AIDS refers to Acquired Immunodeficiency Syndrome which is known as a life-threatening condition caused by the human immunodeficiency virus or HIV. The human immunodeficiency virus works to destroy the immune system, thus shutting down the body's natural defense against infections and diseases. Indeed, as HIV ravages the entire human body, it completely damages the immune system, making it vulnerable to all classifications of infections, including certain cancers that a normal human being without HIV would otherwise fight off on his own. AIDS is the last and worst stage of HIV infection; it does not mean that all people who have HIV will eventually develop the disease, especially with proper treatment and care.
Many different types of immune system cells, tissues, and organs work together to protect the body from attack by harmful bacteria, viruses, and other pathogens. Among these cells, there are white blood cells called CD4 or T-helper cells, which activate and recruit other cells of the immune system to act when a dangerous invasion occurs. Through the infection of these CD4 cells, HIV replicates, spreads, and infects the body. As a result, the destruction of more and more CD4 cells through the action of the virus will weaken the immune system to a level at which it will not be able to adequately protect the body from any infection and disease.
HIV is primarily spread through certain body fluids – blood, semen, vaginal secretions, rectal fluids and breast milk. Major routes of transmission include unprotected sex with someone infected with HIV, sharing needles and/or syringes for injection drug use, transfusion of HIV-contaminated blood or blood products, organ transplantation and mother-to-child transmission during birth or breastfeeding. In rare cases, HIV exposure has also occurred through infected blood or in work-related scenarios such as needlestick injuries.
Once HIV enters the body, it attacks CD4 cells, replicating within them. The immune system responds but, over time, the replication becomes less effective due to CD4 cell destruction caused by the virus. Left untreated, this results in a condition called AIDS. It usually takes many years for HIV to progress to AIDS, and in some situations, patients with HIV live for a long time without developing AIDS, especially when they are diagnosed early and placed on antiretroviral therapy (ART), a combination of drugs that slows down the replication of HIV in the body.
Of the conditions associated with AIDS, the most common is a greatly impaired immune system, which makes the person susceptible to opportunistic infections – infections that would affect “normal” people because of the strength of their immune systems, but not those that can. A person who has a weakened immune system will become painfully ill or even die as a result. Some of these opportunistic infections include pneumonia; tuberculosis; and certain types of fungal infections. Also, it is important to note that AIDS increases the risk of certain cancers, such as Kaposi sarcoma and certain lymphoma types. However, these cancers are opportunistic because they occur more often in patients who have weakened immune systems.
When HIV causes a person's blood CD4 count to drop below 200 cells per cubic millimeter, or a healthy immune system normally has CD4 levels between 500 and 1,500 cells per cubic millimeter, that level is reached. AIDS is then diagnosed. Therefore, if the CD4 count drops below 200 cells per cubic millimeter, or if a person develops one or more opportunistic infections or cancer, that person is classified as having AIDS. This does not mean that all infected individuals will experience AIDS; however, early diagnosis and treatment can prevent or completely reverse the progressive manifestations of the disease.
Antiretroviral therapy or ART is the best treatment for HIV and AIDS. ART involves a combination of drugs that target several stages of HIV's life cycle. These drugs prevent the virus from replicating; slow disease progression and allow immune recovery. People on ART who have achieved undetectable viral loads (the amount of HIV in the blood) can live very healthy lives. ART that is taken consistently and precisely can be reduced to undetectable levels, which means not transmitting the virus during sexual contact - an assumption. Undetectable vs. Untransmittable (U=U) ART has changed the way HIV is treated and has allowed many applicants to live their lives normally without developing AIDS.
There is really no treatment that can cure HIV/AIDS with ART, no matter how effective it is. The virus can remain dormant in the body, hiding in the reservoirs of infected cells, making it impossible to completely clear it from the body. Research is ongoing in trying to address the issue of cure with regard to HIV; yet, for the time being, patients will have to learn to live under the umbrella of long-term medication to cope with the disease.
While antiretroviral treatment (ART) is important in managing AIDS, patients with this disease usually require more than just medications. These patients will benefit from antibiotics for the treatment of infections, antivirals such as acyclovir for the control of conditions associated with weakened immunity such as herpes, and antifungal therapy for both prevention and treatment of fungal infections. Nutritional support and counseling may also be part of care to help these individuals cope with the physical and psychological challenges of living with HIV and AIDS. Psychological support is helpful in helping these people manage through the mental and emotional aspects, including the stigma and discrimination associated with an HIV or AIDS diagnosis.
The global response to AIDS has changed significantly since the disease was understood in the 80s. In the early years of the epidemic, people were largely unaware of the disease. They were generally ridiculed and heavily discriminated against. After years of medical research, many achieved advances in the art of medicine, turning HIV into a manageable chronic condition without any medical treatment. Public health campaigns propagated awareness about HIV transmission and prevention methods, safe sex practices and going for testing as well as complemented efforts to increase people's access to ART. Currently, millions of countries provide availability of ART for free or at very low cost, while efforts are being made to reduce the transmission of HIV globally, especially in the most high-risk populations.
HIV and AIDS continue to pose very serious challenges despite all the progress made in their fight. Access to treatment is still very limited in some places in the world, especially in low-income countries where health care delivery systems are poorly developed. Stigma and discrimination of AIDS and HIV affect many people, preventing them from seeking care and support. ART, although highly effective in suppressing the virus, cannot completely cure it. People living with HIV will have to remain on medication for a long time.
Another pillar of global destiny that links HIV and AIDS is prevention. Prevention methods include proper use of condoms, pre-exposure prophylaxis (PrEP), and harm reduction programs for people who inject drugs. Pre-exposure prophylaxis (PrEP) is a medication for HIV-negative individuals who have an increased risk of contracting the virus. It aims to reduce the likelihood of HIV infection. Early testing and diagnosis contribute greatly to HIV prevention because it is likely that people who know their status will take care of their own and others' health.
AIDS defines the final stage of being infected with HIV, which occurs when a person is doing very poorly in the late-infectious stage of the disease, often leading to severe opportunistic infections as well as cancer. HIV causes this disease by damaging the person's immune system using its human immunodeficiency virus. Brick by brick, HIV builds a health-destroying house on CD4 cells. Antiretroviral therapy can bring a real change in the management of HIV infection, without which there is no hope of a long, healthy life for those suffering from the virus. In short, prevention, early diagnosis and treatment will be the tools available to control AIDS and its spread. In addition, major challenges still arise due to inadequate access to treatment, stigma and ongoing research to find a cure for HIV.
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