIV can be significantly reduced or stalled. With lifelong medication, a person with HIV is usually able to lead a healthy life, and, in many cases, will never develop AIDS itself.
The first signs of HIV usually appear after 2-6 weeks in the form of flu-like symptoms. This condition is known as seroconversion illness. Seroconversion is the stage when a person's body is producing antibodies to HIV, which means that their immune system is fighting the infection.
Flu-like symptoms that accompany seroconversion include:
These symptoms usually last for 1-2 weeks. Once the seroconversion period is over, a person may not experience any HIV symptoms for several years.
Although people tend to feel well at this stage, it is important to remember that HIV is still active. As it continues to reproduce and infect new cells, HIV also damages a person's immune system, which means it is unable to protect the body from illness.
HIV infects a cell by first attaching itself to, and merging with, the host T cells. T cells, also known as CD4 cells, are a type of white blood cell that form a crucial part of the immune system.
Once inside the host cells, HIV multiplies. The virus damages or destroys the cells before moving on to infect more cells.
A CD4 count is an indication of the health of a person's immune system. A healthy CD4 count is between 500 and 1,500.
The CD4 count of a person with HIV who does not receive HIV treatment will reduce over time. Once the CD4 levels fall below 200, a person's immune system will probably be damaged and the person will likely experience definitive signs and symptoms of illness.
People who have HIV and are not receiving treatment put themselves at greater risk of developing symptoms, a condition known as symptomatic HIV. They are also more likely to pass on the virus to another person.
Without treatment, a person is likely to develop AIDS because their immune system is no longer able to protect the body. At this stage, even the most minor infection becomes life-threatening.
Opportunistic infections and AIDS-defining illnesses
A person with HIV may also become ill from opportunistic infections. They are called opportunistic because they take advantage of the weakened immune system.
Opportunistic infections are usually caused by ordinary, harmless viruses, bacteria, and fungi, which only provoke disease when the immune system is compromised. Many of these infections are not life-threatening to a healthy person. To someone with HIV, however, they can be very serious and potentially fatal.
An opportunistic infection is considered to be AIDS-defining when it spreads beyond the region or organ where it is typically found.
Some of the more common opportunistic infections are:
- certain cancers, such as Kaposi's sarcoma
- cryptococcal meningitis
Many people with HIV develop coinfections, diseases that can both have an effect on HIV and be affected by HIV.
Although there is no cure for HIV, medical treatment is available that significantly reduces the amount of the virus in the body to the point where it may become undetectable in the blood.
The amount of virus in a person's body is known as the viral load. An undetectable viral load means that the person with HIV is not infectious and that the virus is not able to damage their immune system.
HIV treatment is known as antiretroviral therapy (ART). It is recommended that everyone who is diagnosed with HIV begins treatment straight away, no matter what their CD4 count may be.
Treatment for HIV is also referred to as combination therapy as people will usually take a combination of three different drugs at the same time. Combination therapy is used because HIV can adapt quickly and become resistant to a single type of ART.
A "fixed dose combination" is when ART drugs have been combined into a single pill, which means that a person can take just 1 or 2 pills a day. It is very important that people take the drugs in the right way at the right time each day.
People with HIV may experience side effects from their ART drugs. The most common side effects are:
When undergoing ART, a person needs to be aware that their medication may interact with other prescription medications as well as herbal remedies and recreational drugs.
Other possible adverse effects include:
- poor kidney function
- inflamed pancreas
- glucose intolerance
A person taking ART drugs may find they experience metabolic effects, such as fat redistribution, hyperlipidemia, and insulin resistance. They may also develop conditions, such as osteopenia and osteoporosis, that will affect their bones.
Despite these problems, there is evidence now of the long-term safety of ART, which has significantly improved the life expectancy of many people with HIV.