Unveiling the Myths and Realities: Understanding AIDS and HIV

The pathogen that causes HIV and AIDS has been known since 1981. Researchers now assume that the HI virus has been up to mischief since the beginning of the 20th century, having evolved from a 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 can now be treated, a cure is not yet in sight. After being infected with the HI virus, many of those affected live for several years without any significant symptoms until AIDS breaks out in them. 

HIV weakens the immune system

In the early 1980s, reports of patients with similar symptoms began to pile up: they suffered from various diseases that the immune system of healthy people typically fights off. Severe pneumonia or unusual forms of cancer, such as Kaposi’s sarcoma, occurred.

In 1982, the disease got its name: AIDS, short for Acquired Immune Deficiency Syndrome. By that time, it had already been diagnosed in 14 countries.

Three years later, the triggering virus was found, and a year later, it was given the name “Human Immunodeficiency Virus” (HIV). Thousands of infected people were already known worldwide, and many of them had already died. 

With the discovery of the virus, there was great hope that a treatment would soon be found. However, it was not until the mid-1990s that a combination therapy was developed – which helped but did not heal. Since then, research has made great strides; however, no cure has been found. But at least the quality of life and expectations of people with HIV are many times better than in the early days.

 

transmission of the HI virus

The researchers suspect the HI virus is a relative of the “Simian Immunodeficiency” virus (SIV), affecting chimpanzees and monkeys. The virus was probably transmitted to humans by eating monkey meat, where it turned into HIV. 

The retrovirus is transmitted from person to person via the mucous membranes through the exchange of bodily 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 French kissing, but scientists now estimate the risk to be practically zero. Shaking hands, hugging, sharing dishes, bathing, or using the toilet are harmless. The virus only survives outside the human body for a short time.

HIV – often no symptoms or complaints for a long time

The HI virus docks onto a protein (CD4 protein) of specific body cells, infiltrates the cell and hides it in the DNA, the “memory” for the human genome – this process is also known as “reverse transcription”. It can remain undiscovered 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 keep copying its genetic information, to produce new proteins and to cut them together to create a new virus. This can separate itself from the host cell and break out into new cells, infecting them and thus potentiating the cycle described.

Since specific endogenous defence cells, in particular, have the protein CD4, to which the virus docks, these helper lymphocytes, particularly, are affected by the virus invasion. This, in turn, leads to the typical signs of the onset of AIDS, the complete picture of HIV infection: symptoms caused by illnesses that arise because the immune system is not working correctly. The affected immune cells are destroyed or can no longer fulfil their tasks because the viruses misuse their power plants to reproduce them.

 

The course of an HIV infection

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

1. primary phase 
2. latency period
3. AIDS-Stadium

Primary phase with flu-like symptoms

After an initial infection, the symptoms only appear a few days to weeks after transmission of the virus and last up to 2 weeks. They are often mistaken for the flu since general fatigue, fever, night sweats, loss of appetite, swelling of the lymph nodes, and skin rash occur.

In this phase, the viruses in the blood multiply exceptionally quickly, which means the infected person is very contagious.

Latency phase – number of viruses decreases

During the latency phase, the defence system deals with the virus invasion. The number of viruses (“viral load”) in the blood drops massively. Some of those affected live for years without feeling any symptoms. However, HIV is not idle but multiplies continuously.

Therefore, the number of CD4 helper cells gradually decreases so that the immune system’s performance steadily decreases. If the infection is not recognized 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”, i.e. infections caused by bacteria, fungi or viruses, which rarely cause disease in healthy people. Typical examples are pneumonia caused by Pneumocystis carinii (PCP) or toxoplasmosis of the brain.

In the blood, this stage of immunodeficiency is shown by a drop in CD4 cells and an increase in the number of viruses.

treatment of HIV

Even if the HIV infection still cannot be cured, the onset of the AIDS stage can be prevented or at least delayed for years if therapy is started early. That is why an HIV test makes sense 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), but vaccination still needs to be in sight. Drug therapy can intervene at different points in the viral cycle. Various active ingredients (usually at least three) are combined for an optimal effect.

In this way, the virus is prevented from entering the cell, its incorporation into the host DNA is prevented in various ways by reverse transcriptase, and protein production for copying and cutting together the viral genome is inhibited. Other points of attack are being tested.

The aim is to minimize virus multiplication, i.e. to keep the virus in check to the extent that it does not impair the function of the immune cells. It is currently not possible to remove the HI virus altogether from the body. According to current knowledge, the therapy must, therefore, be maintained for life.

It is essential to take the tablets regularly and exactly as specified; otherwise, HIV can become resistant, and the medication can become ineffective. Therapy starts depending on the number of viruses and CD4 helper cells in the blood.

Side effects of HIV therapy

The side effects of combination therapy are diverse and depend on the active ingredient and the individual reactions of those affected. Diarrhoea and headaches are often temporary and easily treatable. Acute side effects are not uncommon, especially in the first two weeks of therapy.

 Typical long-term consequences of HIV treatment are painful nerve inflammation (neuropathies) in the arms and legs, as well as disturbances in fat metabolism and fat distribution. In the process, subcutaneous fatty tissue regresses on the face, arms and legs while accumulating in the stomach and neck. In addition, organ damage, such as the liver, can also occur. 

Other side effects of HIV therapy include: 

• nausea and constipation
• Metabolic disorders such as diabetes mellitus
• dizziness
• insomnia
• increased blood fat levels
• renal dysfunction
• osteoporosis
• polyneuropathy

In order not to jeopardize the effectiveness of HIV therapy by stopping 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 management of HIV and AIDS and have a positive effect on the immune system. At the same time, malnutrition can promote the development of AIDS symptoms. The so-called wasting syndrome, associated with significant weight loss, diarrhoea and fever, is particularly typical in the advanced stage of the disease.

Complaints such as loss of appetite, vomiting, difficulty swallowing, general weakness or infections in the mouth can lead to reduced food intake. The result is significant weight loss. Artificial feeding with a tube is sometimes necessary to stabilize the weight.

As a preventive measure, it is advisable to ensure that you eat enough (especially energy and protein) and eat a balanced, healthy diet in every phase of the disease:

• Several small portions a day are advisable, especially if you lose appetite.
• In the event of diarrhoea and vomiting, we strongly recommend compensating for water, vitamin and mineral losses.
• In case of 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, zinc and selenium).
• People with HIV or AIDS should avoid eating unwashed fruit and vegetables, as well as foods containing raw eggs, fish or meat, to prevent an infection with salmonella or toxoplasma.