Acquired Immunodeficiency Syndrome (AIDS)

Acquired Immunodeficiency Syndrome (AIDS) is a condition that occurs after infection with the Human Immunodeficiency Virus (HIV), in which the human body loses its natural immune capacity. AIDS itself is not a disease, but an infected human body loses its natural resistance to infectious diseases caused by bacteria, viruses, etc., because HIV (the virus that causes AIDS) attacks the immune cells present in the blood. As the immune system gradually deteriorates in AIDS patients, opportunistic infections—ranging from common colds to diseases like tuberculosis—can occur easily, and treatment becomes difficult. It can take 8 to 10 years or more for HIV infection to progress to the stage of AIDS. People infected with HIV can remain without significant symptoms for many years.

Currently, AIDS is one of the biggest health problems of the modern era, making it a pandemic. The three main causes of HIV transmission are unprotected sexual relations, blood exchange, and transmission from mother to child. Both the National AIDS Control Program and the United Nations support the view that in India, approximately 80 to 85 percent of infections are spreading through unsafe heterosexual/homosexual contacts. It is believed that the virus responsible for this disease, HIV, was first found in monkeys of a particular region in Africa, and from there it spread worldwide. It is still considered incurable, but research on treatment is ongoing globally. Since its discovery in 1981, around 3 billion people have lost their lives to AIDS.

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Differences Between AIDS And HIV

HIV is a highly susceptible virus that can lead to AIDS. AIDS itself is not a disease but a syndrome. It reduces the human body’s natural ability to fight other diseases. As resistance declines gradually, opportunistic infections—ranging from common colds to pneumonia, tuberculosis, cancers, and other serious illnesses—can occur easily, making treatment difficult, and may even lead to death. This is why AIDS testing is crucial. A definitive diagnosis of infection can only be made through medical tests. AIDS is a contagious disease—meaning it can be transmitted from one person to another. The full name of AIDS is “Acquired Immunodeficiency Syndrome,” which spreads through a specific virus called HIV (Human Immunodeficiency Virus). If someone has HIV, it doesn’t necessarily mean they have AIDS. AIDS occurs if HIV infects the body, and early treatment of the virus reduces the risk of developing AIDS.

AIDS In India

According to a recent study in the British Medical Journal, approximately 14-16 lakh people in India are affected by HIV/AIDS. While initially, in 2005, it was estimated that around 55 lakh people in India could be infected with HIV/AIDS, more accurate estimates in 2007 suggested that the number was closer to 25 lakh. These new figures are supported by the World Health Organization and UNAIDS. According to the 2011 AIDS report by the United Nations, the number of new HIV infections in India has decreased by about 50% over the past ten years.

Possible Reasons For The Increasing Number Of People Affected By AIDS In India

Lack of awareness among the general public about AIDS
Stigma attached to AIDS and sexually transmitted diseases
Absence of comprehensive sex education and awareness programs in schools
Some religious organizations condemning the use of contraceptives, etc.

Symptoms Of AIDS

People infected with HIV may not show any symptoms for a long time. Even after 3, 6 months or more, HIV often does not appear in medical tests. Many AIDS patients develop symptoms like cold or viral fever, but these do not confirm AIDS. Some early symptoms of AIDS include:

Fever
Headache
Nausea and loss of appetite
Swelling of lymph nodes

It is important to note that these symptoms can also be caused by common cold or other illnesses. Therefore, only medical tests can definitively diagnose AIDS. HIV infection has three main stages: acute infection, clinical latency, and AIDS.

Acute Infection

The initial phase of HIV, which begins after infection, is called acute HIV or primary HIV or acute retroviral syndrome. Many individuals show symptoms of flu or mononucleosis within 2 to 4 weeks, while some show no specific symptoms. In 40% to 90% of cases, symptoms appear, including high fever, tender lymph nodes, sore throat, ulcers, headache, or lesions in the mouth and genital areas. These ulcers appear in 20% to 50% of cases. Some individuals may develop opportunistic infections at this stage. Symptoms like gastrointestinal issues such as vomiting, nausea, or diarrhea, and neurological symptoms like peripheral neuropathy and diseases like Guillain-Barre syndrome may also appear. The duration of symptoms generally lasts for one or two weeks. Due to the absence of distinctive symptoms, people often do not recognize these as HIV infection. Many symptoms of common infectious diseases resemble such symptoms, leading healthcare professionals and hospitals to sometimes misdiagnose the disease. Therefore, if a patient develops recurrent fever without an apparent reason, an HIV test should be conducted, as this could be a sign of HIV infection.

Clinical Latency

The next stage following the initial symptoms of this disease is called clinical latency, asymptomatic HIV, or chronic HIV. Without treatment, the second stage of HIV infection can last from 3 to 20 years (average 8 years). Generally, few or no symptoms appear during this phase, although many people at the end of this stage experience fever, weight loss, gastrointestinal problems, and muscle pain. In about 50-70% of individuals, swelling or enlargement of lymph nodes (apart from those in the groin area) is also observed within 3-6 months. Although most individuals infected with HIV-1 have an detectable viral load, without treatment it ultimately increases and progresses to AIDS, while in some cases (about 5%), CD4+ T cells remain present in the body for more than 5 years without antiretroviral therapy (AIDS treatment). Individuals with such cases are classified as HIV controllers or long-term non-progressors, and those whose viral load remains low or undetectable without antiretroviral therapy are called elite controllers or elite suppressors.

AIDS

AIDS is defined in two ways: either when the number of CD4+ T cells drops below 200 cells per μL or when an individual develops diseases caused by HIV infection. Without specific treatment, half of the people infected with HIV develop AIDS within ten years. The most common initial conditions indicating the presence of AIDS are pneumocystis pneumonia (40%), symptoms such as weakness including weight loss, muscle stiffening, fatigue, decreased appetite, etc. (20%), and oropharyngeal candidiasis (thrush). Additionally, frequent respiratory tract infections are common symptoms. Opportunistic infections caused by bacteria, viruses, fungi, and parasites can occur, which are typically controlled by our immune system. Different individuals experience different types of infections depending on which pathogens or infections are prevalent in their surrounding environment. These infections can affect every organ system of the body.

HIV Transmission

Currently, approximately 420 million people worldwide are affected by HIV. Two-thirds of these live in African countries heavily impacted by the epidemic, and among those countries, one in three adults is infected. Every day, about 14,000 people worldwide become infected, raising concerns that HIV will soon spread entirely across Asia as well. Until an effective treatment is found, preventing AIDS remains the best way to combat it.

HIV Spreads Through Three Main Routes

Through sexual contact (anal, vaginal, or oral)
Through body fluids or tissues that are infected (blood transmission or sharing contaminated needles)
From mother to child (during pregnancy, childbirth, or breastfeeding)

There is no risk of HIV transmission from faeces, nasal secretions, saliva, mucus, sweat, tears, urine, or vomit unless these fluids are contaminated with HIV-infected blood.

HIV Transmission Through Sexual Contact

The most common mode of HIV transmission is through sexual contact with an infected person. Globally, the highest number of HIV cases is among heterosexual populations (i.e., sexual contact between males and females), accounting for 64% of new cases. However, the spread of HIV varies across countries and modes of transmission. In the United States, as of 2009, the majority of new HIV cases were among gay men, accounting for 64% of all new infections. The risk of HIV transmission per sexual act in low-income countries is estimated to be four to ten times higher than in high-income countries. In low-income countries, the risk of transmission from an infected woman to a man is 0.38%, while from men to women it is 0.30%. In high-income countries, these risks are 0.04% (woman to man) and 0.08% (man to woman). The risk of HIV transmission through anal intercourse is particularly high, estimated at 1.4-1.7% in both heterosexual and homosexual relationships. Oral sex poses a slightly lower, but still present, risk of HIV transmission.

Body Fluids or Tissues (Blood Transmission or Sharing Needles)

Blood and blood products are the second most significant source of HIV infection. Transmission occurs through shared use of needles during drug injection, injuries with infected needles, contaminated blood or blood products, or medical syringes with HIV-infected equipment. Sharing needles for drug injections has a transmission risk of 0.63-2.4%, averaging around 0.8%. The risk of HIV from using a needle previously used by an infected person is approximately 0.3% (1 in 333 cases), and the risk from blood contact with mucous membranes is about 0.09% (1 in 1,000). In the United States, in 2009, 12% of cases involved people who used intravenous drugs, and in some regions, over 80% of drug users tested HIV-positive. Using HIV-infected blood carries a transmission risk of up to 93%. Developed countries have a very low risk of HIV transmission through infected blood (less than 1 in 500,000 instances) because blood donors are tested for HIV prior to donation. In the UK, the average risk is less than 1 in 5 million. However, in low-income countries, only about half of the blood in use is properly tested, and it is estimated that about 15% of HIV infections in these regions are caused by contaminated blood or blood products, constituting 5-10% of global infections. In sub-Saharan Africa, unsafe medical needles play a significant role in HIV spread. In 2007, this route was responsible for 12-17% of infections. According to WHO estimates, the risk of HIV transmission via medical needles in Africa is approximately 1.2% per injection. While theoretically possible, the risk of HIV transmission from tattooing or scratching has not been confirmed by any cases so far. Mosquitoes or other insects cannot transmit HIV.

Mother-To-Child Transmission

HIV can be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. This is the third most common way HIV spreads worldwide. Without treatment, the risk of transmission during childbirth can be as high as 20%, and through breastfeeding, up to 35%. By 2008, about 90% of HIV infections in children were due to mother-to-child transmission. Proper treatment can reduce this risk from 90% to 1%. Anti-retroviral drugs given to the mother during pregnancy and delivery, performing cesarean sections, avoiding breastfeeding, and providing the newborn with antiretroviral medication are effective ways to prevent mother-to-child transmission. However, many of these measures are still not implemented in developing countries. If infected blood contaminates food during chewing, it can also pose a risk of HIV transmission.

Ways To Prevent AIDS

Remain faithful to your life partner. Do not have sexual relations with more than one person.

Always use a condom during sexual intercourse (masturbation).

If you are infected with HIV or suffering from AIDS, be sure to disclose this to your life partner. Keeping it secret and continuing sexual relations in this condition can also infect your partner and may affect your children.

If you are infected with HIV or suffering from AIDS, never donate blood.

Insist on getting your blood tested for HIV before receiving a transfusion.

If you suspect you have contracted HIV, get tested immediately. It is noteworthy that often HIV particles and infection may not be detected even 3 to 6 months after infection. Therefore, HIV tests should be repeated after the third and sixth months.

Sexual Contact

Consistently using a condom during sexual contact reduces the risk of HIV infection by about 80%. When one partner in a couple is infected with HIV, continuous condom use can reduce the chance of uninfected individuals acquiring HIV to less than 1% per year. Studies also show that women using vaginal condoms offer protection comparable to that provided by male condoms.

According to a study, applying a gel called tenofovir inside the vagina just before sex reduces the risk of HIV transmission by up to 40%. Conversely, spermicides containing nonoxynol-9 increase the risk of infection because they tend to cause irritation in the vagina and anus.

Male circumcision significantly reduces the rate of HIV infection among heterosexual men in sub-Saharan Africa by 38-66% over 24 months. Based on these studies, the World Health Organization and UNAIDS in 2007 recommended male circumcision as a measure to prevent HIV transmission from women to men. However, this method is controversial in preventing female-to-male transmission, and its effectiveness in developed countries or among men who have sex with men remains uncertain. Some experts fear that the misconception that circumcision reduces risk may promote unsafe sexual behaviour, thereby decreasing its preventive effect.

Women who have undergone female genital mutilation are at increased risk of HIV infection.

Programs promoting sexual abstinence do not appear to influence the increasing risk of HIV.

Widespread sex education in schools may reduce the prevalence of risky behaviors.

A large group of young people, despite being aware of HIV/AIDS, continue the practice of underestimating their own risk of contracting HIV.

HIV does not spread through these reasons:

Shaking hands with an HIV-infected or AIDS-affected person
Living with or eating food prepared by an HIV-infected or AIDS-affected person
Preparing food in the same utensils or kitchen as healthy and HIV-infected or AIDS-affected persons

Symptoms of AIDS in the early stages:

Rapid and excessive weight loss
Dry cough
Continuous fever or excessive/night sweating
Swollen lymph nodes in the groin, armpits, and neck for a long time
Diarrhea lasting more than a week; persistent severe dysentery
Pneumonia
Red, brown, pink, or purple spots under the skin, inside the mouth, under eyelids, or in the nose
Persistent forgetfulness

Treatment Of AIDS

Medical science continues to make ongoing advancements in AIDS treatment. Research is ongoing in India, Japan, the United States, European countries, and others for developing treatments and vaccines for prevention. Although AIDS patients can fight the illness and live somewhat normal lives for a limited time despite being infected, it can pose a long-term threat. Research for AIDS treatment is still underway. Today, it has taken the form of a pandemic in India. The treatment of AIDS in India is expensive, and the cost of AIDS medications is beyond the financial reach of the common person. In rare cases, proper treatment has allowed individuals to live with AIDS for 10-12 years, but this is not common.

Now, such medications are available, known as anti-reverse transcriptase enzyme viral therapy or anti-retroviral therapy. These medications, like Cipla’s Triomune, are expensive, costing around 150,000 rupees annually per person, and are not easily available everywhere. These drugs can halt the disease but do not cure it. If these medications are stopped, the disease can recur, so once infected, one has to take them lifelong. If the medication is not taken, the symptoms worsen, and individuals affected by AIDS may die.

A good news is that leading Indian pharmaceutical companies like Cipla and Hetero are soon going to produce a combined triple-drug formulation that will make treatment easier (Cipla will call it Virade). These have also received approval from the Food and Drug Administration (FDA). The annual cost for these drugs will be around 100,000 rupees per person, but this is about 80-85% cheaper than the global price.

Behavior Towards People With AIDS

A major adverse effect of AIDS is that society begins to harbour suspicion and fear. Talking about sexual matters has traditionally been taboo in our society. Undoubtedly, burying one’s head in the sand like an ostrich and remaining unaware or pretending it doesn’t exist is not a solution. Addressing this horrific situation also requires bringing about social change. If the proposed AIDS legislation could be enacted into law in the Indian Parliament, it would be a significant strategic step not only for India but also for the global fight against AIDS.

Disclaimer

This content, including advice, is for general informational purposes only. It does not substitute for qualified medical advice in any way. Always consult a healthcare professional or your doctor for more information.

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